change management strategies for an effective emr implementation.pdf

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httpslidepdfcomreaderfullchange-management-strategies-for-an-effective-emr-implementationpdf 139

Claire McCarthy MADouglas Eastman PhD

Contributing Editor

David E Garets FHIMSS

Change ManagementStrategies for anEffective EMRImplementation



Change Management Strategiesfor an Effective

EMR Implementation

Claire McCarthy MA

Douglas Eastman PhD

Contributing Editor




HIMSS Mission

o lead healthcare transormation through the effective use o

health inormation technology

copy 2010 by the Healthcare Inormation and Management Systems

Society

All rights reserved No part o this publication may be reproduced

adapted translated stored in a retrieval system or transmitted in

any orm or by any means electronic mechanical photocopying

recording or otherwise without the prior written permission o

the publisher

Printed in the USA 5 4 3 2 1

Requests or permission to reproduce any part o this work should

be sent to

Permissions Editor

HIMSS

230 E Ohio St Suite 500

Chicago IL 60611-3270

cmcleanhimssorg

ISBN 978-0-9821070-6-5

Te inclusion o an organization name product or service in

this publication should not be construed as an endorsement o

such organization product or service nor is the ailure to includean organization name product or service to be construed as

disapproval

For more inormation about HIMSS please visit wwwhimssorg



iii

About the Authors

Claire McCarthy MA is a recognized change managementtechnol-

ogy adoption strategist and leader with extensive experience support-

ing people through transitions driven by sofware implementations

mergers reorganizations process improvements and downsizing in

the healthcare industry Ms McCarthy works with healthcare provid-

ers and staff at all levels She advocates or the ront line understand-ing that developing willingness and ability in people is what makes

change successul and produces lasting results She speaks internation-

ally on the topic o technology adoption encouraging healthcare lead-

ers to invest in the people side o electronic medical record (EMR)

implementations

As Director o Organizational Effectiveness or Kaiser Perman-

entersquos national electronic medical records deployment Ms McCarthy

introduced the concept o technology adoption to the organization

and led a national community o practice ocused on developing user

readiness Trough integration o cross-unctional work in change

management training communication union engagement opera-tions lessons learned and workorce planning clinical and business

users were prepared to assume new roles and responsibilities in sup-

port o organizational objectives

With 25 years o healthcare industry technology adoption experi-

ence Ms McCarthy has designed and led the human side o technical

implementations in a wide variety o sofware deployments including

EMRs practice management material managementsupply chain cli-

ent relationship management contracting and sourcing e-commerce

health plan product management and currently ICD-10 conversion

Ms McCarthy is a certi1047297ed William Bridges Organizational

Change practitioner and is accredited in Accelerating ImplementationMethodology rom Implementation Management Associates Inc She

holds a masterrsquos degree in sociology rom the University o Montana

and a bachelorrsquos degree in sociology rom Caliornia State University



iv Change Management Strategies for an Effective EMR Implementation

Doug Eastman PhD is an organizational development executive with

extensive experience managing large-scale change initiatives Withmore than 20 years o consulting experience Dr Eastmanrsquos ocus is

to help organizations grow and manage change by unleashing human

potential His specialties are organizational transormation technol-

ogy adoption and optimization process redesign large-scale change

management strategic planning program and tools development and

acilitation

As the Executive Director o echnology Adoption and Organiza-

tional Capability within the Kaiser Permanente Inormation echnol-

ogy Care Delivery Business Inormation Offi ce Dr Eastman currently

advises senior operational and project executives on the countryrsquos larg-

est private EMR system implementation Dr Eastman leverages bestpractices rom across the program and develops implementation read-

iness tools and methodologies as well as pioneering several best prac-

tice post go-live optimization strategies and programs aimed to ensure

end-users are building the requisite level o system skill pro1047297ciency

Prior to joining Kaiser Permanente Dr Eastmanrsquos consulting career

included positions with Andersen Consulting (now Accenture) Wat-

son Wyatt Worldwide and a boutique employee relations consulting

1047297rm He was also vice president o operations or a technology services

1047297rm or which he was responsible or the companyrsquos restructuring and

repositioning in its marketplace that grew 200 during his tenure

Dr Eastman serves on the board o directors or the ChildhoodAnxiety Network He holds a PhD in organizational psychology rom

the Caliornia School o Proessional Psychology a masterrsquos degree in

psychology rom Pepperdine University and a bachelorrsquos degree rom

Ohio State University

ABOU HE CONRIBUING EDIOR

David E Garets FHIMSS is President and CEO o HIMSS Analyt-

ics and Executive Vice President o HIMSS Mr Garets has 32 years o

experience in inormation technology Beore joining HIMSS Analyt-

ics in 2004 he was Executive Vice President at Healthlink Prior to

that he was Group Vice President Healthcare Industry Research and

Advisory Services at Gartner Previously he was Senior Manager in

Emerging Practices at First Consulting Group and CIO o Magic Val-



ley Regional Medical Center in win Falls Idaho Prior to working in

the healthcare industry Mr Garets spent 13 years in various manage-ment capacities or Aamp

Mr Garets was a course director and served on the aculties o the

College o Healthcare Inormation Management Executives (CHIME)

Inormation Management Executive Courses or 11 years He serves

on the editorial advisory boards o three healthcare inormation tech-

nology journals and magazines and the board o directors o HIMSS

Analytics He is an affi liate proessor at the Medical College o Virginia

at Virginia Commonwealth University

Mr Garets is a HIMSS Fellow and was chair o the HIMSS Board

or 2003-2004 He is an internationally known author and speaker on

inormation technologies strategies benchmarking and the uture ohealthcare Mr Garets has a bachelorrsquos degree in business administra-

tion rom exas ech University

About the Authors v





vii

Contents

Foreword by David E Garets FHIMSS ix

Preace by Claire McCarthy MA and Douglas Eastman PhD xi

Acknowledgments xvii

Chapter 1 Te Business Case or Change Management 1

Section 1 LeadershipmdashEstablishing a Foundation for Change 21

Chapter 2 Vision 23

Chapter 3 Sponsorship 37

Chapter 4 Organizational Readiness eam 55

Section 2 WillingnessmdashBuilding Commitment 77

Chapter 5 Stakeholder Management 79

Chapter 6 Communication 95

Section 3 AbilitymdashDeveloping Requisite Skill 109

Chapter 7 raining Strategy 111

Chapter 8 Reinorcement 127

Chapter 9 Implementation Readiness 137

Section 4 Summary 175

Chapter 10 Te Journey 177

Reerences 185

Index 187





ix

Foreword

By David E Garets FHIMSS

Electronic medical record (EMR) deployments are not about technol-

ogy Tey are about equipping organizations to reach critical business

objectives by providing people with technical capabilities that make

new things possible and by engaging people in changing their behavior

to effectively use the new capabilities to generate resultsTis book will show you how to create an environment or suc-

cess in your organization to not only ensure that your EMR imple-

mentation effort is successul but that your organization builds change

capacity and 1047298exibility in the process Tis new nimbleness will serve

you well in our world o continual change

De1047297ning change management is as important as understand-

ing what change management is not It isnrsquot project management or

solely process improvement Rather it is a set o speci1047297c disciplines

described in detail in this book that when coordinated and integrated

make the difference between tossing money into an EMR pit (simi-

lar to the ones that we boaters throw our money into) or getting thesought-afer changes in your organization

Chapter 2 on Vision is especially important In it Claire and Doug

explain how leadership paints the picture o what is expected rom

the implementation o an EMR I would argue that it is a process that

involves not only representatives o the ront line and their managers

and the senior executive team but also the board An EMR implemen-

tation done rightmdashmeaning the technology works was implemented

on time and within budget and the people modiy their behavior and

processes to achieve commensurate value or the investmentmdashis more

transormative than anything else a healthcare organization could do

It needs to be driven rom the board Tat way the right people iethe CEO and executive management team are held accountable or the



x Change Management Strategies for an Effective EMR Implementation

success o this crucial business initiative with an inormation technol-

ogy componentDale Sanders then CIO at the Northwestern Medical Faculty Foun-

dation and now CIO at the Cayman Islandsrsquo Health Services Author-

ity pointed out that ldquoyou need to dedicate the time and resources to

constantly iterate re1047297ne and improve the utilization o the EMR over

time ar beyond its installation and go-live Itrsquos a race without a 1047297n-

ish line rain und and plan accordinglymdashdonrsquot short-change the

investmentrdquo In other words recognize that you are not done at go-

live yoursquove just started achieving technology adoption and changing

behavior to get value rom your EMR investment

Tis book should be required reading or every member o the

executive team in every healthcare organization that is planning toimplement an EMR in the next ew years I was happy to be asked

to review the book and to write the orewordmdashand not or the ame

and ortune It was because I would then have to read it and Irsquom glad

I did I learned an incredible amount about a topic that most o us in

the technology world do not understand well and that is dealing with

people issues Claire and Doug nail it here and I guarantee yoursquoll be

thankul or the knowledge they share

Having said that reading this de1047297nitive work on change man-

agement or EMR implementations is not going to provide you with

enough knowledge on the topic to preclude your engaging or hiring

change management expertise In act just the opposite yoursquoll ullyunderstand why you need to get some help Welcome to the epiphany



xi

Preface

By Claire McCarthy MA and Douglas Eastman PhD

Tere is much discussion today about implementation o EMR sys-

temsmdashdiscussions that usually include excitement anxiety and

downright dread Tere is also a lot o talk about whether EMRs cre-

ate opportunities or healthcare organizations such as transorming

the way care is delivered reducing medical errors increasing internaleffi ciencies or clinical and administrative users improving revenue

capture and providing a host o other critical bene1047297ts Te promise

(some would say antasy) is big

But above all an EMR implementation is disruptive Te process

can realistically be equated to a tornado whipping through an organi-

zation and lie as you once knew it is turned upside down and the new

processes expectations priorities roles and methods overwhelm the

workplace

Our intent in writing this book is to assist others who may be

struggling with many o the same issues we have addressed By sharing

lessons rom our numerous 1047297rsthand sofware implementation expe-riences we will equip you with successul practices and prepare you

to lead or participate effectively in change managementtechnology

adoption efforts so that meaningul use can be achieved

Te primary audience o this book is everyone who leads or is

directly involved in the people-ocused change managementtech-

nology adoption efforts o an EMR implementation Our secondary

audience is everyone else who has a stake in the usersrsquo willingness and

ability to change behavior so the potential o the technology can be

realized So whether you are actively engaged in change management

technology adoption work or your support and advocacy o change

managementtechnology adoption is neededmdashthis book is or youRegardless o your speci1047297c role (executive middle-management

ront-line supervisor physician nurse medical assistant I proes-



xii Change Management Strategies for an Effective EMR Implementation

sional consultant or other stakeholder in the success o an EMR

implementation) our hope is that you will gain an appreciation orthe importance o users and the effort required to ensure operational

success Tis book emphasizes effective ways to plan and implement

change Te content is based on decades o combined experience man-

aging the people side o sofware implementations in healthcare

It is important to point out however that this book is not meant to

be a course on change managementtechnology adoption Our intent

is not to review existing research or current academic models and the-

ories but rather to share the insights and lessons we have learned in

delivering sustainable results and healthy organizational change over

the years

For technically-oriented project leads the success o an EMRimplementation tends to ocus too heavily on ldquoscrewing in the sys-

temrdquo on time and on budget But as important as it is getting the

EMR technology up and running should not be the primary ocus

Equal emphasis must be placed on how the new technology will be

embraced utilized and leveraged to realize a return on this signi1047297-

cant investment Flipping the switch and turning the technology on is

merely hal o the game

We believe the promise o an EMR implementation is great with

potentially signi1047297cant returns or the patient user organization and

or the industry as a whole When we hear words such as electronic

computerized and automated it sounds as i lie will be made easier andbecome more organized and effi cient However healthcare organiza-

tions do not always think about the critical steps involved in making

these hopes a reality Tis is due in large part because managing the

people side o an implementation and developing and installing major

technology require different skills sets Neither side o the coin is nec-

essarily more important but they both must be seen as equally signi1047297-

cant Te role in managing the people side o an implementation rarely

1047297ts neatly into how technically-ocused projects have historically been

measured and this creates a scenario in which the people side is ofen

misunderstood discounted and worst case ignored altogether Con-

sider the difference between what it takes to install the system (a tech-nology ocus) and what it takes to get the desired outcomes (a ocus on

people doing things differently)



Preace xiii

Te management o ambiguity resistance and user motivation is

admittedly hard to measure and unortunately involves methods thatare not always easily checked off a list Te process is more 1047298uid and

organic than linear At times it is unpredictable requiring rethink-

ing and course corrections Afer all we are dealing with people Not

everything is clear cut Donrsquot believe anyone who tells you it is

People come with different backgrounds rames o reerence

experience with technology comort with change or ambiguity trust

in leadership and so orth Whatever the mix o scenarios users never

start rom the same placemdashand they move through the change pro-

cess at different speeds meaning they continue to be in different places

throughout the project Te good news is that users do grow and develop

over the course o the project and many eventually accept things theywouldnrsquot agree to at 1047297rst But they require understandingmdashtheir ears

needs hopes and their reactions to the challenges that impact their

ability to perorm A sound comprehensive people strategy that cre-

ates an environment in which they can succeed is essential

I the goal o your EMR implementation is to achieve sustainable

results growth or organizational transormation then a substantial

investment in people must be central to your overall implementation

strategy Afer all it is the user who makes or breaks your EMR imple-

mentation and ultimately determines the amount o return the organi-

zation will realize Te better prepared people are or the change and

the less they see it as threatening the aster they will deliver value

Quoteldquordquo

ldquoMan is still the most extraordinary computer of allrdquo

- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy



xiv Change Management Strategies for an Effective EMR Implementation

HOW HE BOOK IS SRUCURED

Preparing an organization or a successul EMR implementationinvolves a big picture approach that takes into account all the actors

that in1047298uence behavior change Te idea is to establish an organiza-

tional contextmdasha culture in which desired behavior is supported and

reinorced through a variety o methodsmdashcreating a learning organiza-

tion that grows to achieve its vision priorities and goals In this book

we present an Implementation Readiness Model and discuss each ac-

tor involved in ensuring the organization and users are ully prepared

to realize the potential o the new technology

Tis book is organized in a simple ashion First we make the busi-

ness argument or change managementtechnology adoption explain-

ing why technology implementations will not deliver bene1047297ts without

a signi1047297cant ocus on users Next we discuss two critical success ac-

tors in any large-scale change management effortmdasha clear vision and

effective leadership

Ten we argue or the development o a cross-unctional team

o representatives rom key areas within the organization the Orga-

nizational Readiness eam (OR) and introduce a pragmatic model

that outlines the scope o complexity and work that the OR man-

ages throughout the project lie cycle Tis establishes a oundation

or subsequent chapters in which each provides urther detail about

the inter-relationship o work involved to effectively drive sustain-

able change Tese chapters dig deeper into lessons learned and best

practices related to stakeholder management communication train-

ing strategy and reinorcement as all must be aligned to successully

satisy the end goal o a meaningul implementation

Finally the Implementation Readiness chapter shows how the

prior chapters serve as building blocks to ormulate a comprehensive

and powerul Implementation Readiness Program aimed at securing

ready users who are engaged and prepared or the transitional changes

ahead in the world o an EMR Te book ends with a discussion o

our key lessons learned and insights regarding the overall journey Pay

particular attention to some o the larger challenges related to an EMR

implementation as these scenarios have proven to have a signi1047297cant

impact on an organizationrsquos speed and ability to position itsel or ben-

e1047297ts realization



Preace xv

It is important to stress that ocusing on just one actor o imple-

mentation readiness is not suffi cient to drive organizational changeand sustainable results Each chapter describes an individual actor in

detail and provides lessons and useul examples tools and other bits

o inormation intended to help you succeed in preparing your orga-

nization or a successul EMR implementation But the real purpose

o the book is to raise awareness o how all actors work in concert to

in1047298uence desired change associated with an EMR implementation Te

actors work best as an integrated whole overlapping and reinorcing

each other Tey typically have separate leadership but whether or-

mally integrated or not they are pieces o one picture

Like other books you can jump to any chapter o interest at any

point However we strongly encourage you to read the book cover tocover 1047297rst to gain an understanding o the end-to-end process and how

each actor contributes to overall success A strategy that accounts or

all actors is more effective than just one intervention or multiple dis-

connected interventions In this case the sum is de1047297nitely greater than

all o its individual parts

We speak to you in a conversational and straightorward man-

ner to make this rather diffi cult side o an EMR implementation more

approachable We hope you will 1047297nd our insights valuable and will

leverage this book as your implementation reerence guide It will ur-

ther your cause i all stakeholders accountable or a successul launch

in your organization have a common ramework or approaching the

collective end goal We certainly wish wersquod had a book like this years

ago to guide us through the mine1047297eld o sofware implementationsFinally we hope you enjoy the process o supporting people

through the transition to the world o EMRs Tere is something very

Quoteldquordquo

ldquoExperience is a hard teacher because she gives

the test first the lessons afterwardsrdquo

- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law



xvi Change Management Strategies for an Effective EMR Implementation

rewarding about seeing people who were earul and resistant even

in tears and thinking seriously o quitting eel the pride o accom-plishment when they succeed Each person who stays the course and

becomes a contributing member o the electronically enabled organi-

zation represents untold cost avoidance Knowledge and talent stay in

the organization replacement costs are avoided relationships are pre-

served and critical staff shortages are reduced echnology adoption is

truly a contribution to the bottom line

In the words o one o our grandathers ldquoPeople change when

theyrsquore damned good and ready and not beorerdquo Wersquore here to get

them ready



xvii

Acknowledgments

Te authors would like to thank the ollowing individuals or sharing

their expertise and experiences or this book

Saaa Al-Haddad MD

Internal Medicine

University Hospitals

Cleveland Ohio

Ronnie D Bower Jr MA

Manager Change Management

BayCare Health System

ampa Florida

Nabil Chehade MD MSBS

CPC

Director Medical Inormatics

Regional Chie o Urology

KP HealthConnect RegionalPhysician Lead

Kaiser Permanente Medical

Group

Cleveland Ohio

Kenneth Goodman MD

Associate Director Center

or Continuing Medical

Education

Department o Family Medicine

Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente

Oregon Federation o Nurses

and Health ProessionalsHealthcare Inormation

echnology Committee

AF Healthcare

Portland Oregon

Lindsey P Jarrell FACHE

Senior Vice President amp CIO


ampa Florida

J Scott JoslynCIO

MemorialCare

Long Beach Caliornia

Margaret M Rudoph PhD

Consultant

Vancouver British Columbia

Canada

om Smith

CIO

NorthShore University Health

System

Evanston Illinois





1

C983144983137983152983156983141983154 983089

Te Business Case forChange Management

ldquoWersquore not in Kansas anymorehelliprdquo

In the introduction an EMR implementation is compared to a tornado

in that it whips through an organization turning lie upside down and

throwing users into a world 1047297lled with new ways o doing things and

seeking ways to recapture some sense o balance and control EMR

technology disrupts the status quo and along with the many opportu-

nities it promises it also brings a whirlwind o seemingly never-ending

changes which can have an entirely different effect on different people

While an implementation that is effectively managed even brings these

challenges a poor implementation can be disastrous and will cost the

organization much more time energy and money to get things back

on track

Dorothy the character rom the movie Te Wizard of Oz held

her composure pretty well through the tornado that ripped her rom

a calm stable lie on the arm and threw her into a oreign world She

was able to manage through the obstacles and challenges and stay the

course as she ollowed the yellow brick road in search o the wizard

Some say this is similar to the experience users have except or the

part when Dorothy wakes up rom her dream and 1047297nds hersel back

home as she remembers itEMR implementations donrsquot have to be nightmarish or users but

there certainly will be obstacles and challenges along the way Te key is

to help users through the road blocks and enable them to experience a



2 Change Management Strategies for an Effective EMR Implementation

positive journey Tis process is always easier when people know what

they are getting into eel supported and are prepared or what liesahead both good and bad Tis is the role o change management

CHANGE MANAGEMEN DEFINED

Itrsquos important to understand why you should make an investment in

the people side o the projectmdashbringing in the best technology pos-

sible doesnrsquot mean anything unless users are comortable and pro1047297-

cient in its use Te truth is just because you build it doesnrsquot mean they

will come

Letrsquos start by answering the two questions we are most ofen asked

ldquoWhat is change management anyway What is it change managers

dordquoo avoid conusion wersquoll say up ront we are not talking about

change management as it relates to technical issues such as version or

change control We also want to be clear that change management is

not project management What we are talking about is the human side

o electronic medical records implementations the human-ocused

work o engaging and preparing people to succeed in the new world

o EMRs

A word about project management while good project manage-

ment acilitates change management the two disciplines are not the

same Project management is much more linear and task-ocused

whereas change management deals with the complexities o human

behavior But a good project plan creates a structure and a ounda-

tion in which the change management process can occur Tereore

the two disciplines though different complement and support each

other

A word o caution do not conuse the project plan with the end

result Te plan is necessary and it guides you throughout the process

Te plan is proactive itrsquos the order in the chaos But technology adop-

tion is kind o like herding cats itrsquos unpredictable and you need to

maintain 1047298exibility to respond as things evolve Tis is a more reactive

process than what may be expressed in a plan In our experience an

EMR implementation requires both structure and 1047298exibility

Tere is a saying in change management circles When one door

closes another one opens but sometimes itrsquos hell in the hallway Change



C983144983137983152983156983141983154 1 Te Business Case or Change Management 3

management deals mostly with the hallway situation acilitating the

human transition rom the present to the uture Tese days change isongoing and requires ocused leadership i it is to be as ast and pain-

less as possible

Te three legs o the project stool represent the critical compo-nents o an implementation (Figure 1-1)mdashPeople Process and ech-

nology Te people are the most important When technology projects

ail it is primarily due to a lack o use and not a ailure o the sof-

ware Te ocus o change management is people and the objective is

to change behavior Tis is good or business because it accelerates the

change process so bene1047297ts are achieved aster Change management

is not about being nice or placing an emphasis on eelings Itrsquos about

perormance improvement and results

I you search the literature you will 1047297nd a variety o de1047297nitions o

human-ocused change management Tey all cover similar concepts

sometimes using different terminology Te simplest explanation ochange management is to say ldquoItrsquos all about the peoplerdquo But or the

purposes o this book we expand on that concept and use the ollow-

ing de1047297nition o change management

bull A structured process designed to deal directly and intentionally

with the human actors involved in not just planning and imple-

menting an EMR but through behavior change achieving the

anticipated bene1047297ts that justi1047297ed the project in the 1047297rst place

bull Desired behavior change is achieved by helping people understand

and internalize change and by preparing them to be successul

contributors in the uture state In the case o EMR implementa-

tions effective change management delivers users who are willingand able to use an EMR in a way that satis1047297es the requirements o

the job the needs o the patient and the health o the organization

Key Tip

Our assumption is that the software you are implementing

works If the software doesnrsquot work you have another kind of

problem one that even the best change management wonrsquot

resolve

Key Tip



problemmdashone that even the best change management wonrsquot

resolve




Well-designed integrated people-ocused work builds logically

over time in a way that makes sense to the user It brings users along

guiding and supporting them so they arrive at where you want them

to be Tis is about willingness and ability hearts and minds You must

have both

Te overarching purpose o change management is to acceleratethe speed at which people move successfully through the change

process so that anticipated bene1047297ts are achieved faster And there

are additional bene1047297ts to change management Trough optimizing

the effi ciency and effi cacy o users an effective EMR change manage-

ment program will also

bull Improve organizational outcomes and perormance (effective use

o the system generates value to patients and the organization)

bull Enhance employee satisaction morale and engagement (when

people learn new skills meet perormance expectations and con-

tribute to a greater good they eel pride in their accomplishments)

bull Improve service quality (users eel valued and supported by anorganization that makes an investment in them this positively

impacts how they treat patients)

Figure 1-1 The Three-legged Stool

Technology

People Process

Technology

People Process




bull Help achieve hoped-or bene1047297ts (bene1047297ts that include EMR value

realization reduction o errors return on investment)bull Create higher levels o openness trust involvement and teamwork

(develop an engaged workorce)

bull Build change capability and capacity in the organization resulting

in improved ability to respond quickly and effectively to new situa-

tions (create organizational nimbleness through embedded change

management knowledge structure and process)

In other words it really is all about the people Intentionally man-

aging the cultural behavioral and organizational changes that need

to take place to make the desired EMR uture not only a reality but

a sustainable reality pays off on many levels in that it also acilitates

organizational transormation Building on individual capability andorganizational capacity change management results in a change-

capable culturemdasha huge advantage in todayrsquos competitive and ast-

changing world

Change Management echnology AdoptionmdashWhatrsquos the Difference

Tere are a number o terms that people use to reer to the work

involved in managing the people side o a change effort We think o

change management as the mother ship that is the umbrella term that

embraces all specialties within the 1047297eld Similar to the various special-

ties or domains o service within a healthcare system change man-agement proessionals may choose speci1047297c areas o ocus echnology

adoption speci1047297cally inormation technology (I) is one such area

and it involves the application o change management principles to the

implementation o I Te focus of this book is technology adoption

and we will mostly use this term instead of change management

throughout the rest of the book

Effective technology adoption proessionals align themselves with

the operationalbusiness side o the organization and tailor solutions

that drive behavioral change and tangible outcomes Tey participate in

EMR implementation projects rom the beginning driving the people

side o change throughout and continuing to add value post-live as theEMR becomes part o the central nervous system o the organization




HE IMPORANCE OF HE PEOPLE SIDE

OF AN EMR IMPLEMENAIONTere are many reerences in the literature to ailed change efforts and

I implementations Estimates are that only one third o these projects

achieve success which means two thirds ail to meet expectations Te

good news is that ailure is optional as much has been learned about

why some change efforts ail and others succeed

Herersquos the issue while the change that is going to occur is an exter-

nal eventmdashthe EMR implementation a reorganization proposed out-

sourcing a promotion etcmdashthe transition rom old to new that those

who are impacted experience is a psychological and emotional pro-

cess It is this transition that is diffi cultmdasheven when a change is sel-

imposed or considered positive

In the words o William Bridges a key thought leader in manage-

ment o transitions ldquoIt isnrsquot the changes that do you in itrsquos the transi-

tion afer the change that doesrdquo1

For an implementation team part o the problem encountered

during transition is that change is messy people start where they are

not where we want them to be And when considering the personnel

within a typical hospital people can be all over the place in terms o

comort with computers stage in lie commitment to the organiza-

tion ear o change etc Add to this the act that or change to be suc-

cessul three things must occur People

bull Must let go o their current reality have an ending

bull Go through a conused period in-between (hell in the hallway)

bull Only then can have a new beginning 1

o take this a step urther while I consultants want to install the

system and make enhancements the users will ultimately determine

how the system is used Tis use is affected by human not technical

actors

bull Different rames o reerence backgrounds experiences with

technology

bull Organizational history and experience with other large-scale

change projects

bull Levels o resistance ear ability to deal with ambiguity

bull Degree o alignment o ldquoWhatrsquos in it or merdquo or the various stake-

holder groups




bull Ineffi ciencies uncovered because the system creates transparency

bull Workarounds that become quickly entrenchedbull Pressure to get through the day can override doing what is right

bull User worklie balance issues coming into play rom the very

beginning

All o these actors create problems or implementation teams that

just want to install technology How do you effectively address the

people issues Or is it easier to just install the technology and assume

that people will learn because they have to use it Some on the imple-

mentation team may alsely assume that users o an EMR system will

snap into place over time and do what is right or the organization

Tis thinking is a oolrsquos paradise

In the oreword to this book Dave Garets made the point that EMRdeployments are not about technology but about equipping organiza-

tions to reach critical business objectives by providing employees with

technical capabilities that make new things possible and by engaging

them in changing their behavior to effectively use the new capabilities

to generate desired results

With all due respect to the technical side o an EMR implemen-

tation installing the technology is only hal the battle Tis is not to

degrade the importance o the technology Te act that we spend a lot

o money researching technology acquiring it con1047297guring it install-

ing it and supporting it speaks to its importance I we werenrsquot imple-

menting EMRs we wouldnrsquot even be having a discussion about EMR-related change management




But implementation o the technology is just a 1047297rst and very nec-

essary stepmdashbecause in and o itsel the technology does not generate

value Te technology is necessary but not suffi cient or bene1047297t realiza-

tion to occur o create value requires people and this is why change

management is so important oo much o a ocus on technology even

in the early stages will create issues downstream And even with the

best technology i not used effi ciently hoped-or bene1047297ts will be tough

to achieve

CIO Perspective

ldquoDuring my masters program I took an Organization Development

class that really opened my eyes to peoplesrsquo needs during large-scale

change Since the OD class I have been very interested in what makes

people tick and why people react in different ways to the same

environment No matter how good of an idea a large-scale technology

implementation is we will always have early adopters average adopters

and laggards As leaders within large organizations we have a

responsibility to plan for and respect all types of technology adopters

Ultimately the people who work within in our organizations want a positive

human experience when they are at work

Utilizing a change management methodology enables the implementation

and leadership teams to provide a positive experience during the period of

significant change By utilizing a solid change management methodologythe organization promotes team communication a safer environment for

the patient a work environment that promotes trust and an environment

where people are allowed to talk about the fear of change All of this

promotes a better human experience and a much stronger work force

hellip An effective change management program has meant the difference

between good go-lives and great go-lives at our 10 hospitalsrdquo


SVP amp CIO


Clearwater FL

CIO Perspective

During my masters program I took an Organization Development

















between good go-lives and great go-lives at our 10 hospitals


SVP amp CIO


Clearwater FL




Remember that change is a personal experience It is also local and

individual And itrsquos hardmdasheven when itrsquos sel-imposed and positive

Tere are no shortcuts People have to go through the process o change

in much the same way that we move through the stages o grie2 It canrsquot

be avoided or skipped You can measure twice and cut once or you

can cut now and then do costly remediation later Either way you canrsquot

avoid the expense or time required or real change to occur

SYSEMS PERSPECIVE

Experienced technology adoption proessionals embrace a systems

perspective when given the assignment to drive perormance man-

age perceptions and increase the utilization o new and existing tech-

nology A systems approach is the ability to see the big picture and

address the interrelationships among the variables within the abric o

CIO Perspective

ldquoIrsquove been in healthcare IT a long time and I now realize itrsquos

all about change management What was considered soft is

now hard We know so much more about how to install

technologymdashItrsquos the people part we donrsquot know well yet

and so itrsquos hardrdquo

Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective

Irsquove been in healthcare IT a long time and I now realize itrsquos



technologymdashitrsquos the people part we donrsquot know well yet

and so itrsquos hard

J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo

ldquoNo man can think clearly when his fists are clenchedrdquo

- George Jean Nathan

Quoteldquordquo

ldquordquo






the organization and in1047298uence the combined impact these variables

have on organizational effectiveness As each variable has the powerto in1047298uence the outcome o any intervention behavior change is ofen

not sustainable because variables tend to work against one another

Effective technology adoption strategies account or this interrelation-

shipinterdependency and aim to bring these variables into alignment

as a means or driving sustainable results

Figure 1-2 introduces the Organizational Fabric Model which

highlights the six primary threads (or variables) that are interwoven

in the abric (or culture) o an organization Te model suggests that

all six threads must work in concert to successully shape the organi-

zational abric A well-woven technology adoption plan strategically

manipulates these threads to in1047298uence desired change A poorly wovenplan in which a thread or combination o threads is not accounted

or leads to disaster or by way o analogy will hit a snag down the

road Depending on the 1047298exibility and durability o this abric a snag

can result in a huge hole that detracts rom the overall strength o the

intervention Te intent o the Organizational Fabric Model is to stress

how important it is to understand the uture state recognize how each

variable or combination o variables will come into play and develop a

sound technology adoption program that appropriately in1047298uences this

set o variables to reshape the abric or culture so desired change can

actually take place

Te Organizational Fabric Model will be revisited in subsequent

chapters as each thread or variable is explored in urther detail For

now we reiterate that technology adoption strategies must not rely

on only one or two threads to drive behavior change Sustainable out-

comes result rom an organizationrsquos ability to leverage the combination

o all six threads working in concert to create an environment orsuccess

Key Point

Fundamentally culture is ldquothe way we do things around hererdquo

Key Point





CREAING AN ENVIRONMEN FOR SUCCESS

echnology adoption is about creating a context an environment in

which change can be achieved and sustained over the long term Tis

involves two levelsmdashorganizational and individual

With an EMR implementation the organization must create thesupporting environment provide needed training and resources

articulate a clear direction coupled with clear expectations engage its

people include them in the process and reinorce desired new behav-

iors Tis is not about checking things off a list but rather about 1047297nd-

ing synergy among impacted groups giving them what they need and

coordinating efforts to meet the end goal Itrsquos an ongoing effort

o give you an idea o what we are talking about herersquos an exam-

ple o an individual situation occurring within a social context Tink

about what happens when you want to make a signi1047297cant change in

your personal liemdashquit smoking stop drinking lose weight Itrsquos one

thing to talk with a doctor or another proessional about what needsto happen when yoursquore in their offi ce but once you leave the offi ce

you then return to your social reality I your riends and amily donrsquot

want your behavior to change you will have a tough time All the rein-

Figure 1-2 Organizational Fabric Model

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications




orcements and temptations will conspire to prevent you rom mak-

ing changes But i you can get some important people in your lieto make the changes with you or at least support you in the process

you have a much greater chance o success Te lesson is donrsquot send a

changed person back into an unchanged environment if you want

to see behavior change

Engaging individuals involves arousing two key aspects mdashwilling-

ness and ability Te organization must in1047298uence both in order to suc-

ceed With the help o the Skill Versus Will Matrix (Figure 1-3) think

about it this way

bull When people want to do something but donrsquot know how they canrsquot

(willingunable)

bull When people know how but donrsquot want to they wonrsquot(ableunwilling)

Can you think o examples in your own lie when you have been in

either o these situations

Consider the circumstance o people who know how to do some-

thing but donrsquot want to do it Tis is a ldquowillrdquo not a ldquoskillrdquo issue and it is

a very common technology adoption dilemma I the amount o work

and effort involved are not perceived by the user as being equal to the

Figure 1-3 The Skill versus Will Matrix

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow




return or value experienced through the implementation the user will

most likely choose to reduce the effort A goal o an effective people-ocused strategy is to identiy potential areas o disconnect and 1047297nd

ways to increase the perceived value to users Te assumption is that

when the return is perceived to be greater the effort increases When

there are no incentives to try harder it may be diffi cult to drive desired

behavior change

Te point in getting users to actively support the deployment o

an EMR is about a lot more than a communication plan or eature

unction training Managing the people side o an EMR implementa-

tion requires a savvy technology adoption plan that ties sponsorship

training communication work1047298ow harmonization user support and

reinorcement with the business priorities o the organization andeffectively coordinates all o these activities with the user in mindmdashin

an environment that reinorces desired behavior changes

Key Questions

Two key questions to remember throughout the

project arehellip

(1) How will this decision impact the user

(2) How might it impact patients

Key Questions


project are






Consider this example

In this example what are the key elements o this process that

ensure success

bull Te picture of success the desired outcome is clearmdashit is or the

child to become a unctioning adult in the community

bull How this happens is clearly de1047297ned in behavioral terms Tere is a

process that is known and understood by the entire community

including children

bull Leaders at all levels in the community agree on the desired out-

come support the entire process and actively ful1047297ll their roles to ensure success Leaders include village elders and ormal lead-

ers parents o the children inormal opinion leaders and amily

members

bull Te children who are about to become adults take an active role

in their own transormation taking responsibility or their suc-

cess Tey receive guidance and counsel rom elders Tey know

and understand the transormation process and what they must do

to achieve their new status Goals and steps are clear Tey also

understand the consequences o not successully transitioning to

adulthood

bull I there is more than one child slated to go through transormationto adulthood at the same time they are a peer group and as appro-

priate prepare together and support each other

Key Point

In native cultures there tend to be rites of passage that serve

to transition a person from childhood to adult status in the

community The child may actually leave the village for a day or

two of contemplation following a prescribed process When the

child returns he or she is redefined as an adult and assumes

the consequent privileges and responsibilities The entire

community reinforces the personrsquos new status the new adult is

not allowed to return to being a child whenever itrsquos convenient

but is supported to complete the transformation to adulthood

The change to adulthood does not happen in a vacuum but is

part of a carefully designed process that ensures success

Key Point















bull Te entire community works together to bring about the

transormationbull Success results in positive reinforcement

Te environmental context is the trump card in any implementerrsquos

hand It takes a lot o work to create a suitable environment but it is an

essential ingredient in being able to drive and sustain change

Willingness and Ability

Earlier we mentioned willingness and ability as key concepts in tech-

nology adoption Willingness and ability can also be thought o as

hearts and minds or will and skill Te point is the same regardless

o the terms used People need to be supported on both an emotional

level to commit and on an intellectual level to be able Te questionto be answered is ldquoWhat are the conditions under which users will

accept and adopt the EMRrdquo

Letrsquos talk about willingness 1047297rst

Willingness or hearts is the commitment to go orward Tis is

impacted by many things including the ollowing elements

bull Leadership Perceived support or lack o support or the change

rom senior executives in the company the cascade o sponsors

down through the organization and just as importantly rom the

employeersquos direct supervisor

bull Communication Quality and requency o verbal and written

messages that describe the desired uture state tell why the changeneeds to happen and what will happen i change isnrsquot made set

clear expectations explain how the company will prepare and sup-

port people to success and describe local details such as timelines

etc

bull Reinforcement Degree o appropriateness and timeliness o

rewards or demonstrating desired new behaviors and conse-

quences or sticking to the old ways

bull Participation Degree to which users are involved every step o

the way either directly as individuals or indirectly by being effec-

tively represented by trusted local opinion leader peers who serve

as liaisons between users and the project teambull Organizational History with Change Previous organizational

experience with changemdashgood and badmdashwill in1047298uence user per-




ceptions and expectations o the EMR implementation Under-

standing the past is important in planning or the utureTis all sounds logical but the reaction to it can be emotional Tis

is where people conront their ear o ailure eeling stupid making

mistakes etc Remember that the change may require people to give

up the very things that they believe made them successul in the past

Tis can be a diffi cult sell

Ability or minds is about the actual capability to successully

meet new job expectations Tis is impacted by many things including

the ollowing elements

bull raining and Support In most cases the new EMR abilities must

be learned An effective training program that is role-based and

intentionally ocused on preparing people to perorm new jobexpectations is key Just discussing desired outcomes is not enough

though we have to clearly tell people what we want them to do

Tis requires an intellectual understanding o what and how a

conceptual understanding is necessary but not suffi cient Most

people need to practice something new to develop competence and

con1047297dence Sae opportunities to practice preerably with immedi-

ate eedback are very important to pro1047297ciency development and

sustainability

Getting people to move in the direction you want is the diffi -

cultymdashsome say the hardest part o the whole project And i you agree

that people are the oundation o successmdashthat bene1047297t realization isdependant not on technology but on people agreeing to go through

personal disruption learn new things change established patterns and

conront their earsmdashthen we must be proactive and courageous in

addressing the human issues

Tis is the people side o the project Tis is the organizational read-

iness unction It involves collaboration coordination and sequencing

o activities inormation and events rom all people-ocused areas Te

idea is to have all the people-ocused unctions working together to

reach clearly de1047297ned shared outcomes Te organizational readiness

plan to create individual and organizational readiness is the umbrella

that connects it allmdashthe glue that holds it together and the grease thatmakes it workmdashor the user We will address the structure and process

or doing this in more detail in subsequent chapters




Good News on wo Fronts

1 Tere is a social science Tere is a body o work research andsubsequent publications about the human experience with change

Tere are proven change management strategies tools and tech-

niques Tis isnrsquot olklore hooey or black magic Te transition

process is known and predictable Tere is a change curve that

describes the steps (Chapter 5 Stakeholder Management) And

though there is no silver bullet it isnrsquot rocket science Senior

healthcare executives must take the emerging proession o change

managementtechnology adoption seriously Not understanding it

is no excuse or ignoring it Tat is ar too expensive an option

2 All people go through transition when changemdashgood or badmdash

happens in both their personal and proessional lie You canrsquot

avoid it Te wonderul thing is i you learn about change and

transition at work it will improve your personal lie Tis is one

o the times to ldquotry this at homerdquo Wersquore all humanmdashat work and

at home So treat your people as the humans they are and avoid

some predictable expense and diffi culty Lead your organization

to a successul outcome and speed up the process by treating your

staff as customers 1047297rst

Donrsquot make the mistake o glossing over the critical human aspects

o change Hire experts and 1047297nd the emotionally intelligent people in

your organization who want to participate And remember you can

install technology without your people but you canrsquot ully implement

and achieve return on investment without them Consciously choose

to move fear and resistance to trust and adoption Itrsquos a case o pay

now or pay later I you wait until later it will always cost more ech-

nology Adoption is expensive but not as expensive as trying to gloss

it over and then having to undo the damage When ailure happens it

Quoteldquordquo

ldquoNot everything that can be counted counts and not everything thatcounts can be countedrdquo

- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein




takes a long time or people to re-engage And in todayrsquos world this

presents real problems or healthcare organizations aced with short-ages in many proessions Tere is a huge risk o alienating and poten-

tially losing needed staff or in causing long delays We can do better

Not so long ago it wasnrsquot conventional wisdom that clinical application

rollouts are not I projects More frequently than not these were consid-

ered technical projects in which the point of celebration was when con-nection from workstation to central processor was reliable and wireless

access actually worked Te classic I People-Process-echnology trian-

gle never got much past echnology to the real hard work on the People-

Process axis Tat has all changed in the 21st century system implemen-

tations that are both successful and valuable have had people and process

on the front burner

When MemorialCare embarked on a 1047297ve-hospital roll-out of an

EMR in 2002 it had several things in its favor

bull Te technology the organization ultimately acquired was robust and

reliable it worked

bull It had 15 yearsrsquo experience with CPOE (computerized providerorder entry) Terefore although unevenly adopted it was not new

territory

bull It had had the experience of a system-wide roll-out and standard-

ization on a general 1047297nance human resources and materials man-

agement system When all was said and done users had not been

suffi ciently involved standardization fell short because involvement

was low business leadership was diffuse and I ownership was too

high It was judged successful overall but the organization continues

to move slowly forward with an underutilized set of applications

With this experience and the insights of others MemorialCare pri-

oritized engagement of physicians nurses pharmacists and other staffWell before 1047297nancial commitment to a new system was obtained Memo-

rialCare hired a ldquoCare Planning Executiverdquo a person whose full-time




activities were devoted to the project 1047297rst to help understand the drivers

of a new system scope out the territory to be covered gain the com-mitment of senior leaders as well as governance and outline the case

for change At my insistence the Care Planning Executive a registered

nurse and former hospital chief operating offi cer joined the organization

reporting to the system-wide CEO as a peer and partner of the CIO not

a staff member and a peer to the CEOs of each medical center campus

Tat dedication alone made clear the commitment intentions and over-

all priority of the company

Among several other critical success factorsmdashand the outcome was

a successmdashwas the overall employee engagement program that the Care

Planning Executive established In summary it was an education mar-

keting and training program dedicated to equipping the affected staffwith the knowledge and tools to embrace unavoidable change Staff com-

munication was clear that it wasnrsquot change for changersquos sake but a major

move forward in the paperless way care would be delivered and work-

1047298ows would be streamlined Of course at the time no one could have

foreseen later moves by government to push everyone in this direction

(with the American Recovery and Reconstruction Act of 2009) Because

of our early efforts wersquore now very well positioned

J Scott Joslyn

CIO

MemorialCareLong Beach California



About the BookDespite the promise of improving care and other benefits EMR implementations are highly disruptive to the

organization This book prepares you to lead or participate successfully in change managementtechnologyadoption efforts so that meaningful use of EMRs can be achieved The authors provide successful strategies

to plan and implement change The content is based on their decades of combined experience designing

and leading technology adoption programs

Sections of the book deal with establishing a foundation for change building commitment and developing

requisite skill in helping users be successful with technology The book includes numerous lessons learned

tips for success best practices and case studies from organizations that have handled change well

About the AuthorsClaire McCarthy MA is a recognized technology adoption strategist and leader

with 25 years of healthcare industry experience supporting people through softwareimplementations and other large-scale change efforts As Director of Organizational

Effectiveness for Kaiser Permanentersquos enterprise-wide EMR deployment Ms McCarthy

led a national community of practice focused on preparing users to assume new

roles and responsibilities in support of organizational objectives Ms McCarthy

speaks internationally on the topic of technology adoption encouraging healthcare

leaders around the globe to set the stage for benefit realization by investing in the

people side of EMR implementation

Douglas Eastman PhD is an organizational development executive with extensive

experience managing large-scale change initiatives With more than 20 years

of consulting experience Dr Eastmanrsquos focus is to help organizations grow and

manage change by unleashing human potential His specialties are organizationaltransformation technology adoption and optimization process redesign strategic

planning and program and tools development As the Executive Director of Technology

Adoption and Organizational Capability within the Kaiser Permanente IT Care

Delivery Business Information Office Dr Eastman has pioneered several of Kaiserrsquos

implementation readiness toolsmethodologies and post-live optimization strategies

programs adding to the organizationrsquos ability to realize the benefit of its technology

About HIMSS The Healthcare Information and Management Systems Society (HIMSS) is a comprehensive healthcare-

stakeholder membership organization exclusively focused on providing global leadership for the optimal

use of information technology (IT) and management systems for the betterment of healthcare Founded in

1961 with offices in Chicago Washington DC Brussels Singapore and other locations across the United

States HIMSS represents more than 23000 individual members of which 73 work in patient care delivery

settings HIMSS also includes over 380 corporate members and nearly 30 not-for-profit organizations that

share our mission of transforming healthcare through the effective use of information technology and

management systems HIMSS frames and leads healthcare public policy and industry practices through

its educational professional development and advocacy initiatives designed to promote information and

management systemsrsquo contributions to ensuring quality patient care

ISBN 978-0-9821070-6-5

Order Code 564


Chicago IL 60611ndash3270

312-915-9295

www himss org



Change Management Strategiesfor an Effective

EMR Implementation

Claire McCarthy MA

Douglas Eastman PhD

Contributing Editor




HIMSS Mission




Society





the publisher



be sent to

Permissions Editor

HIMSS



cmcleanhimssorg

ISBN 978-0-9821070-6-5




disapproval




iii

About the Authors










implementations




























acilitation










































About the Authors v





vii

Contents






Chapter 2 Vision 23












Reerences 185

Index 187





ix

Foreword






















































xi

Preface













workplace




























the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org



HIMSS Mission




Society





the publisher



be sent to

Permissions Editor

HIMSS



cmcleanhimssorg

ISBN 978-0-9821070-6-5




disapproval




iii

About the Authors










implementations




























acilitation










































About the Authors v





vii

Contents






Chapter 2 Vision 23












Reerences 185

Index 187





ix

Foreword






















































xi

Preface













workplace




























the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org



iii

About the Authors










implementations




























acilitation










































About the Authors v





vii

Contents






Chapter 2 Vision 23












Reerences 185

Index 187





ix

Foreword






















































xi

Preface













workplace




























the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org










acilitation










































About the Authors v





vii

Contents






Chapter 2 Vision 23












Reerences 185

Index 187





ix

Foreword






















































xi

Preface













workplace




























the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org
















About the Authors v





vii

Contents






Chapter 2 Vision 23












Reerences 185

Index 187





ix

Foreword






















































xi

Preface













workplace




























the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org





vii

Contents






Chapter 2 Vision 23












Reerences 185

Index 187





ix

Foreword






















































xi

Preface













workplace




























the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org





ix

Foreword






















































xi

Preface













workplace




























the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org




























xi

Preface













workplace




























the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org














the years

























Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org



Preace xiii























Quoteldquordquo


- John F Kennedy

Quoteldquordquo

ldquordquo


- John F Kennedy










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org










































Preace xv


























Quoteldquordquo



- Vernon Law

Quoteldquordquo

ldquordquo



- Vernon Law













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org













them ready



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org



xvii

Acknowledgments



Saaa Al-Haddad MD

Internal Medicine


Cleveland Ohio




ampa Florida


CPC





Group

Cleveland Ohio

Kenneth Goodman MD



Education


Cleveland Clinic

Cleveland Ohio

Marie Hamilton RN

Kaiser Permanente



echnology Committee

AF Healthcare

Portland Oregon




ampa Florida

J Scott JoslynCIO

MemorialCare



Consultant


Canada

om Smith

CIO


System

Evanston Illinois





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org





1

C983144983137983152983156983141983154 983089













on track





















will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org











will come









o EMRs








other















less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org






less as possible























Key Tip




resolve

Key Tip




resolve








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org








have both














Technology

People Process

Technology

People Process

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org

















changing world
















































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org
































actors


technology


change projects



holder groups







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org







beginning





























to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org











to achieve

CIO Perspective




















SVP amp CIO


Clearwater FL

CIO Perspective




















SVP amp CIO


Clearwater FL











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org











SYSEMS PERSPECIVE






CIO Perspective






Scott Joslyn

CIO

MemorialCare

Long Beach CA

CIO Perspective






J Scott Joslyn

CIO

MemorialCare

Long Beach CA

Quoteldquordquo



Quoteldquordquo

ldquordquo


























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org
























actually take place







Key Point


Key Point























Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org






















Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications

Sponsorship

Stakeholder Mgmt

Training

Vision

Reinforcement

Communications












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org












about it this way


(willingunable)









Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow

Skill

Will

WONrsquoT

WONrsquoT

DOES

CANrsquoTLow

High

HighLow HighLow









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org









behavior change








Key Questions


project arehellip



Key Questions


project are








ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org






ensure success





including children




members







adulthood



Key Point












Key Point






































etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org



























etc






























sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org






















sustainability














































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org
































Quoteldquordquo


- Albert Einstein

Quoteldquordquo

ldquordquo


- Albert Einstein














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org














on the front burner




reliable it worked


territory
































J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org






















J Scott Joslyn

CIO






































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org





































ISBN 978-0-9821070-6-5

Order Code 564



312-915-9295

www himss org

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