Managers, the Link Between EHRs & Effectiveness

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 - Julia Adler-Milstein, PhD
Julia Adler-Milstein, PhD

IT is a just a tool. It takes people to make IT effective. In complex organizations such as hospitals and healthcare systems, good or bad management may make or break adoption of EHRs. That was the hypothesis that researchers tested in a recent study.

Julia Adler-Milstein, PhD, a health policy and management researcher at the University of Michigan in Ann Arbor and the study’s lead author, discussed their findings with Cardiovascular Business.

How did you get involved in this research area?

JA-M: I became interested in health IT and the potential impact it could have on the healthcare system over a decade ago when I was working at the Center for IT Leadership at Partners HealthCare in Boston. It was a small think tank group that was trying to quantify the value that could be realized from nationwide adoption of healthcare records and CPOE [computerized physician order entry].

It was at a point in time when these systems were not widely adopted. It was a formative experience because I started to recognize the power of these systems to transform and improve care but also how hard it was going to be to actually do that. The technologies in and of themselves weren’t going to cure diseases or improve care. They had an important role to play but a lot of other things had to fall into place.

What made you think about looking at management?

It came from the growing number of studies with a consistent relationship between EHR adoption and improvement in performance. It sets up the natural question of under what conditions would we expect EHRs to improve performance.

EHR adoption is an incredibly complex change management undertaking. There is the technology side of it but that is only a part. You need to be skilled at helping people change their behaviors, their workflows and everything else. That would take good management.

It was a combination of talking with a lot of people on the front lines of EHR implementations and evidence from other industries that had shown strong relationships between good management and effective IT. If this matters in other industries, then it is likely to matter in healthcare.

It often is said that healthcare differs from other business models. Would you agree?

There certainly are differences. When I think around this domain of effective use of IT, it is harder for me to argue that the things that make information and information technology valuable in other industries will not be true in healthcare.

Some of the market pressures are different in healthcare. But when we talk about infrastructure and tools, I don’t think that argument holds as much water. Having good data is valuable no matter what industry you are in.

Does hospital management differ from management in other industries?

There is a common set of good management practices that are true of all settings but there are particular challenges in healthcare settings. Your frontline staff are extremely skilled experts who have received a lot of training. You don’t usually see that in many other industries.

There also may be schisms between the two sides if they don’t interact that much.

That is one of the theories in our paper. In those well-managed organizations, those administrators have figured out how to build a strong bridge to frontline clinicians. In organizations where that is not happening, probably EHR adoption is perceived as much more of top-down. ‘We are being forced to use the system and we don’t want to.’  It shouldn’t be surprising that there aren’t gains from that scenario.

Did the interviewers ask specifically how the EHRs were being used?

When they collected the data they weren’t even thinking about connecting it to the EHR piece. One of the things that is fascinating to go back and do now is to take well-managed and poorly managed organizations and ask exactly that question. Try to figure out if we can more precisely point to what is happening differently in organizations that are well managed vs. not, specifically with respect to EHR use.

In the paper you talk about four different areas: operations, performance, target setting and talent management. Are all of these equally important in this context or is there one that stands out?

I think they are all important. Some of the process pieces may lend themselves a little bit more to EHRs because you could imagine that one of the things that EHRs are good at is instituting some type of process control. That might seem a little more relevant than talent management.

Even there,