We might as well get started on the right foot…
When a project begins we do our best to be transparent about what needs to be done. At its heart, a project can be defined in simple terms: • Kick-off • Analysis • Design • Implementation • Go Live • Fine Tuning & Maintenance
The Kick-off tends to be a description of what we’re all doing as a project team, how we’ll do it in general terms, and what management expectations are so we can achieve them. Hopefully each team member will receive some of the value that comes out of the project.
This is all fine and dandy; additionally, it’s good to pay attention to some of the human aspects involved in working with a team. Sometimes the personalities we work with are just as important as all the other aspects of the project combined because these personalities shape the project. If we get off on the wrong foot and people act like people will, copping resentments, jumping to conclusions and hiding their secret agendas, man, are we in for a wild ride. These sorts of human behaviors can derail a project quickly and efficiently or drag it on into a miserable experience.
How do we avoid these behaviors? We try our best, and in the end, who knows? The proof is in the pudding. Here are some ramblings and a plan I use to help form a group of individuals into a team.
Most of the old hands at running projects have been battered by the consequences of a lack of transparency. If the entire team is not forthcoming about details, like a key software user being just plain resistant to change or a manager not seeing enough value in what we’re doing for a big enough payoff, the project could be doomed to fail. Projects are a lot of work, and it’s good to know they will be worth the effort. Sometimes, if difficulties arise and a project fails, management will decide to try to implement the software again a couple years later. If the same people are involved and their issue is not resolved up front, trouble re-surfaces.
It’s good to get to know the people on the team and their issues early in the project and face those issues in a transparent manner with the rest of the team; no blame, no subterfuge, just honesty. There are a number of ways to do this, and a guided conversation has been effective for me in the past…perhaps not every time, but it sure breaks the ice and hopefully team members know what they have to say is being heard. I like to use an interactive diagram that lists key points like these:
• Restate the Goals and Objectives This helps get everybody on the same page. These are team goals. Sure, individual members will have goals that should be heard and accounted for and some of those will be added to the initial list.
• Initial Observations These could be about anything…maybe somebody has a better idea than one that’s been stated as part of the team’s focus.
• Value Statement Get a handle on the value that will come out of the project and get it down on paper or in some electronic document like a project plan; team members will likely see different value points depending on their perspective. This can be the beginning of defining a payoff for each team member.
• Benefits Talk about the benefits of the project…after all somebody should be getting something good out of all this work. I try to get folks to talk about the payoff a lot.
• Concerns What could go wrong? Where are the stumbling blocks? There are a thousand questions that could be asked about concerns. A bit of advice, though, discussions about concerns can swing into a negative vein, so it’s usually good to ask for solutions to the concerns.
• Next Steps In addition to the project plan, add in some next steps that are a result of this exercise that could be beneficial to the outcome of the project. Oh, and that helps fine tune the Project Plan, which we’ll discuss another time.
The point of this exercise, I think, is to encourage team members to speak up, offer solutions, and if their solution is accepted – Yay! If their solution is not accepted – Eh.
If team members agree on most of the topics above, they’re likely to participate in the Next Steps with some enthusiasm, and the less-than-stellar solutions have a tendency to fall a bit flat, even with the person who brought it up. The key is to briskly complete the current objective and move to the next step until we meet the goal. Perhaps the process described above helps us start out on the right foot.
That makes me wonder about that old saying…what if you’re left-footed?Read more →
Oh boy. Another gizmo for the Electronic Health Record (EHR).
Actually, I like digital gizmos, especially when they have a practical application. At first glance, the Digital Pen in use with Next Step Solutions has a fit in the Behavioral Health Electronic Health Record landscape(EHR).
Next Step is interesting because variations of the software serve small private practices for one to three professionals, mental health clinics, and even state psychiatric hospitals. They even serve physical therapy and long term care facilities. This sort of variation on a theme can be a great strategy to grow a software business and increase product’s flexibility, which can not only give the programming team a workout but also discover a market that was previously not discovered valuable. This diversity of products can also be tough to support if the manufacturer strays too far from the foundation of the software. That said, when I first got into this business the company and software product I worked with served mental health departments, occupational therapists, even chiropractors, and eventually methadone clinics…we managed just fine.
In particular, Next Step’s (EHR) is worth a look by Mental Health Professionals in private practice and small offices. Most of the inquiries I receive about software are from professionals in these small environments looking for EHR options. And the presence of their Digital Pen functionality is intriguing. If it’s not in use in these smaller environments, I’d bet it soon will be.
The website says the Digital Pen is in play for Long Term Care facilities, but I talked with the folks at Next Step, and they indicate some facilities in Florida Mental Health treatment are successfully using the product…It’s hearsay, but yup, that’s what I heard.
It’s a forms-based approach to the EHR, and some professionals thrive with that approach, making it work in a world that places high value on a process-driven, workflow attentive method of doing business. Forms can still gather the same information, and depending on the software design, can incorporate previously gathered information as well as pass it along to other aspects of the EHR. As long as the implementation of the software follows workflow wisdom, the value of the EHR using data that’s entered one time is still captured.
It’s a fact of life that more than a few professionals in the business of mental health and addictions treatment have an aversion to computers. If there has to be a record, they prefer paper. Whether it’s fear-based, or a belief computers are impersonal or just a dislike of typing, reasons are less important than the solution: they prefer paper.
The Digital Pen is a panacea for these folks.
Mechanically, the professional can sit with the consumer and fill out the paper form they are used to, and a tiny camera in the pen records what’s written for later upload to the computer. It’s that simple. For professionals who’ve been filling out forms on paper, then struggling to enter the data into the computer, step two is replaced with a simple upload of data.
Reducing this technology to its simplest level, the Digital Pen records the coordinates on the paper form where the professional checks a box, enters a date or writes a character then the coordinates are sent to the computer to complete the document in electronic form.
One key aspect of this process deserves a note: In order to upload the pen’s recorded form to the computer, there needs to be an electronic version of the form in the computer in the first place, and the way it gets there is by using the software’s development tools. This means you need somebody on staff to use the software’s form designer features, or to hire somebody like yours truly to maintain and extend the forms library…it’s usually a minor effort or expense, and nevertheless, something to remember.
In the end run, the Digital Pen tackles a reality that a lot of us software professionals can sometimes ignore. A significant number of professionals avoid the EHR, and the reasons are personal. The Digital Pen might be a solution to bring them into this brave new world of electronic records.Read more →
The incredible shrinking computers have invaded!
Computers are everywhere, and we use them without even thinking about it. I bought a new smart phone recently, and it came in three sizes, small, medium and large. Microchip technology has come into play in physical health care. Tablet computers are everywhere. I shudder to think how many small computers are in a new car, appliances, even alarm clocks. But where’s the value in Mental Health and Addictions Treatment?
Is smaller really better?
Let’s go back to that smart phone. Professionals can receive automated Emails on their smart phone from their Electronic Health Record (EHR) telling them to log into their system to find out which patient needs help NOW. In a world where a consumer with a problem can wait weeks instead of hours for an appointment with a mental health professional, the value of this sort of instant attention-grabber is obvious. You can get that on the small model smart phone, and for that purpose, smaller is better.
I manage my calendar on my smart phone. For a professional who wants to do the same, the EHR can send a calendar event that’s been scrubbed clean of patient information; this integrates the updated professional staff scheduling information on the smart phone with the EHR. The calendar works for me on my medium size phone, but I wouldn’t want to try this on a smaller phone with my clumsy fingers.
I read a lot. I use Kindle software on the medium size phone and it’s OK, not fabulous. I take a lot of photos and they display OK, but quite tiny. This feature functionality would be better on the large sized phone (which doesn’t fit in my pocket well) or fantastic on a tablet computer (which feels like lugging too much around and could get “lost” on the New York subway).
I recently accessed a customer’s EHR on my medium size phone to sign a document…it worked, but not very well. For running an EHR in the field, I wouldn’t want anything smaller than the mini-tablet.
The coolest small thing to come down the pike in the past decade or so is the advances in microchip nanotechnology, and I recently received an article discussing how this marvel can help diagnose Type-1 diabetes. What if mental health and addictions could use the same technology?
Misdiagnosis of schizophrenia as something like Asperger’s Syndrome or depression or bipolar disorder, while probably not common, does happen…what if nanotechnology could be employed to validate diagnosis? We already know that chemical changes in the brain accompany disorders like schizophrenia; a device for use in the field to test blood or saliva that provides proof of diagnosis could help professionals deliver better care to consumers.
There are a number of smart phone apps available to monitor moods and activities, and these are promoting the use of smaller devices to accomplish a mental health goal. This technology is currently in play, so what can we expect in the future? Perhaps we’ll see a watch that monitors chemicals in our sweat and triggers an alarm when moods or physical cues indicate the onset of certain behaviors.
Every so often we see a new “cure” for addiction surface. How about using nanotechnology to silence DARPP-32, the brain protein that facilitates addictive behaviors. It’s being discussed and could hapen
The point of using technology like this and the EHR in mental health and addictions is to deliver improved diagnosis, treatment, documentation and outcomes to treatment, and all this technology is getting smaller and more portable.
Think small.Read more →
I’m no professional, but I’d say prioritizing can make or break us in mental health and addictions treatment.
OK, so my work as an Electronic Health Record (EHR) Consultant has a very professional aspect, but I’m not a mental health and addictions treatment professional. We all have priorities, but it seems to me that the mental health and addictions treatment professionals’ priorities are likely to be based on criticality and probably carry more weight in the grand scheme of things than an EHR Consultant’s.
Let’s look at a day in the life of a sample mental health clinic. Our sample professional can be faced with priority list of tough choices about a whole caseload of consumers, and in the moment talking with a consumer who is experiencing suicidal ideation; this case creates its own ever-changing list of priorities. Simultaneously, the Chief Financial Officer (CFO) of the organization has a stake in our sample professional’s priorities for the day. The CFO’s priority is in making sure the professional’s work gets paid for with the highest rate of return. Yet another item in this day would be passing muster with audits in order to keep the money once treatment has been delivered and the bill paid to that professional, a situation that deserves its own spot high on the priority list. Our sample professional is still concerned with her consumer, whose welfare remains the top priority, however, after that she will likely cooperate to assure the other two priorities are met. The CFO and auditor both maintain their number one priorities, too, which can seem like a conflict.
So, all the priorities are on each other’s lists, it’s a matter of perspective as to which item floats to the top. In the end, the entire team involved in this day-in-the-life description needs to agree on one set of priorities…what comes first and how much energy should be devoted to getting each item on each list of priorities done.
When it comes to the EHR implementation, these daily scenarios need to be weighed for organization-wide importance and ordered realistically on the organization-wide list. Without team cooperation, what’s best for the entire organization may fall to the wayside and priorities may change enough to run out of budget before the EHR is fully implemented. A team needs to be forged; flexible and intent on doing the most for the organization with the available budget. Some items will be left off the list because money tends to run short before work.
The mission of the EHR is to document consumer treatment, bill for it and account for where the money goes; the mission of an EHR implementation project manager is to configure, train, comment, cajole and lead all these people to a happy consolidation of priorities that will satisfy them all in the end – at least mostly. It’s a tough job, satisfying many masters in an ever-changing environment, and if we don’t get agreement on consolidation of priorities at the outset, our project may be doomed. Sometimes priorities are mismanaged and the job is left unfinished with users struggling with a partially implemented EHR.
How can that happen?
When software configuration is out of kilter or the software’s procedures don’t dovetail with the organization’s, there are a number of factors that can be affected. Discoveries of inappropriate design and configuration come up during implementation and if the project manager and team aren’t responsive and willing to negotiate priorities, it leads to unexpected development costs. Sometimes the perfect solution is sacrificed for the good-enough solution.
Because difficulties like these are ignored, too many EHR implementation projects have been left incomplete, and that hurts the EHR manufacturers’ reputations, as well as hurting the professionals and support people who rely on the software to inject some efficiency into the flow of their work. A solid consolidation-of and agreement-upon priorities is the first step, and to avoid leaving a project unfinished, a balancing act comes into play. The team needs to stick to their guns and implement according to the original consolidation of priorities as closely as possible. When that goes off-track, the project usually requires more time, work and resources to live up to changing priorities OR some items on that priority list are dropped off with a plan to address them later (complete with a scheduled date)
I recently encountered the effects of an extensive issue where consolidation of priorities was not well done and consequently ineffective. In the Mental health and addictions treatment world, the number one reason not to use the EHR is a lack of “user friendliness”, which can mean about anything you want it to mean. Some of the project was completed, but not all. Managing schedules for consumers and professionals was left incomplete. Billing and posting payments was left about half done.
Consolidation of priorities to even make the implementation work for a team like the one described above was ineffective…gotta keep on top of that.
We want our highly skilled professional team described above to stick around, so configuring and implementing the software with “user friendliness” in mind becomes imperative. Since our EHR wasn’t implemented and managed to meet a set of negotiable, consolidated priorities, the list may have been unrealistic for the budget. The team may not have had a realistic appraisal of the number of man hours required for the job, or explosive growth may have gobbled up a bundle of the team’s time that was supposed to be devoted to the implementation. Priorities were not met, plans to meet them didn’t get made immediately upon realization that was happening.
Consolidating priorities has to be a joint agreement among all the players and needs to be revisited and re-negotiated on the inside of the organization. There has to be some give and take and a clear view of what’s best for the entire organization. If reality changes the priorities, a new plan with an adjusted budget needs to be agreed upon and approved.
…Easy-peasy, right?Read more →