New Technology in Nursing: Interview


Implementing new technology is a laborious endeavor for the executive staff of healthcare facilities. Annette Brown, Director of Nursing Informatics in Eisenhower Health, has experience leading the transition process from paper charting to electronic health record (EHR) system provided McKesson in 2008 and then to EPIC in 2017. Eisenhower Health is a progressive health care complex comprised of a 463-bed hospital, a health science building, a children’s center, and multiple outpatient facilities in southern California (Eisenhower Health, n.d.). A. Brown was in charge of selecting, planning, and implementing the system. She also had to find talents and partners and managing all the resources for the two transitions. The present paper offers a discussion of the barriers associated with implementing new technology from the first-person perspective.

Selection

Selecting a technology may become a hard task for healthcare leaders since it is accompanied by a considerable degree of uncertainty. Even though the change is most of the time dictated by the time, there are no universal decisions. In 2008, A. Brown faced the problem of selecting an innovative technology that she did not wholly understand (A. Brown, personal communication, May 30, 2019). She had to conduct research and evaluate every flaw of the EHR systems that were on the market at that time (A. Brown, personal communication, May 30, 2019). When selecting new technology, a healthcare leader makes a choice from three variants: make the selection without any help, employ talents, or hire a consulting team. A. Brown supports recruiting a mix of experts for the transition process as opposed to hiring a company to ensure proper interoperability (A. Brown, personal communication, May 30, 2019). However, the conclusion is made from personal experience and maybe irrelevant to other situations.

The selection process is a complicated task due to the necessity of taking into consideration the needs and worries of multiple stakeholders. According to Kruse, Kristof, Jones, Mitchell, and Martinez (2016), the barriers to implementing new technology are connected to cost, physicians’ resistance, and patients’ concerns. The board of directors always wants the most cost-efficient solution for the problem. However, the cheapest systems may have numerous flaws, including privacy issues, which are crucial for the patients. Bhuyan, Bailey-DeLeeuw, Wyant, and Chang (2016) state that most of the patients want to have control over the data that is stored in cloud servers. Additionally, physicians may become frustrated with the additional workload associated with learning new applications and workflow procedures. Therefore, a selected technology must be optimal in price, complexity, and data protection.

The choice was made to adopt the McKesson system in 2008 and EPIC in 2017. The first time A. Brown was assisted by a team of talents who evaluated McKesson as the most efficient solution (A. Brown, personal communication, May 30, 2019). However, the software could not follow the pace of modern healthcare and had to be replaced in 2017 by EPIC. The second time A. Brown hired a company to help with selection, and they chose EPIC since it was the most popular system at the time (A. Brown, personal communication, May 30, 2019). Therefore, if she were to select a new technology again, she would recruit a mix of specialists for support.

Planning

Planning is arguably the most critical part of new technology implementation. At the same time, it is a confusing endeavor, particularly for people with limited experience in the matter. For this reason, A. Brown utilized the services of talents and consulting agencies for the two projects (A. Brown, personal communication, May 30, 2019). While planning a change, it is convenient to choose a theoretical framework and develop a strategy in accordance with the theory. A. Brown claimed that Patricia Benner’s theory helped her during the transition to the McKesson system in 2008, but no theory was utilized for the second transition (A. Brown, personal communication, May 30, 2019). As a result, the interviewee opted to stager the immersion rather than migrating all the system simultaneously (A. Brown, personal communication, May 30, 2019). Even though gradual implementation may be connected with interoperability issues, it is easier to make adjustments and test the new system while utilizing the staging method. In short, A. Brown’s major mistake for the second planning was not utilizing a theory.

Implementation

The final step in the transition to the use of new technology is the most unpredictable part of the matter. Even though executive staff always have an idea of how the process should go, most of the time, the previously developed plan is altered in the process. According to Kruse et al. (2016), the implementation of new technology is often associated with considerable technical challenges and difficulties in training. Additionally, the adaptation to a new workflow may cause irritation in staff members due to increased workload (Abernethy, Gippetti, Parulkar, & Revol, 2017). These obstacles often interfere with the implementation of the original plan leading to increased cost and duration of the transition process. Moreover, interoperability is also one of the primary concerns in case of migrations from one system to another. Jabbar, Ullah, Khalid, Khan, and Han (2016) define interoperability as “the ability of two or more systems to exchange information and to use the information that has been exchanged, thus supporting collaboration” (p. 80). While changing an EHR system, the old and new programs may be incompatible with each other causing significant problems in migrating the data.

A. Brown had to deal will all the issues mentioned above. She faced complications with interoperability between McKesson and EPIC software, which led to additional costs and an increased adaptation period. Eisenhower Health lost over $3 million and an extra year of unnecessary time for transitioning from one system to another (A. Brown, personal communication, May 30, 2019). She also stated that employees were harder to train during the electronic-to-electronic switch because they were already accustomed to navigating, documenting, and utilizing McKesson’s software (A. Brown, personal communication, May 30, 2019). The original transition from paper records to McKesson’s system went smoother due to the lack of interoperability issues and staging of the process (A. Brown, personal communication, May 30, 2019). In brief, the implementation process may differ depending on the task and circumstances; however, there are common problems that may be avoided by utilizing the experience of peers.

Conclusion

Implementation of new technology may be accompanied by various barriers and complications. The problems are connected to contrasting and sometimes competing for the interests of different stakeholders. Among common problems are the implementation costs, staff’s resistance to change, privacy concerns, and interoperability issues. A. Brown provides valuable insights on the matter from the executive staff viewpoint. She believes that change should be compliant with a theoretical framework, planned and executed by a mix of talents, and implemented in stages.

References

Abernethy, A., Gippetti, J., Parulkar, R., & Revol, C. (2017). Use of electronic health record data for quality reporting. Journal of Oncology Practice, 13(8), 530-534. Web.

Bhuyan, S., Bailey-DeLeeuw, S., Wyant, D., & Chang, C. (2016). Too much or too little? How much control should patients have over EHR data? Journal of Medical Systems, 40(7). Web.

Eisenhower Health. (n.d.). About us. Web.

Jabbar, S., Ullah, F., Khalid, S., Khan, M., & Han, K. (2016). Semantic interoperability in heterogeneous IoT infrastructure for healthcare. In 6th International Conference on Information Society and Technology (80-85). Kopaonik, Serbia.

Kruse, C., Kristof, C., Jones, B., Mitchell, E., & Martinez, A. (2016). Barriers to electronic health record adoption: A systematic literature review. Journal of Medical Systems, 40(12). Web.