Unlike the user, the customer is always right

Adirondack Medical Center's private practitioners didn't just ask for a new electronic health records system in early 2004, "they demanded it," according to Mike Kelly, CIO of the $83 million US-based healthcare network. Composed of an acute care facility, two long-term care facilities and numerous outpatient facilities, AMC services 50 private practitioners who either care for patients or refer patients to the organization's services.

One of the primary goals of AMC's EHR system is to share patient information across New York's 26 regional healthcare facilities in a secure, HIPPA-compliant manner. Electronic patient medical records may include reports on past diagnoses, surgical procedures, imaging studies, allergies, drug histories and laboratory test results. By providing doctors with greater access to this information, AMC's goal is to ensure that physicians can provide patients with care appropriate to their conditions and that the delivery of this care is accurately recorded and preserved.

On this last issue, Kelly says that "Our physician community is justifiably concerned that in order to be paid for their services in the future, they're going to have to provide greater documentation that they actually delivered the services that they claimed to provide."

But while it was clearly time for AMC to graduate from its antiquated system of paper charts and place patients' medical records on their physicians' laptops and desktops, Kelly and his IT department knew the transition wouldn't be easy. Although AMC's physicians were "eager adopters of medical technology," Kelly was also aware that his customers -- those same physicians -- were a notoriously demanding group and jealous of their time and that it would be a hard sell convincing them that enduring stringent HIPAA-mandated online security measures would be worth their trouble.

"Our physicians viewed authentication, backup, permissions and access control as nuisances designed to aggravate them and slow them down," Kelly says.

Rather than fight a lonely, uphill battle, he developed a number of strategies to garner support. For starters, he held regular meetings with AMC's medical staff to involve them in the decision-making process on everything from software and hardware purchases to ISP and networking selections. In this way, Kelly sought to reduce potential friction and encourage a sense of collective ownership of the project. Next, he hired a project manager with extensive physician office billing and management experience to lend expertise, credibility and an objective voice. Finally, the IT department held training classes for end users, including hospital sponsor meetings, at 7am or at 5:30pm to accommodate the physicians' schedules.

"Our physicians now understand that IT projects are very complex and very time-consuming," Kelly reports, "and, as a result, they've become our biggest fans."For good reason: since introducing the EHR system last year, some of AMC's private practitioners reportedly have been able to treat an average of five additional patients a day -- 20 additional patients a week. By tracking patients' visits electronically, AMC has managed to cut the time it takes its many of its physicians to be reimbursed by 20 per cent. And plans include building a patient portal (scheduled for a 2009 release) so that patients can take a more active role in their health care choices.

Making the Change

While no strategy -- whether it's getting ground-floor support, forging alliances or collecting feedback -- can fully prepare a CIO for the rigors of a customer-focused IT undertaking, or guarantee its ultimate success, understanding the nature of the beast can make a huge difference.

AMC's Kelly, for example, knew that physicians won't stand for being dictated to. Columbia Business School's Peters understood that implementing anything for a group of academics was as much about managing their expectations as it was about devising an implementation plan, no matter how sophisticated. IT accomplishments in higher education are often measured by alumni support and school spirit -- customer satisfaction -- not simply by dollars alone. "The returns we get are very different from a corporation," Peters says.

In all cases, however, CIOs who are embarking on customer-facing projects need to remember something no businessperson ever forgets: the customer is always right.