2022 was the year of digitalisation across Tatarstan, a small republic in Russia. 

As part of this, the digitalisation of one of its major hospitals, the Regional Clinical Hospital (RCH), was pursued under the government's National Healthcare and Demography projects. 

Within 10 months of digital transformation, the hospital passed the requirements for the Stage 6 HIMSS Electronic Medical Record Adoption Model (EMRAM), a model that gauges an organisation's adoption and maturity of the use of the EMR.

But in achieving this incredible feat, RCH had to deal with resistance from the inside. 

"Information technologies are often viewed as less of a priority by [staff], that is why the implementation of the new medical information system and protocols was faced with resistance from some staff members who are key stakeholders in this process," RCH head of marketing Diana Altynbaeva shared in the session, "Digital Transformation in 10 months according to EMRAM Standards: Recipe from One of the Stage 6 Hospitals."

To overcome staff resistance, RCH turned to the HIMSS approach to digitalisation.

"Overcoming the resistance of 3000 employees was a great challenge for [us]," admitted Altynbaeva, who was tasked to sell the idea of implementing the HIMSS standards and a new medical information system. 

"We have created a group of commissioners for the implementation of HIMSS standards. Change agents have been assigned in all structural divisions; they served as our partners in showing a culture of openness and safety based on HIMSS standards."

Hospital executives also engaged staff in open dialogues to discuss issues. 

"Russian doctors are perfectionists by nature. And for a doctor to admit a mistake is a huge mental barrier that keeps our medicine conservative," Altynbaeva claimed. "We have trained staff that it's important to talk about mistakes and risks – and we still continue to do this."

Altynbaeva's team also conducted education courses, short lectures, and training to get their staff onboard the new digital system. 

A culture of openness

In the process of achieving the Stage 6 EMRAM certification, RCH had to digitise its incident management system. This new system saw an uptick in incident reports, which was never seen before. 

"The preparation for certification and the introduction of HIMSS standards made it possible to find a clinic management model that meets modern challenges, provides high-tech safety, and lays the foundation for a culture of openness," Altynbaeva said.

"Today, our specialists are willingly reporting incidents they face because they know that this is an instrument to [ensure] the safety of their patients and all of themselves and their colleagues. We can say that our approach to registering incidents is quite transparent."

Overall, Altynbaeva attributed the success of their recent Stage 6 EMRAM achievement to their effective change management. 

"The work with personnel was organised according to the best methods of involving them at the stages of implementing changes."

RCH could also have not done it without the huge and timely support from the Tatarstan government and the hospital's stakeholders. 

"In the search for optimal approaches in the application of digital solutions and management of a multidisciplinary clinic, the HIMSS approach was identified as the only standard in the world that combines and evaluates medical business processes, personnel, medical standards and information technologies in a single bundle to ensure patient safety," Altynbaeva explained.

RCH is now pursuing Stage 7 EMRAM, which if successful would clinch them the award of second to achieve this validation in Russia after the Nikiforov Russian Center of Emergency and Radiation Medicine in St Petersburg.