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.
ADDITIONAL COMMUNICATION MECHANISMS
Unique EHR Implementation Name In addition to a communication network, numerous additional mechanisms may be utilized over the 12 months prior to the go-live to inform employees across the organization about the EHR. How best to do so will vary according to the organization, degree of implementation, cycle of implementation, and so forth. Development of a unique (to the organization) EHR implementation name can be a useful exercise for several reasons. Not only does it allow for personalizing the highly technical EHR, it is a tremendous way to inform, even engage, the staff in the upcoming activity. This "naming" may be done through an organization-wide contest. Attaching a prize to the successful name helps to ensure rather widespread participation.
Initial announcement of plans for an EHR generally elicits substantial questions from stakeholders. It is difficult for the leadership to at all times be adequately prepared to answer widely disparate questions, particularly as they come from the diverse constituents which make up a health care organization. As such, it is generally useful to prepare an EHR fact sheet/laminated card which can be easily referred to by those same leadership but may also be distributed widely across the organization.
Despite following the best thought of plans for communication, invariably there will be angst and frequently outright disdain for the proposed EHR; the changes involved in an EHR implementation are after all, substantial. In anticipation of such concern, it is useful to plan regular "road shows" to the various departments and sites impacted most significantly. Change tends to be most significant right at the point where the front line employees interact with patients. This will certainly include administrative entities such as registration and scheduling as well as lab and support departments (e.g. radiology, pathology, etc.) but especially clinical staff such as nurses and physicians.
Whenever possible, it is helpful for members of the Project Champions to perform these road show visits themselves and to be supported by appropriate technical expertise (analysts, technical support, builders and depending on the phase) so as to update, address issues, train, and inform staff of mechanisms where they might address concerns. These areas should include the clinical leadership team, the user groups, hospital EHR task forces, and others.
TOWN HALL MEETINGS
Town hall meetings should be scheduled on a monthly basis and should be done with anticipation of the majority of the team being available for a question and answer session. These are useful venues for the EHR leadership and hospital administration to demonstrate solidarity. These meetings benefit by short and well prepared presentations at the outset of the meeting.
Topics to present will be based on the organizations point in the implementation as well as considering where the organization has been, where it is now, and where it is going in EHR upgrade. For example, after vendor selection but before EHR design begins, it would be useful to communicate the results of the audit process with particular attention to the organizations technical and computer competence (e.g. where we were), how the vendor selection process identified a solution and how that meets the organizations requirements (e.g. where we are), and how the organization will begin designing the specific modifications of the solution so as to be consistent with the organizations unique processes (e.g. where we are going). So as to ensure widespread circulation of information distributed at Town Hall meetings, it is useful to send out at least weekly bullet point summaries of EHR status, plans, and clinical leadership team and user group activities.
STANDARD MEETING REPORTS
Even greater levels of detail concerning EHR activity needs to be a regular report at administrative leadership, senior operations, clinical leadership team, medical staff, and department head meetings. These reports should include specific EHR presentations with updates on status, plans, structural issues, etc.
DAILY EMAIL UPDATES
During the extensive work requirements of an EHR implementation it is easy to get lost in the significant amount of progress being made on a regular even daily basis and therefore question what information if any should be distributed to the wider organizational audience. Unfortunately, not doing so heightens concern for the many employees not intimately involved with the process on a regular basis. It is therefore useful to decide early on to provide daily emails giving EHR functional updates. Such communication is especially important during the later months of implementation immediately before and even after the go-live.
As previously indicated, distribution of EHR updates should be provided in as many venues as possible. A project intranet should be a standard component to the EHR implementation process as it greatly facilitates standard communication across the enterprise; it is also useful as a mechanism to distribute information on EHR functional updates for those interested in its review.
Consistent with the thinking that one can never over communicate during significant change, utilizing standard mechanisms to inform such as posters, brochures, and fliers at nursing stations, doctors lounge, staff cafeteria, etc. are certainly recommended. In addition to staff, articles in organizational newsletters and publications, reach patients as well and can begin the process of communicating the anticipated change to this critical group.
Communication is facilitated by identifying "go-to" persons or "super-users" during the training and go-live periods. These individuals should be well versed in one or more areas of the EHR to which they are assigned. Most often they will represent many or all of the staff actively involved in the EHR build. Particularly during the final phases of the implementation, they may also be composed of consultants and/or vendor representatives. These superusers can be identified by having them uniformed with uniquely colored shirts or coats and perhaps bearing a logo or name of the EHR project.
A very useful technique, and which actually may be required to optimize the final stages of the EHR implementation, takes advantage of video-conferencing capabilities. Availability of such a tool allows constant communication of the leadership during the critical go-live period but also during meetings heading up to this time. Such a capability is especially important with EHR implementation involving multiple sites.
This technology can be used to provide demo's to an audience at multiple locations and despite this limitation, allow for an interactive process. In like manner, web based technologies may be utilized to facilitate all aspects of the EHR process including regularly scheduled meetings for not only design and build, but for training and provision of updates. Our favorite example of this is our "virtual war room" during our big bang "go live", which involved multiple time zones. For over a week straight, war rooms at each site had video-conferencing live 24x7.
This allowed team members to walk into a room and immediately engage in dialogue with their colleagues across the other sites. How else can 180 "go live" resources across multiple time zones remain completely up-to-date???
Communication of an organization's change to an EHR is particularly important during the go-live and immediately post go-live period so as to allay fears from the evident disruption, even minor, that invariably occurs. Such communication can be verbal from areas as diverse as registration to lab and nursing. Providing small "script" cards to these individuals can ensure a common explanation and expectation and as a bi-product, serve as a useful communication to the stakeholders themselves. It is often useful to place patient friendly posters around the organization in anticipation of the go-live.
This not only avoids the patient being caught off guard when their care provider begins documenting in a computer rather than a paper chart, but can be used to promote the benefits of the EHR in optimizing the patients health care experience.
When the EHR implementation project reaches the stage where training plans are being finalized, the need to communicate that message becomes necessary if only for scheduling purposes. However, this portion of the communication plan provides an opportunity to communicate substantially more than simply ensuring stakeholder compliance with attendance. Training sessions become a venue to demonstrate system capabilities and thereby build energy and enthusiasm. This message can be delivered in a number of forms but is most often given as presentations by super-user staff. The training materials can be used as a communication vehicle in addition to their evident educational support. Such materials can include instructional CD's, manuals, slide shows.
From a conceptual perspective, there is nothing in this article that you should find new or complex. Proper communication management around an EHR is the same as any other large change initiative. That being said, like any other large change initiative it is easy to marginalize the importance and minimize the time allocation. For many EHR executives, proper communication management could be the difference between perceived success and failure.