1 EHR and HIE Beliefs Assessment

Section 1.7 Assess

EHR and HIE Beliefs Assessment

Use this assessment to help understand your facility’s readiness for adopting an electronic health record (EHR) and health information exchange (HIE). Understanding early beliefs can help with effectively educating, planning, engaging staff, and training.

Time needed: 15 minutes to complete survey, 8 hours to assess survey results Suggested other tools: NA

1. How to Use 2. Once you have introduced the fact that your facility will be adopting EHR and HIE, distribute the survey below (on paper – to ensure that those who are resistant to using a computer have a voice) to all staff and psychiatrists. Even though some of these persons may not use EHR or HIE, they may do so later or be affected in other ways. Seek responses within one week. If many people will be missing during the week, select a different week. If you have a low response rate, extend the deadline by a week. 3. Do not circulate the interpretation of results as part of the survey. You will use the interpretation information to help the HIT steering committee and organizational leadership understand the results. You may then share other forms of the results with the entire community of respondents. 4. Once you receive all surveys back, tally results. For small organizations it is best to not categorize respondents. If the facility is large enough, you may want to distinguish between administrative staff or professional staff/psychiatrists. Record results using the form below (one form for each category. If you have more than one facility, you may want to tally by facility as well. Record the number of respondents and the percent responding from all potential respondents in each category. For example, if you have 12 therapists and receive seven responses, that is a 58 percent response rate. The response rate is a quick way to assess level of interest. 5. The structure of the questions is designed to prevent selecting answers in only one category (e.g., all Agree). Some statements are written in a manner that agreement might be considered a negative; other statements are written so agreement might be a positive. Agreement may be a risk factor (denoted by red), a cautionary area (yellow), or a strength (green). 6. Once you have tallied all responses, identify how many statements are in each of the risky, cautionary, and strength areas. If many statements reflect risk, this obviously indicates a high overall risk. In this case, your challenge is considerable education and careful planning. A small number of statements with risk generally indicates overall interest and comfort with HIT—and the areas of risk can be relatively easily targeted in your educational activities. 7. Use the information about each statement within the Interpreting Results information below to initiate discussion in your organization. Plan what you will do for each area of risk.

Section 1 Assess—EHR and HIE Beliefs Assessment- 1 10.EHR and HIE Attitudes Assessment

This assessment will help us understand the facility’s readiness for adopting EHR and HIE technology. At this time, you may not be fully knowledgeable about what is possible with EHR or HIE, but understanding early beliefs can help effectively plan and provide the right education to all.

11.Instructions Please complete this survey and return to: ______by: ______. Indicate the facility at which you are based:______Indicate your position by checking the appropriate box. If you perform more than one function, check only the ONE that consumes most of your time:  Administrative/operations staff  Professional staff or contractors Concerning EHR and HIE, check the column that most closely describes how you feel about each of the following statements: Strongly Agree Neutral Disagree Strongly Agree Disagree 1. EHR and HIE increases overall efficiency. 2. Computerized alerts and reminders can be annoying. 3. Our clients and/or their families likely are expecting us to use a computer for their records 4. EHR and HIE will improve my personal productivity. 5. EHR and HIE are difficult to learn how to use. 6. Use of EHR in front of clients is depersonalizing. 7. EHR is not as accurate or complete as paper records. 8. EHR and HIE improves quality of care and client safety. 9. Once all documents are scanned into the system, we will have a complete EHR. 10. A first step toward a successful EHR and HIE is addressing workflow and process changes. 11. We are in an age where we must exchange data electronically with others. EHR and HIE help us do this. 12. Behavioral health is too complex anymore without access to clinical decision support provided by EHR. 13. EHR and HIE are not as secure as paper records. 14. We cannot afford EHR or HIE. 15. EHR can have unintended consequences if we don’t apply professional judgment in its use. Copyright © 2014, Margret\A Consulting, LLC. Used with permission of author.

12.Results Form for (Identify position, and facility as applicable) Record tally of number of responses in each category. Calculate percent and record as well. One example for an organization with 88 respondents, representing all possible respondents is provided in italics below.

Concerning EHR and HIE, participants checked the Strongly Agree Neutral Disagree Strongly column that most closely describes how they feel about Agree Disagree each of the following statements: 1. EHR and HIE increases overall efficiency. 30 40 10 0 8 (34%) (45%) (11%) (10%) 2. Computerized alerts and reminders can be annoying. 3. Our clients and/or their families likely are expecting us to use a computer for their records

2 4. EHR and HIE will improve my personal productivity. 5. EHR and HIE are difficult to learn how to use. 6. Use of EHR in front of clients is depersonalizing. 7. EHR is not as accurate or complete as paper records. 8. EHR and HIE improves quality of care and client safety. 9. Once all documents are scanned into the system, we will have a complete EHR. 10. A first step toward a successful EHR and HIE is addressing workflow and process changes. 11. We are in an age where we must exchange data electronically with others. EHR and HIE help us do this. 12. Behavioral health is too complex anymore without access to clinical decision support provided by EHR. 13. EHR and HIE are not as secure as paper records. 14. We cannot afford EHR or HIE. 15. EHR can have unintended consequences if we don’t apply professional judgment in its use. Date Completed: Total Strength: Caution: Risk: 80% 11% 10% Highlight or circle the statements above where responses indicate most risk factor for agency. Copyright © 2014, Margret\A Consulting, LLC. Used with permission of author.

13.Interpreting Results Use the following information to initiate discussion of your findings: 1. EHR and HIE increases overall efficiency. Behavioral health facilities have many ways to become more efficient through greater access to data, more complete and legible documentation, and reduction of rework. Agreement with this statement is healthy, although interpretation must be coupled with an analysis of the response to statement #4. Many people believe in overall efficiency, but won’t accept changes for personal productivity gains. Disagreement with this statement may require you to give more specific examples of EHR and HIE functionality and more thorough expectation setting. 2. Computerized alerts and reminders can be annoying. Provision of alerts and reminders is an inherent, but not the only, part of clinical decision support. Too many alerts can be annoying, but none defeat the purpose of EHR. A balance of agreement and disagreement may reflect the appropriate skepticism for finding just the right level of alerting. Strong agreement with this statement may demonstrate resistance to change; strong disagreement, however, may be unrealistic. 3. Our clients and/or their families likely are expecting us to use a computer for their records. Many more clients and/or their family members have used or use computers than health care delivery organizations give them credit for; and an increasing number of these may wonder about how well their clinicians are keeping up to date if they are not using computers. Agreement with this statement also recognizes that clients have an important role to play in their personal care.

Section 1 Assess—EHR and HIE Beliefs Assessment- 1 Disagreement with this statement identifies the need for managing change in staff members and clients. 4. EHR and HIE will improve my personal productivity. Setting realistic expectations about productivity is important. Many new users have heard that using a computer takes longer; others expect to see great time savings. Strong agreement with this statement may reflect unrealistic expectations. Agreement is the desired state. Disagreement with this statement may signal the need for education. 5. EHR and HIE are difficult to learn how to use. Some skepticism about the difficulty of learning to use EHR is healthy; being overconfident (strong disagreement) of one’s ability to learn to use EHR and HIE can actually work against its adoption. Even if some professionals may have used EHR or HIE at another facility, they will still have a learning curve with any new EHR. Any of the middle-of-the-road answers to this question are generally considered a good sign of readiness. Strong agreement may be evidence of resistance to change. 6. Use of EHR in front of clients is depersonalizing. Use of EHR at the point of care is essential to gain quality, safety, and efficiency value. Studies demonstrate that the perception of depersonalization is a professional perception not shared by most clients. Agreement with this statement signals that professionals may not be confident in their computer skills or generally resistant to change. New forms of communication with clients may need to be introduced. Role playing is a good strategy to overcome this concern. 7. EHR is not as accurate or complete as paper records. This concern has arisen because unintended consequences with EHR have occurred (see also statement #15) and as a result of how different the output of EHR may be in relationship to the paper record. Agreement with this statement demonstrates potential resistance to change, as well as the challenge for educating not only about what is possible to accomplish with EHR and HIE but diligence in viewing EHR and HIE as tools—not substitutes for the professional. Care also must be taken to ensure that documentation improvement and data quality auditing normally done with paper records is not eliminated in the electronic environment. 8. EHR and HIE improves quality of care and client safety. A primary purpose of EHR and HIE is to improve safety and quality of care. These are essential goals and, if not recognized, could be an issue in gaining adoption. However, EHR and HIE alone do not improve safety and quality of care, so strong agreement could signal unrealistic expectations. 9. Once all documents are scanned into the system, we will have a complete EHR. This belief arises because many behavioral health professionals are reluctant to give up narrative note taking and view the EHR as an automated form of the paper record. Unfortunately, most find that scanned documents are more difficult to retrieve than paper charts. Most importantly, they do not generate clinical decision support. Agreement with this statement suggests a narrow view of what constitutes EHR. 10. A first step toward a successful EHR and HIE is addressing workflow and process changes. Agreement with this statement represents a strong understanding of EHR and HIE and willingness to change. The vast majority of EHR and HIE failures have come about because workflow and process changes were not attended to. Disagreement puts the organization at high risk and must be addressed through leadership commitment to the time and resources needed to address these changes. 11. We are in an age where we must exchange data electronically with others and EHR and HIE help us do this. Cautious optimism might be the best response about exchanging data electronically. EHRs still face interoperability issues. HIEs are much newer to the industry than EHRs and the

4 functionality necessary for their effectiveness is still being worked out in many areas. Disagreement suggests resistance to change. 12. Behavioral health is too complex anymore without access to clinical decision support provided by EHR. Improvement in quality of care is probably the primary long-term benefit of EHR. Disagreement with this statement may suggest that current quality issues are not recognized, or suggest a lack of appreciation for EHR functionality. 13. EHR and HIE are not as secure as paper records. EHR and HIE can be made more secure than paper records if policies about security access controls, audit trails, and proper encryption utilization measures are adopted. Disagreement with this statement suggests need for education about computer security and commitment to policy enforcement. 14. We are not able to afford EHR or HIE. A healthy skepticism about cost is important. Strong disagreement suggests an unrealistic view of resource requirements; strong agreement may be used as an excuse not to acquire an EHR or participate in HIE for other reasons. 15. EHR can have unintended consequences if we don’t apply professional judgment in its use. A number of articles have recently described problems with unintended consequences of EHR. Virtually all of the articles—or at least responses to the articles—have recognized that in large measure the results have come about because of lack of attention to workflow and process design, or because of reliance solely on the computer rather than also professional judgment. Copyright © 2014, Margret\A Consulting, LLC. Used with permission of author.

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