1	There are some physician offices that still look like this!
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4	An Unfortunate Truth
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6	Balancing IT in the Physician’s Office
7	Implementing New Systems May be technical or non-technical New systems mean new methods and behaviors For technical systems, there is still an often-ignored People and Organizational Issues side (often referred to also as “change management”)
8	Implementing New Systems People-type issues can arise in any size or type of organization and their likelihood or form depends upon the individual Organizational-type issues may vary widely depending upon issues such as organizational size, culture, and level of bureaucracy
9	As a Rule . . . Organizational resistance will typically be less in a small organization than a large one However, a small organization typically has less resources to deal with problems that do arise on either the technical side or the change management side Impact on balance— ? ? ?
10	Differing Change Impacts Impacts can vary widely according to roles Major impact on physician Might be little impact on staff except for having to deal with an unhappy physician Major impact on staff Might be little direct impact on physician except for having to rely upon support from an unhappy staff
11	Key Point Implementing new technical systems often surfaces existing people and/or organizational problems Try to deal with these problems before the technical implementation If not possible, at least avoid allowing the technical system to be blamed for the problem
12	Technology Impact Information technology can impact a physician’s efforts in four main areas: Workflow Payment Productivity Liability
13	Technical Barriers System or technology is slower than expected Alerts, features of the technology or system are inaccurate or not as advertised Technology duplicates records and/or processes
14	Technical Barriers System requires multiple sign-ons System is time consuming—takes too long to enter or retrieve data Inadequate potential for customizing the technology to support unique practice patterns
15	Technical Barriers Screen presentation are poorly designed Screen sizes and other components are too big, too small, or too cumbersome Anything else?
16	Workflow Barriers Generally information systems require that the physician and the physician’s staff confirm to the information system norms. Anything else?
17	Patient Barriers Physicians question if the technology will help or hinder their interaction with patients. It is possible to effectively face the patient and still enter information into a computer system? Anything else?
18	Thinking About … Are there strategies to bring computer systems into a physician’s office and not be consumed by the barriers mentioned?
19	Adoption
20	Enabling Change
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22	Identifying and Grouping Physicians
23	Willingness to Adopt
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25	Physician Adoption of Information Technology VHA Research Study 2004 https://www.vha.com/portal/server.pt/gateway/PTARGS_0_2_202_0_0_35/http%3B/remote.vha.com/public/research/docs/physician_it.pdf Or https://wwwvha.com (Under Research) The adoption of information technology will increase through active attention to key enablers that include: knowledge value communication involvement infrastructure and support leadership
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27	Demonstrating Value Demonstrate value—anticipate, calculate and demonstrate the value of information technology to potential users. Devote time, energy and resources to watch, study and understand what physicians understand and how they do what they do—it is all about workflow!!! Target the right solutions (value)—focus on safety, quality and workflow efficiency Take value to a personal level
28	Strategy for Demonstrating Value The most important element in the decision to adopt technology is found in the benefits delivered by making the change From the physician perspective, value comes in a few essential forms: Save the physician (including fewer calls) Improve patient care or clinical outcomes Reduce the opportunity for error Improve the physician’s ability to generate revenue
29	Leveraging Knowledge Leverage knowledge and experience. Identify and capitalize on the spheres of influence and social networks of physicians Spread the word of success Recognize physicians Repeat the cycle of involvement, communication and success
30	Strategy for Leveraging Knowledge and Experience Capitalize on spheres of influence and social networks Who would you go to for advice that you can trust? Who do you interact with regularly?
31	Managing the Change
32	Clear Objectives It’s far easier to manage if you know what it is and if you know what you want to do with it. No one should begin a major effort without first being clear what they intend to achieve and how they intend to conduct the total process.
33	Reality Like it or not, introducing change is a highly political process
34	Change Management Change management is the process of assisting individuals and organizations in passing from an old way of doing things to a new way of doing things.
35	Assess The General Organizational Climate This is a key stage to understanding… the strengths and weaknesses, identifying the major organizational areas of both excitement and resistance, identifying potential stumbling blocks, understanding the vision the staff holds for the future, and reviewing the options
36	Analyze The Benefits From Various Perspectives Analyze information Create implementation options.
37	Prepare the Staff for Change Planning and Exploration Phase Clearly communicate the vision and the role that information technology will play. Ask frequent users about use of the current system and desires for a new system. Ask opinion leaders
38	Involve Who When? Must creatively seek opportunities Different levels/roles at various times/places in the process Conceptualization Design/evaluation/selection Implementation Training Support
39	Key Point A significant factor in achieving eventual success is starting with a realistic set of expectations System performance Cost Time and effort
40	Strive For Rapid Implementation When the system is ready to implement and the staff have been prepared and trained, carry out the implementation as rapidly as possible.
41	Provide Extensive Support Initial and ongoing This support has two aspects Task-oriented aspect of providing rapid, competent help. Caring and support. The duration of this intensive support period will depend upon the complexity of the system, the size of the group, and the level of information systems sophistication within the group.
42	Plan Some End-Stage Fun Express support both through a celebration and being present Stress that this is a celebration of reaching a significant milestone on a long journey—not an arrival at the destination Stress the proactive, forward looking aspect of the culture
43	Another Key Point Good change management focuses on building psychological ownership in both the impending change and the process to achieve it In a health care setting, this means including groups such as the patients
44	The Basic Strategy Involve and communicate Communicate and involve
45	Think About It… What will it take to tip physicians toward supporting, accepting and/or adopting a new information system for their practice?
46	Summary
47	No Magic Wand, But . . .
48	The Real Aim While we use communication and involvement as tools, we really seek ownership and “buy-in”—i.e., a commitment to the proposed change
49	Common Sense?
50	Have Confidence and Courage!
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