One person, one record: How the right approach to clinical information systems can transform health care for all

Over the last several years, health-care organizations across Canada have made major investments in clinical information systems (CIS), which are key to delivering on the vision of having one person with one record by making health information easily and comprehensively available across the system. These investments are laying the foundation for years of potential improvements across the system and are critical to realizing the important health-care goals outlined in the Quintuple Aim: improved population health, enhanced experiences for both patients and providers, reduced costs and greater health equity.

While the benefits are important, CIS implementations can also create challenges, including significant costs, risk of low rates of adoption and organizational and health-care service delivery disruptions. But there are opportunities to address these challenges, which we’ve been exploring through our work with organizations across North America as well as during a panel discussion with two health-care chief information officers currently leading some of the most ambitious CIS transformations in Canada. Below are four of the key takeaways from the panel discussion and our work with organizations on these transformation programs.

1. Securing organizational buy-in 

CIS implementations are less about the technology and more about changing the delivery of health-care services. This means they require buy-in from both clinicians and patients.  This can be difficult to secure without the following:

• change management as a critical component at every step;
• visible executive sponsorship and alignment with organizational strategic objectives;
• collaboration among different stakeholders to collectively plan and deliver the system; and
• empowering end users to make important decisions. 

2. Managing costs and funding

CIS implementations are large undertakings with significant financial and human resource requirements, with some organizations spending hundreds of millions of dollars (although the number may vary based on the number of sites and other features). While most organizations see some savings from phasing out disparate clinical systems, the initial funding needed to implement a high-functioning CIS program is still quite high. Here are some opportunities to address this:

• If you’re a small- to medium-size hospital system, consider partnering with others to defray the one-time implementation costs and ongoing operational requirements. A number of organizations in Ontario have done this successfully.
• Make sure the business case has considered the system’s alignment with the organization’s long-term strategic objectives.
• Explore alternative approaches to evaluating the available funding and financing options. Consider, for example, the approach of one organization, which was able to combine government funding with money from operational budgets by prioritizing the program and delaying other initiatives.

3. Ensuring the right patient experience

Patient experience is key to any successful CIS implementation, especially when people are navigating a system that all too often treats them as a new patient each time they access care. Organizations will also need to make sure patient quality and safety remain the central focus of the transformation program. Here are some ways to do this:

• establish a patient advisory committee involving patients and patient advocates to seek their perspective, challenge the status quo and participate in solution design;
• establish patient safety, quality of care and experience as key drivers of the transformation and decision making; and
• consider self-serve capabilities that let patients access data, communicate with their care providers and complete pre- and post-surgery information checklists and surveys.

4. Realizing the benefits

Organizations are eager to quickly realize key benefits of a CIS program, which include improved patient satisfaction, fewer errors as a result of using barcodes to administer medication and time savings through the use of decision support tools. But many organizations think about the benefits at the end, when it’s very difficult to articulate and measure them without a benchmark. This is why it’s important to consider the benefits up front and then use them as a lens for all critical decision making.

Here’s what you can do:

• Consider quantitative and qualitative benefits, as well as how to measure them, in the solution design and, following that, as a part of subsequent upgrades and enhancements. This serves as a reminder of the value proposition.
• Make sure stakeholders, such as clinical staff, are clear on the benefits for patients and themselves. This is especially important as many organizations have been able to keep existing systems working and available for staff to use.
• Operational benefits should be owned and driven by operational leadership, including clinical leaders.

Optimizing outcomes

These are just some of the key considerations for health-care organizations implementing a new system. To optimize outcomes, it’s also important to consider other elements of the journey, such as:

• Interoperability, integration and consolidation: Whatever system you create will eventually need to integrate with the larger health-care ecosystem. You’ll also need to consider important issues related to sharing information, such as privacy and security.
• Infrastructure Improvements: It’s important not to underestimate the overall infrastructure improvements required for the CIS program to be functional. This could be as high as 30% which, if not considered up front, can eliminate contingency budget.
  
• Ongoing governance and operational IT budget: Launching your CIS program is just the beginning of the overall journey to a better health-care system. Make sure you allocate the operational budget required for continued evolution to ensure a well-governed, safe, secure and high-performing system that provides ongoing clinical and organizational benefits.
  

A comprehensive framework for health-care transformation

Through our work helping organizations manage complex clinical transformation projects, we’ve seen how powerful the outcomes can be. For those looking to make the most of the opportunities for their organization, we’ve developed a comprehensive transformation risk and advisory framework that covers the full life cycle of a CIS project.

Our experiences supporting a number of academic and provincial health-care organizations using this framework have shown how the right approach to CIS implementation can help deliver on the important goals of the Quintuple Aim. To learn about the possibilities for your organization, please contact us any time.