1. Key Success Factors and pitfalls to avoid in HIT change management

KSFs:

Implementing a new electronic health records (EHR) system is a big change. Successful management of that change involves thinking not only about the new technology but also about the people. J.S. Shoolin suggested the following list for the manager to lead the physician down the road of change(Shoolin, 2010) :

Listen to the anger and negativity. Don’t assume the naysayer will disappear. In fact, it is more likely they will have an audience whose fears must be assuaged. 
Communicate. You can’t do this enough. Recognize that small sound bites help.
Recognize culture. Culture eats strategy for lunch every day. Understand at the beginning that EMR implementation is a cultural shift – as Jim Collins would describe this degree of change: a Big Hairy Audacious Goal.
Be ready to help. One-on-one at-the-elbow-support will buy your acceptance.
Realize bargaining exists. Be prepared to listen, but still hold the line.
Obtain medical staff leadership support from the start. They will be a huge ally.
Actively listen, both to sympathize and for improvement ideas and suggestions. More importantly, acknowledge when and if changes will be made.
Support. Create less angst.
Encourage those who have reached acceptance-applaud them for their perseverance.
Finally, realize this takes time. You cannot make this change overnight. It is a journey, not a destination

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Fig1. Critical Success Factors and Management Interventions for Managing Change(The Office of the National Coordinator for Health Information Technology, 2016)

PATs:

Lack of communication of the benefits of change: change can be confusing for all. Effective change management should include a plan to communicate the change to stakeholders. Although the need for change is obvious to someone, it probably won’t be to others.
Large-scale change is attempted in one hit: Remember that change can be made almost overnight, but it never works when it is instigated too rapidly. Staff need to be trained, new cultures engrained, and new processes and procedures planned and implemented.
Ignoring the stakeholders of change: Take time to listen to concerns, and make certain that different stakeholders have the opportunity to voice their fears openly in team meetings and coaching sessions.

2. Do we need to consider different strategies for managing change for the various cultures in healthcare (medical culture, nursing culture, technical culture, administrative culture)

It might be unnecessary to consider different strategies for managing change for the various cultures. We predicted that EMR implementation would cause culture to become increasingly group and developmentally oriented due to the nature of the implementation process and the increased information sharing allowed by the EMR. Instead, however, Katherine Reynolds et.al demonstrated that after the EMR conversation, the organization appears to be shifting in a less group-oriented direction(Reynolds, Nowinski, Becker, & Beaumont, 2006).

It is important to understand the specific needs for change in varied groups and set expectation accordingly. Managing the change associated with an EHR implementation requires a solid understanding of how the individuals within a medical practice fit into the process, from driving change, to implementing it, to ultimately benefiting from it.

3. Kotter Model for Change Management

Here's the Kotter Model for change management. Its three phases in application of EHR are shown as follows:

Overview of the Three Phases of Kotter’s Change Management Principles and Related Actions for Paper to EHR

National Learning Consortium

For more details, refer to NLC's report, Change Management in EHR Implementation.

4. Are there different degrees of change - some major, some minor?

Change in the health care setting is on a spectrum. While the main change in health care organizations in the past 10 years has been the adoption of the Electronic Health Record systems and the features that go along with that, there are also many smaller quality improvement projects that can be done. For example, some masters students in UW’s Clinical Informatics and Patient-Centered Technologies program do small changes for their organization with just a few stakeholders. While there is a general schema for health organization’s change, there is change high and low in health organizations.

5. Are organizational change and organizational resistance to change in HIT different from general change and change resistance?

Organizational resistance to change in HIT is more similar than different to organizational change elsewhere. Organizational change in other industries is a key issue and there is generally resistance to change. In an article by Harvard Business review, they stated that changes in procedures in general businesses had a success rate of 20-50% (Strebel, Harvard Business Review). These numbers echo that change is met with resistance. In HIT, we are learning that the implementation of the EHR and privacy restrictions are met with conflict. While it’s easy to say that doctors and the healthcare industry are different, it appears that change is met with conflict in all industries and healthcare just has the epic task of implementing the EHR.
Link to article: https://hbr.org/1996/05/why-do-employees-resist-change

6. Organizational Change and NLP

In order to examine organizational change and NLP we examine a pilot implementation of NLP methods to predict CAUTI which is a common hospital acquired infection. The authors explored an NLP application in a large, urban, tertiary care facility for veterans. Branch-Elliman et al. found that with a positive predictive value (PPV) of .54 they could predict CAUTI. In this implementation they did not perform as well as the standard surveillance system. This hits home a common point that NLP cannot be used alone without the interpretation by doctors. Furthermore, this pilot study goes to show that many studies are needed in order to implement an organizational change.

Reflection Blog

Reflection blog for Part 5: Manage Change: click me!

References:

Branch-Elliman, W., Strymish, J., Kudesia, V., Rosen, A., & Gupta, K. (2015). Natural Language Processing for Real-Time Catheter-Associated Urinary Tract Infection Surveillance: Results of a Pilot Implementation Trial. Infection Control & Hospital Epidemiology, 36(9), 1004-1010. doi:10.1017/ice.2015.122

Reynolds, K., Nowinski, C., Becker, S., & Beaumont, J. (2006). Organizational culture changes in an integrated delivery system with a fully implemented electronic medical record. AMIA Annu Symp Proc, 2006, 1075.

Shoolin, J. S. (2010). Change management - recommendations for successful electronic medical records implementation. Appl Clin Inform, 1(3), 286-292. doi:10.4338/aci-2010-01-r-0001

The Office of the National Coordinator for Health Information Technology. (2016). Change Management in EHR Implementation Primer.

Strebel, P., Why Do Employees Resist Change?, Harvard Business Review, May-June 1996