Journal excerpt: Provider struggles

ACDIS Journal Excerpt from The ACDIS CDI Blog

No matter the level of training and preparation you put into implementing a new technology, you’ll likely still encounter some struggles along the adoption journey. Inevitably, regardless of the project, there will always be a few troublesome providers, according to Vaughn Matacale, MD, CCDS, director of the CDI advisor program at Vidant Health in Greenville, North Carolina.

“There are three buy-in types for new technology,” he says. “The early adopters are the people who hear there will be new technology, seek it out, and basically embrace and incorporate it into their workflow. Then there are the majority of us who are the normal adopters, where when new technology is implemented and information is given out, we adopt it then. And finally, there are the late adopters, [of which] some are non-adopters who reluctantly go along if there’s no other choice.”

Those falling into the late adopter category prefer to apply more thought before incorporating something new; they want to make sure the new technology is actually going to work for them, and are often reluctant to accept perceived or actual changes to their existing workflow. With any new technological solution, make sure you know how the tool will affect physicians’ daily work and long-term workflow before you fully implement it, recommends Christopher M. Petrilli, MD, SFHM, medical director of CDI and clinical lead of value-based management at NYU Langone Health in New York City.

“A lot of the issues I’ve seen have resulted from difficulty finding information that you need in the most efficient way possible,” he says. “How do you find the most recent labs and vitals without having to dig around multiple tabs? Or if I do have to search, what’s the most efficient process to navigate to the data I’m looking for? Any  interruption to a provider’s workflow can cause adoption hesitation.”

When physicians do run into trouble or resist adopting the new solution, revisit your peer-to-peer education with a focus on the physicians who are having a problem. This education can be provided by another physician or even by a CDI staff member or informaticist.

“Sometimes people just struggle with new technology, and that’s where other people from the team can do at-the-elbow support with struggling physicians and help integrate the new technology,” Matacale says. “Leadership should also be aware that new technology will cause interruptions to normal physician workflow, and they need to be patient with that learning curve.”

Even if all your physicians happily adopt a new technology, any interruption to physician workflow may lead to negative effects on documentation, even just for the short term. Matacale suggests reviewing your technology implementation and update schedule to try to limit these impacts.

“When you have established providers who are clinically very busy, adding [technology] on can sometimes be burdensome, so you have to look at timing and implement technological updates in batches so that you can have one update rather than multiple. That way physicians aren’t constantly dealing with new technological updates,” he says. “Make sure that the updates you’re implementing are going to be improving documentation in the long run. Gauge what is important enough to merit causing that disruption to workflow.”

When choosing a solution, in addition to keeping an eye on physician workflow impacts, make sure that the new solution will lead to outcomes that align with your organization goals and that the negative effects don’t outweigh the positives, Petrilli says. If your chosen solution will cause undue disruptions instead of improvements, it may not be the best solution for your needs.

“You may think new technology is going to be beneficial but the burden to providers becomes excessive, which is not a good long-term strategy,” he says. “For example, if you implement a technology that is going to catch any and every clinical abnormality on a patient record, there may be flags for clinically irrelevant conditions, and constant interruption may occur leading to significant alert fatigue and failure to advise on the specific  unifying diagnosis, which the technology fails to capture when the human factor of CDI specialists would.”

For necessary technology that still may interrupt physician workflow, Matacale says CDI professionals can do a few things to lessen such disturbances, including:

  • Involve physicians throughout the implementation process.
  • Communicate physician workflow impacts to leadership to ensure proper expectations.
  • Bring clinical leadership to the table for feedback and adjust your solutions accordingly.

For smaller changes, the best way to ensure the most seamless integration without much interruption to physician workflow is to implement the solution a little bit at a time, so that when they are using the EHR they hardly notice the small differences, Matacale says.

For larger changes or implementation, you may need to slow down the timeline. When you move slowly, you also have a better chance at making sure you’re doing things right the first time, which helps you avoid rework later.

“You want to make sure you’ve done the work to set yourself up for success,” he says. “If you don’t spend enough time on the front end to hit all the areas you need and involve everyone who will be using the new technology to gain their input, you’ll be more likely to miss something and then have to do it all over.”

Editor’s note: Read this full CDI Journal article here.

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