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Change management culture to support telehealth technologies

If a healthcare organization wants to successfully implement a new technology, especially telehealth technologies, it needs to create a change management culture.

Sometimes implementing a new technology can create a certain culture within a healthcare organization rather than an organization creating its own change management culture that will support the technologies it needs.

Seth Bokser, M.D., associate professor of Informatics and Pediatrics at the University of California, San Francisco (UCSF), used the example of when his healthcare organization implemented Epic's EHR.

"I think on one hand it's been very important for our organization to see that we can go through this huge metamorphosis and come out the other side and have survived turning our organization upside down," he said at the mHealth + Telehealth World Congress conference in Boston. "On the other hand I think people are still licking their wounds from the EHR implementation."

Those "wounds" he's referring to are the fact that EHRs aren't doing what they promised and EHRs tend to get in-between clinicians and patients.

Bokser explained that Epic sent "a very benevolent army" to UCSF to help with the implementation.

"[They] sort of told us what to do and how to do it and we successfully implemented the her, but we didn't get to exercise those change management muscles natively to develop that culture of change," he said. "We developed a culture of Epic and we are, I think, still struggling with that and regaining our footing [to] truly develop an innate culture of change."

A panel of experts agreed: Creating a change management culture that supports and fosters change is key to successfully implementing new technologies, including telehealth technologies.

Identify a clinical problem

One important step toward gaining physician and staff buy-in and creating a change management culture that supports implementing telehealth technologies -- or any new technology -- is to identify a clinical problem that telehealth can help solve.

Start with a problem that people actually recognize is a problem. Don't build technology solutions first.
Neil Evans, M.D.chief officer of the Office of Connected Care, U.S. Department of Veterans Affairs (VA)

"Start with a problem that people actually recognize is a problem," said Neil Evans, M.D., chief officer of the Office of Connected Care at the U.S. Department of Veterans Affairs (VA) and associate chief of staff for informatics at the VA Medical Center. "Don't build technology solutions first."

Evans said that at the VA, "We think about problems in three categories." Those categories are:

  • access to health information and health relationships;
  • access to useful health information; and
  • increasing the convenience of healthcare and the value of the experience.

"Is this a solution that's going to help my customers, veterans, get access to the trusted healthcare relationship they're coming to the healthcare system for?" Evans said. "Is this something that is going to give them access to tailorable, useful, valuable health information, their own health information? ... Is this something that's increasing the convenience of healthcare or increasing the value of the experience?"

Evans suggested trying to use this framework when thinking about whatever problem a healthcare organization wants to solve with telehealth technologies -- or any other digital technology.

Discuss the possibility of telehealth with physicians

Getting hospital staff on board with a new technology can be a challenge. John Jenkins, M.D., chief clinical officer of connected care at Cone Health, a nonprofit network of healthcare providers in North Carolina, suggested having a conversation with physicians about the possibilities of telehealth.

Jenkins shared how his team did this with the oncology department.

"What came out of that meeting was a dedicated symptom relief telehealth clinic that was devised for our patients who are undergoing chemotherapy and radiation therapy so you don't have to go all the way to the hospital to have your symptoms assessed and then a treatment plan started," Jenkins said. "It's been an incredible patient satisfier."

This, in turn, helped the physicians see that "this is something we need to be doing," Jenkins said.

"We demonstrated the success of the platform and then we curated the information to the primary care providers and now it's the best thing since sliced bread," he said.

The goal should be ease of use

Bokser said that from the very beginning the goal should be to make technologies "delightful and easy to use."

Jenkins likened this goal to "how Amazon changed retail."

"Several years ago you'd go to the mall and buy something. I can't think of the last time I went to a mall, but I do know that I have an amazon package waiting for me at home," Jenkins said. "So they were able to figure out how to revolutionize access to merchandise so that people could have access when they want, where they want, and how they want. I think healthcare is challenged to be able to provide that kind of access to care."

Bokser provided an example of a technology that linked UCSF's EHR care team to the paging system. The technology made peoples' lives easier and "it spread virally," he said.

"Very little training, very little executive buy-in," Bokser said. "It was truly one of those well designed technologies. Unfortunately those are not the norm; they tend to be the exception, but they need to become more of the norm."

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