McKenzie Medical Center is one of the largest primary care clinics in West Tennessee. It enhances the access and quality of medical care available to residents of McKenzie and surrounding areas. Its two satellite clinics and three hundred employees offer both family medicine and specialty care by providing the same quality of care for their patients as they would expect for their own family.
When the economy took a turn for the worse in 2009, the U.S. government enacted an economic stimulus package to save and create jobs, as well as invest in infrastructures, education, health, and energy. Part of that stimulus included the Health Information Technology for Economic and Clinical Health Act that offered incentives through Medicare and Medicaid to physicians who adopted a certified Electronic Health Records (EHR) system and demonstrated a meaningful use of this new technology. Further, physicians who refuse to adopt an EHR by 2015 will face financial penalties.
The benefits of EHR systems include improved patient care and reduced costs on a national and local level. The government estimates that complete EHR adoption would save taxpayers $10 billion, as well as generate savings for individual health systems. EHR adoption also improves the quality of patient care by reducing medical errors and duplicate treatments.
Eager to comply with the stimulus act and incur the benefits of an EHR system, McKenzie Medical Center located in McKenzie, Tennessee, set a goal in September 2010 to achieve 100 percent EHR adoption by January 1, 2011 and collect the full stimulus payment.
The EHR adoption team, lead by physician and managing partner Volker Winkler, M.D., recognized that EHR adoption is a behavior challenge rather than simply a software implementation process—a realization many clinics and healthcare IT providers overlook.
With that understanding, Dr. Winkler knew his system faced an uphill battle in changing three hundred employees. His workforce had used paper records for decades and wasn’t technologically savvy. For example, their urologist didn’t own a cell phone or have an e-mail address.
Dr. Winkler knew they needed help to overcome resistance to EHR adoption and change long-standing behaviors.
Prior to their September launch, Dr. Winkler and his team attended a conference hosted by their EHR provider. In one session, they heard a VitalSmarts speaker teach the Influencer model for changing behavior.
Intrigued by the prospects the Influencer model offered for their initiative, Dr. Winkler brought in VitalSmarts to train fourteen managers in Influencer Training. The management team consisted of clinical nurse leaders, lab directors, satellite clinic managers, one physician, and one managing partner.
The team worked with VitalSmarts to develop a robust influence strategy for achieving their ambitious goal of 100 percent EHR adoption in less than four months.
Influencer Training teaches that changing widespread behavior requires altering six sources of influence targeted at personal, social, and environmental factors. This model became crucial to McKenzie Medical Center’s initiative.
By early October, the entire system experienced extreme push back regarding EHR. Patient volume was down by half, providers were angry and frustrated, and patient care suffered.
Progress was slow. Initially, less than 40 percent of patient charts were entered into the EHR system and less than 20 percent were coded. Additionally, the staff was drowning under forty-five pages of open encounters or approximately one thousand incomplete patient charts—a significant hurdle considering an open encounter prevents a new encounter from being initiated causing problems during patients’ follow-up visits. As a result, the providers were forced to close their walk-in schedule and shut down all future appointments until they could align their processes with EHR.
However, while some offices were neck-deep in crisis, a few early adopter providers were already functioning at 100 percent EHR and seeing more patients than before.
To encourage providers to persist through the challenges of changing behavior, Dr. Winkler and his team created a full Influencer plan. A few of the strategies in that plan included:
Personal Motivation: To change negative perceptions about EHR, Dr. Winkler’s team visited other health systems and observed EHR in action. They brought back stories to their workforce of the benefits they observed. These vicarious experiences helped employees connect to the mission of 100 percent EHR adoption.
For skeptical providers, Dr. Winkler’s team leveraged opinion leaders who, in most cases, were highly respected nurse managers. These nurses helped convince hesitant providers that EHR adoption was an inevitable change they needed to embrace.
Personal Ability: To ensure that every employee had the skills to use the EHR system, Dr. Winkler’s team brought a trainer from their EHR provider on-site. Each provider spent a day with the trainer exploring and testing the EHR system with various patient scenarios.
Social motivation and ability: Dr. Winkler’s team used positive peer pressure to change behavior. They recognized successful clinics in company-wide meetings. They also paid early adopters to coach struggling providers.
Structural Ability: Dr. Winkler’s team provided the necessary equipment to ensure EHR ran smoothly. They installed high-speed printers and portable computers in each clinic. Nurses and physicians could take the computers into the patient consultation to document care and write on-the-spot prescriptions.
Dr. Winkler’s team also tracked the percentage of patient charts entered in EHR and the percentage of charts coded and “out-the-door” in less than five days. They shared the results weekly so everyone could view the system-wide progress as well as individual providers’ progress.
By using the Influencer Model, McKenzie Medical Center not only pushed through the growing pains of EHR implementation, they also achieved their goals.
By January 1, 2011, the system reported 100 percent adoption of EHR and 100 percent of patient charts entered in the system. As a result, patient volume returned to normal and for many providers, increased.
And the results continued to pour in. By March 1, 2011, all of the patient charts were properly coded and “out the door” within three days, beating their goal of accomplishing the task in five days. By May 1, the open patient encounters were reduced from 45 to 15.
To date, McKenzie Medical Center has maintained these goals—demonstrating a total change in behavior. They also qualified for their stimulus resulting in a $340,000 payment.
When asked how the Influencer Model contributed to their success, Dr. Winkler explained that it was instrumental not only for EHR adoption, but for any behavior change goal.
“Every day we face problems, challenges, and opportunities,” said Dr. Winkler. “No matter what that challenge is, anytime I’m trying to affect change, I go back to the Influencer Model. In fact, the next big challenge we and every other health system in the country will face is tracking quality measures under the HCAHPS initiative. The Influencer model is my model to get us to the highest levels of quality patient care.”