Moving from EHR Awareness to Adoption by Staying Focused on the Patient Experience

Patty PetersonFrom staff nurse to commercial and federal health care consulting and management, Patty Peterson has had an impact on health care systems across the country. While she calls the greater Chicago area home, she devotes her clinical and business background to the role of Clinical Lead for the Leidos Partnership for Defense Health.

Patty carved out some time for us to share highlights from her career and to illuminate the critical role the adoption process plays in the implementation of electronic health records. Patty explains how the merger of the change management and clinical teams this year has helped to drive the strength of both teams and increased the success potential of future WAVE deployments.

You have an extensive and impressive professional background that has focused on clinical transformation in the acute care setting as well as large scale clinical electronic health record implementations. What are some of the highlights of your professional journey?

I started out as a staff nurse in general medical surgery and then specialized in neo-natal intensive care. I then went into hospital management and rotated among different departments including medical surgery, maternal child surgery, critical care, ambulatory, pharmacy and rehabilitation to expand my general knowledge and scope around hospital operations. I chose consulting because I felt I could affect health care to a greater degree working across health systems across the country.

How long have you been with the Leidos Partnership for Defense Health (LPDH)?

I’ve been with LPDH from the beginning of the program. I helped to write the proposal and I was part of the pursuit team that put the proposal together. I was working on the commercial side of Leidos at the time and when we won, it was such a unique opportunity, I asked for the opportunity to come and support the program.

How do you bring this rich background together – business, consulting, nursing expertise – to meet the unique needs of the Leidos Partnership for Defense Health program?

I consider consulting to be the best part of hospital management because your job is to facilitate conversations, bring people together, drive consensus, and make improvements in the way the care is delivered without the staffing, budget and other issues you deal with in hospital administration. So the knowledge and expertise you bring when you bring that together – physicians with nurses with therapists – drives the common goals of improving health care delivery and improving the patience experience.

And along with that is the requirement to maintain your knowledge and your    competency. I make sure I stay current on what is going on in the health care world.

Changes were made to consolidate the Change Management and Clinical teams this These two teams have merged to form the Adoption team under your leadership.  What are the benefits of these organizational changes and how will the changes improve the overall deployment strategy? 

The merger has really brought the best of two worlds together. The clinical folks understand operations. They understand the work flows that have the greatest impact and how to translate it into clinical speak that the clinicians and end users will understand. The change management team is really strong around change management theories, the adoption curve, and communications methodology.

With the merger, the clinical team informs the change management team about the tools they use with their Super User calls ensuring that the content used to drive the change discussion is pertinent to clinicians. This approach resonates more with end users than it did in the past.

What are some of the fundamental requirements of EHR adoption? What components must be present for adoption to be successful?

First, you look at the adoption curve. You start with awareness of the program –the Why. Why are we doing this? Why is it important?

Second, we help leadership and staff put a steering committee structure together to ensure that clinicians have a venue to take action if they find a work flow that doesn’t work, or need to make something happen.

But every step of the way, from the Command Executive Brief kick off, until the time that you go live, there should be a schedule and periodic change management activities that drive momentum forward.

One of the first things we do is help staff look at their work flows. Through business process sessions, we help end users understand what is going to be different and what the impact is for them.

From there we put together a Change Impact Summary which is their working document that helps them look internally in their individual departments to see what they need to do differently to ensure they are ready for the changes and “go live.” The Super User calls are set up to support that. We also organize fairs to continue to increase awareness.

We are on schedule to “go live” with Wave 1 in September. What is your team focused on as we approach that event? How are you preparing clinicians and providers for a successful implementation?

The Super User calls will continue. We’ve been having ongoing conversations around some of the work flow challenges and specialty areas that need more attention.

We are also supporting the Program Management Office (PMO) in different change management activities. The PMO and Defense Health Agency Health Informatics office are the primary owners of change management and adoption at the deployment sites, more so than LPDH.

We work with the PMO and provide tools to help them become comfortable with performing system demonstrations at the Wave 1 site. We have also provided presentations and scripts and have prepped them with Q&As.

Likewise on the clinical side, we put together a program called “Parallel Charting.”

We implement this tool close to “go live.” The clinical staff takes an existing patient chart and replicates it into the new system.

From an adoption perspective, this helps staff realize that they can get everything done to take care of the patient. We encourage them to use interdisciplinary teams and perform hands-off on the new records between the doctors and nurses replicating their future workflow by actually putting it into the new EHR MHS GENESIS.

How are these great medical professionals at the facilities managing this complex digital environment beyond all the other skills they need to acquire? What are your observations as you work with them?

It’s like anything else. The technology is an enabler. As you get more young people coming out of school medical facilities expect that technology skill to be there.

Many health systems use their technology or EHR as a marketing tool particularly as they are trying to get physicians to come to their organization so the capabilities they have around their EHR are pretty helpful and change is hard for some people.

You get in and work with an organization and learn who the early adapters are going to be and you learn who is going to be challenged a bit more. And I found that when you work with clinical folks – nurses, therapists, doctors – if you stay focused on the patient and stay focused on patient outcomes it’s easier to bring them along.

It’s best if you can figure out a way to show how technology is going to make it better for the patient in the long run, and hopefully make it easier for them as they get more skilled around it.

Is the Adoption team integrated with training at any point?

What we do from a clinical team perspective is support both training and testing.  The trainers who write and deliver the content are not necessarily clinical or work flow experts, so our team helps to review the training content to make sure its pertinent and accurate for users. If the content doesn’t match what that clinical specialty does, you lose a little credibility. We ensure the content is sound from a clinical perspective. We do the same with testing around the test cases. We want to develop test cases that not only test the functionality but also test the work flow. The best way to do that is to make sure you have clinical staff involved in developing or reviewing those test cases, and that’s what we do.

When you come across technical infrastructure barriers in a facility does it slow down the adoption process?

When that happens, I think it leads to resistance. It gives a venue for resistance to change. So it’s a matter of having to walk staff through it. There’s nothing we can do from an adoption perspective other than to bring that information back to our core team.  Just as we did with the IOC sites and continue to do through WAVE I, we work with the PMO to determine how we can resolve it.

Do you see any distinguishing factors in comparing the military environment and facility and a private sector hospital when implementing adoption techniques. Are there unique characteristics that presents benefits or challenges in the adoption process?

If you look at the staffing and size of the military facilities, many of them are small and people wear a lot of different hats which means they don’t have a lot of free time and there’s less people to share the responsibility of taking on this adoption work.

I think that is one of the challenges that we’ve had to face. And the change in the roles that they use and the way you build and take the Cerner roles and make sure they work for the facilities has been a bit of a challenge for us.

We learned during the IOC that a nurse in the commercial world, while still a nurse in the federal, has a scope of practice that might be a bit different. The same is true for nursing assistants and pharmacy techs. They have a bit different scope of practice in the military than what we see in the commercial world.

Would you outline for our readers what your adoption approach and strategy for Wave 1 deployment is and what you foresee to be the major challenges for deploying the MHS solution to Travis Air Force Base, Naval Health Clinic Lemoore, Presidio of Monterey, Mountain Home Air Force Base, and surrounding clinics?

Our adoption strategy is a combination of tools: in-person meetings; working with department heads; supervisor training; scheduled calls with Super Users; focused discussions where we know there are challenges; support to the steering committee; and fairs and other events on a monthly basis that will keep MHS GENESIS in the forefront so the messaging doesn’t get lost.

And that’s always going to be consistent no matter what WAVE we are in. We execute a schedule of events from the Command Executive Brief up until we are ready for GO LIVE. We incorporate tools and methodologies to help prepare managers and department heads to lead their units. And we provide content to make sure there is something scheduled every month to help drive awareness and adoption of the new record.