There is tremendous irony in the fact that so much of the go-live operations management process is often done on paper. One such example of this is how go-live command centers are managed.

These command centers often are manned by staff who are constantly updating whiteboards, transcribing issues into electronic issue management systems, and manually generating status reports for overall progress. These procedures are cumbersome and add delays into the process of identifying support issues that may be pervasive.

Leveraging technology to record support issues at the point of incident allows an easier input method and an issue to be triaged more quickly. Simple mobile apps and other technology can be used to record these incidents and electronic dashboards can be used to highlight pervasive issues and generate automated status reports of overall system health.

A digital command center is hugely successful for an electronic health records implementation when all parties are committed to its success, said Matthew Ernst, director of training, documentation and support for digital innovation and consumer experience at Thomas Jefferson University.

“Our EHR implementation occurred in two phases,” Ernst explained. “During the buildup to phase 1, my team met a lot of resistance from all the EHR teams and consultants on the use of tablets, on the use of an online portal to submit issues to an IT service management system, and on the use of performance analytics instead of spreadsheets. Comments varied from we have always done it this way to this is going to fail as staff will not be able to use the technology to keep up with the demand.”

During the first phase of the go-live, the attitudes and perceptions changed as the teams saw the technology working, and realized how much easier and more efficient it was for their work and saw the improvements in the consumer experience, Ernst said.

“As soon as the phase 1 go-live ended, the EHR teams were knocking down our doors to expand the use of technology with more tablets on the floor, enhanced workflows within the ITSM and expanded performance analytics dashboards,” Ernst said. “The use of technology-enabled a faster, more efficient implementation and saved us more than $100,000 just in the elimination of the paper conversion.”

There is always resistance to change, though. During discussions with the EHR implementation team and their consultants, the concept of a digital command center was met with great resistance. Their approach was to use the same methods always used for an EHR go-live – use of paper forms for issues that are faxed to the command center and manually converted to an ITSM, and issue tracking and trending via excel spreadsheets.

“The consensus was that any changes in these processes would cause mass confusion and a failure at go-live,” Ernst said. “It was interesting as these are the same people who have the latest smartphone and would never think of using a flip-phone.”

Ernst will speak on the subject at the HIMSS18 Conference & Exhibition during an educational session on March 7 entitled “Digital command center for EHR implementation.”

Ernst said session attendees will learn many things about digital command centers, including that the obstacle is the way and innovation and change require perseverance and commitment.

“The obstacle is the way – be one with the problem and you will own the solution – many times in health IT, a solution is provided for a problem without truly understanding what it is and has it been addressed,” Ernst said. “This is one of the reasons why solutions fail or underperform due to a low adoption rate. IT has to be a partner with the client to truly understand the problem and have them be part of the ownership of the solution.”

And innovation and change require perseverance and commitment, he said. Many times changes and innovation are tied to the initial costs and/or efforts with little credence given to long-term savings and/or efficiency gains.

“In our example, the initial consensus was to use a paper form and fax it into the command center instead of spending $30,000 for the tablets,” he explained. “Our argument that there are issues with faxing, that forms are illegible for the analysts, and there is a cost to convert these into our ITSM system, started to gain traction, but in itself didn’t solidify the decision.”

The decision to move ahead was made when it was discovered that another parallel project going live after the EHR implementation required the use of tablets. The tablets were able to be used for both projects, thereby eliminating the extra costs.

“The end results are that the digital process was more efficient and consumer-friendly and provided more than $100,000 savings in staff time through the elimination of the paper conversion,” he added.

Health IT is under tremendous pressure to do more with less as demand continues to grow and it becomes no longer practicable to throw additional resources at a project.

“There needs to be creative and innovative approaches to problems where the client is a partner and has ownership in the solution,” Ernst said. “Otherwise, health IT will be seen as a cost center and not as an integral part of the health system. In our case, the real accomplishment was the partnership and ownership built across teams to develop a solution that delivered short-term and continuous long-term benefits. Digital was just the method of delivery.”

Matthew Ernst will be speaking in the session, “Digital command center for EHR implementation,” at 4 p.m. March 7 in the Venetian, Palazzo G.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com