While an organization implementing an electronic health record might be so fortunate as to have a thorough and well defined contract, support of its leadership, and a committed and capable team, all that is likely to be for naught without a carefully structured communication plan. It would be unreasonable for an organization's leadership to expect a successful outcome from any meeting without first providing participant's adequate notice of the gatherings site, date, timeline, and agenda. In like manner, forging ahead with an EHR implementation that does not thoroughly communicate key components of the process to the entire organization is setting the endeavor up for serious setbacks with the potential of outright failure.
An EHR communication plan must recognize the substantial change the entire organization is about to go through. It must take into account that an EHR implementation is so much more than a technical endeavor and therefore must consider the substantial impact on the individual. Doing so takes the project to the level which is necessary for front line employees to adequately vest in the process. The goals of the communication plan, therefore include: demonstrating the need for and the rationale behind the EHR implementation, allaying fears, encouraging and facilitating participation, creating and maintaining enthusiasm for the project, and anticipating and/or averting obstacles. This review will outline a communication plan we recommend be used a template for health care organizations as they traverse the many challenges inherent to an EHR implementation.
CHARACTERISTICS OF AN EFFECTIVE COMMUNICATION PLAN
To be effective an EHR communication must contain a number of fundamental components:
- First, it needs to provide a thorough and accurate assessment of the current state as well as a rational justification for the expected or proposed change. The communication should acknowledge that the task ahead and that currently being engaged in is not expected to be easy; however, the aim of the change is to optimize the quality of care provided to the organizations patients.
- Second, the message(s) should be repetitive and presented through redundant channels.
- Third, the format of the message(s) should be both "push" and "pull" in nature.
- Fourth, the message(s) need to be clear and understandable to a disparate audience.
- Fifth, some tailored message(s) should be included for specific audiences.
- Sixth, the message(s) should provide timely updates so as to avoid surprises which only stoke an already anxious organizational membership.
- Seventh, the plan should avoid stops and starts; that is, it needs to be reliably presented throughout the course of the EHR implementation process.
Part of the EHR proposal will out of necessity include aspects of the communication plan including a timeline. Early identification of a communication schedule is necessary for budgetary considerations and coordination with multiple organizational units beyond operations (e.g. marketing, human resources, and others). The overall EHR project schedule can be used as a strawman for developing the detailed communication schedule.
It is essential that the plan be scheduled so as to coordinate with the major cycles of the project (i.e. vendor selection, planning, requirements, design, build, testing, training, implementation, and post-go live adoption). Being able to satisfactorily communicate plans for such cycles to the staff is dependent on there being well orchestrated communication among the EHR project and executive teams as well. Given all of the above, a formal communication strategy needs to be well in place at a minimum of one year prior to the go-live.
Preparation of a formal EHR proposal for the organizations decision making body (e.g. executive committee, board of directors, etc.) will generally include a communication schedule. Doing so requires among other things, a detailed audit of the organizations current technical capabilities and competency. It also requires an assessment of functional requirements based on the organizations unique clinical and business processes. Identification of appropriate individuals to perform such evaluations is of some importance as it would not be uncommon for these same individuals to segue into much of the various EHR project teams.
Wider broadcast of ongoing consideration for and components of an EHR will be communicated to staff as a natural consequence of these processes. Properly performed, this will not only engage a substantial number of employees directly but will invariably communicate to the much wider audience as well. In addition to evaluating the staff's computer competence, these processes should provide the EHR leadership team important insight into the depth of understanding or lack thereof on the part of the employees regarding all that an EHR can provide.
As such, it provides a more detailed bellwether of what might be anticipated for both communication and educational need. Conversely, this same process should also begin to prepare the organization for the endeavor ahead by characterizing some of the challenges that might be anticipated with an implementation. Therefore, in addition to an information gathering exercise, the audit process does provide an important communication forum in and of itself. More detailed aspects of how to assess EHR competence and educational need as well as the particulars of EHR training, will be the subject of a future presentation by the authors.
COMMUNICATING VENDOR SELECTION
We have previously indicated that perhaps the single most important aspect of a successful EHR implementation is selection of the correct software solution. Even more than the audit process, solution selection requires cooperative effort by both operations and IT. We suggest that IT facilitate the process and provide technical guidance; however, operations make the functional fit decision. As such, appropriate representation takes into account the entire spectrum of disciplines, interest, and expertise in the organization. Part of the process of identifying the selection team should include consideration and instruction on how these same individuals can continue the process of communicating with staff that they are in fact representing in this critically important aspect of the EHR implementation. Ongoing communication during a selection process expected to take several months and thousands of hours, helps to ensure that the solution selected is consistent with the culture and business processes of the organization.
This communication plan should include delineation of a communication network which is based on the structure of the project team. The network should include both formal and informal communication mechanisms and be in both a horizontal and vertical direction throughout all areas of the organization. These areas certainly include but are not limited to administration, clinical affairs, information technology, and patient accounting in addition to the project team. An important requirement of the ultimate function of the EHR includes creation of a clinically driven communication leadership team.
This same team also plays an important communication role during the implementation process. It is essential that this team truly represent the organization's clinical leadership in addition to administrative and IT leadership. The clinical leadership team should be positioned to administer various user/worker groups [e.g. computer provider order entry (CPOE), clinical documentation, and others] including assuring facile intergroup communication so as to optimize each others efforts. Other groups also involved in this communication network should include an EHR Executive Team, a Project Champions Team, a Project Management Team, multiple, as needed, Operational Project Teams, IT Project Teams, and hospital task forces. As the members of these various teams are a cross-representation of the organization, they need to provide frequent updates of their activities to their constituents. Wide-spread identification of communication leadership is an integral component of the communication strategy.
Consistent with any major change management, it is essential that the leadership be aware of the disquieting effect that the EHR process will have throughout the organization. Stakeholders will look to the EHR leadership to maintain their bearing in unfamiliar territory. Therefore, part of the communication process necessitates bringing those individuals to the forefront through EHR "kickoff's" and like events. It goes without saying that at this critical juncture, the EHR executives must be aligned and strong in their support of the project. As a result, it is similarly important for the leadership teams to have regular meetings dedicated wholly or in large part to the EHR. Doing so helps to ensure that the staff are not receiving conflicting information.