Are we systematically failing health information technology's potential for implementation in healthcare?

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Over the past 7 years I have spearheaded, been a participant in or consulting on numerous initiatives designed to improve health outcomes. More recently our teams have sought to leverage health information technology tools such as clinical decision support, obtaining data for evaluation from our Epic EHR, and optimizing best practice alerts and other information technology solutions. While our intentions are good I have found that failing to spend the time upfront in designing meaningful interventions often leads to unnecessary challenges and even failures. As in meaningful use, implementations seem to often fall flat, not just because of lack of champions or executive sponsorship but seemingly due to a failure to appropriately PLAN the implementation. Building relationships and listening to stakeholder input is a slow yet necessary step. It can be a particular challenge when there occurs in parallel a push from leadership to meet certain timelines often driven by misaligned external incentives. This leads to a rush to throw resources at the problem to speed up implementation without taking into account behavioral factors-after all execution involves actual people and the desire for them to change or DO something. The pre-implementation planning phase when done rigorously and with enough lead time can virtually ensure success.

I have led or been a key participant in several formal research studies as well as less formal health systems implementations using implementation science. While there are similarities with quality improvement or the IHI Plan-Do-Study-Act-Model , which leverages rapid experiments and analysis to "try out" various solutions, implementation science is based on a conceptual framework that aims to take evidence based interventions and adapt them to the local context, thereby "ensuring" success. This is a bit contrary to the one size fits all approach touted by so many IT and other leaders to maximize efficiency-in reality careful planning pre-implentation (looking at workflow, engaging stakeholders, identifying champions, addressing potential barriers and facilitators) is CRITICAL to successful implementation of evidence based practice. Time spent up front actually saves time on the back end. But how to get leaders to recognize that and deploy the resources needed?

In many initiatives focusing on process metrics alone throwing one solution at the problem in a one size fits all approach leads to wasted time, duplication of resources, lack of engagement and wasted time and money. This in turn leads to more stress for management and accelerates burnout in healthcare due to lack of engagement and input of clinicians into their workflow and patient relevant outcomes and indeed may not be congruent with the actual patient EXPERIENCE. And many would argue the EHR aggravates this rather than fostering potential solutions. For tackling complex problems such as how social determinants of health impact goals, I found this article insightful and also to demonstrate the effort that needs to go into assessment prior to implementation.?Time is money, or is it? I welcome comments on what solutions have worked for others to improve patient care and engage both leadership and practicing clinicians.

Theis RP, Blackburn K, Lipori G, Harle CA, Alvarado MM, Carek PJ, Zemon N, Howard A, Salloum RG, Shenkman EA; UF CTSI Learning Health System Program. Implementation context for addressing social needs in a learning health system: a qualitative study. J Clin Transl Sci. 2021 Aug 31;5(1):e201. doi: 10.1017/cts.2021.842. PMID: 35047213; PMCID: PMC8727713.