Friday, May 17, 2013

Lessons Learned: Hospital Information System implementation

Published by: Ankush Shinde on 13th Jan 2012 | 

Hospital Information System (HIS) plays a crucial role in integrating people, process and technology to deliver superior patient care. Automation of clinical, administrative and financial processes in hospital results in efficient data management and information dissemination for the users. Physicians, Managers and other healthcare staff members can access the information without delay or errors. The implementation of right HIS solution in hospital greatly increases its efficiency and reduces medical errors, thus improving patient’s safety and quality of care.
This article analyzes a HIS implementation projects for a small and medium sized hospital from the perspectives of conflicts and problems the project faces.  After analyzing issues encountered during implementation, the main lesson of this article is that the fundamental challenge of HIS implementations is not technology but organizational and human changes, which, if not properly understood and addressed, can lead to unidentified consequences causing implementation failures.
Identification of problem:
During HIS implementation projects, the major issue faced is end user adoption to new software application usage.  As it impacts the way end user performs daily task, it is important to develop confidence in them by addressing their queries and concerns. The most critical part of project is to train and make end user feel comfortable during implementation effort.
 The challenges and barriers:
 The major challenges during HIS implementation are resistance to change and learning difficulties due to lack of computer skills while using new application features.
Other challenges faced during implementation are:
·         Infrastructure, application and organization of implementation processes
·         Management of end user requirements with existing solution
·         Requirements planning
·         Integration of internal and external information systems
·         Balance between different end users and departments
·         Redundant, inaccurate or confusing master data
·         Standardization of data definitions, representation and vocabulary
·         Technical (Hardware, Networking and software tools)
·         End user profile 
·         End user training
·         Software functionality
·         Post implementation support
·         Lack of information about HIS implementation
·         Lack of knowledge about administrative needs of hospital
The approach used to address the problem
The proven methodologies and experiences of other ERP and HIS implementation projects are utilized; their pain areas, achievement or failure reasons are taken into consideration.
The HIS implementation planning was done as per needs and expectations of various stake holders.
Before starting implementation we ensured that hardware and adequate workstations are provided to each end user.
 The most important part of implementation project is end user training. We trained end user rigorously on pilot basis and involved them in implementation activities. We also included continuing hands on training for end users who require additional inputs to learn using application modules. Training is imparted in actual clinical or day to day administrative scenarios so that users can correlate and understand functionality.
 We tackled physician resistance by encouraging them to use system to view patient reports and information instead of order entry. We also identified young physicians who are computer-savvy and involved them in implementation process.   
The Analysis
The core issues faced during HIS implementation are balancing expectations from end users and stake holders’ point of view, product limitations to meet certain requirements, understanding of the implementation efforts in terms of scope, required actions and the proper timing of actions. The main challenge of HIS implementations is to manage the elements of change in the organization so that the intended, desired changes are implemented successfully and the unintended surprises that could lead to failures are avoided.
Consequently, the end users job tasks are handled more and more within the frames of the HIS system. Thus the HIS system had an increasingly critical role in the patient care. However, such increase of criticality is not always welcome by those who needed to use more information systems in their daily job tasks.
Many end users feel forced to use the HIS system and see the main content of work as a mere clerical activity behind the screen. It is difficult to justify the need to use the system because initially it doesn’t   always bring direct benefits to end users needing to fill in data.  The benefits are visible later, especially at the group level.
The implementation of the HIS system acts as a catalyst for change in the established processes in the hospital. As part of HIS implementation, process re-engineering will most likely result in centralization of some administrative functions, like accounting, financial reporting and financial control.
HIS addresses and improves the clinical and administrative work flows in hospital. The primary responsibility of Health IT professionals is to help the users as they are not experts in technology. The HIS solution enables them to do their job more efficiently including the patient care delivery.
For majority of end users, while using the system physically to perform day to day activities usability, flexibility, configurability are most important. To increase the satisfaction of the end users with HIS, hospital authorities and vendors should involve end users right from the first phase of implementation.

In case of upgrades and changes in solution end users should be communicated and followed periodically.

One of the important part of end user adoption strategies is 'Train the Trainer ' which is  helpful in providing  prompt attention and solving questions and concerns of end users by vendor or IT department.
The best way to develop confidence in end user is hands on training. There may be delays at first, but once end user gets hands on experience, they are on track. We observed that the more end user learns, the more they know, and the more valuable they become for organization. 
During implementation effort treat every end user as a valuable member of the process of technology adoption. They should feel part of change and acknowledge them if they have any input which maybe crucial for success.

The end result should make the users feel ownership of the new development, as if they themselves selected the software. Once that thing happens, it will allow them to be more effective on the job, and make them adopt the new change successfully.
The HIS implementation strategy is necessary to ensure smooth transition to new work methods and improve patient care delivery. The HIS implementation is an opportunity for the hospital to clearly identify the areas where they need help, and find solutions to meet those needs. Creating HIS implementation strategy should be one of the first steps.
Identifying problem areas is always not an easy job. If we consider a hospital with over 1000 beds, which has people, working in various departments with diverse functionalities, we may come across problems galore to maintain all functions. In such a case it is important that healthcare organization should involve their employees or find ways to make sure that all the problem areas are identified.
The implementation strategy should contain ongoing training, developing confidence and proper approach to issues faced by end users.  The tackling of end user issues with proper perspective and right frame of mind are the most important measures to ensure successful implementation.