By Gary Mooney, InterSystems
“People don’t buy features, they buy benefits” is a principle that resonated and stuck with me since I first heard it expressed by the brilliant Dr John Frain during my undergraduate studies for a combined honours Computer Science and Business Management degree.
Whilst this principle was directly referencing the sale of goods and services, for me, there is a direct parallel with the deployment of EPR and other digital solutions where end-users, predominantly frontline healthcare staff, are the consumers.
Whilst users are the consumers of the EPR, their currency is not monetary, but rather their time, effort, and motivation. And so, the deployment process of an EPR involves a significant element of selling the solution to consumers to convince them to invest their time, effort, and motivation on top of what are predominantly under-resourced and overworked clinical services.
EPR deployments that focus purely upon activities such as installation, configuration, training, and go-live run the very real risk of suffering poor user adoption and ongoing broader customer dissatisfaction. That detracts from the opportunity to implement continuous improvement and benefits/outcome programmes from the point of go-live.
This article shares some perspectives and experiences relating to building positive user adoption from the deployment of an EPR, or other digital solution. In doing so, it is also assumed for the purposes of this article that the solution being deployed reflects the functional and usability needs of healthcare services, and users (I appreciate therein lies a significant assumption!).
EPRs and User Satisfaction
Electronic Patient Record (EPR) solutions represent a significant investment in time, resource, and on-going budget expenditure for healthcare services. EPRs also promise to deliver improvements in service performance and establish the necessary digital foundations to support transformational models of integrated care that are required to meet the demands of modern society.
Whilst the functional capabilities are important, they alone do not guarantee the successful outcome for the deployment of an EPR. KLAS Research has reported research data that shows a widespread perception of EPR success for the same version of an EPR solution, with some organisations reporting significant benefits and outcomes, whilst others describe ongoing challenges and unhappiness with their EPR. KLAS Research data on the ‘Satisfaction Discrepancy for the same EPR solution’ shows a 62 percentage point difference in satisfaction between two organisations using the exact same EPR solution. [Source: https://klasresearch.com/arch-collaborative].
A key factor that plays a significant role in determining the perceived and actual value of an EPR relates to the extent to which it is seamlessly adopted by frontline staff to become a seamless and supportive tool, used effectively and efficiently to facilitate the planning, management, and delivery of care.
When an EPR is deployed and “done to” front line staff, this can result in significant adoption challenges from users that are likely to have a poor understanding of the solution value and what it means for their day-to-day duties. Whilst organisations typically have the authority to determine and demand the systems staff use, such approaches, particularly for complex organisational structures found within the UK’s National Health Service (NHS), have time and again proven to be problematic.
Meaningful User Engagement
User engagement throughout the deployment of an EPR solution is critical in being able to communicate the value of the solution and gather insights into the ideas, concerns, and expectations of users (the consumers) throughout this process. It is a well-established and critical element of a successful change management programme. However, engagement activities can at times be reduced to broad and generic programme updates, presentations, and in-person sessions that are in essence one-way communication events from the programme to the attendees.
Equally, user engagement during the adoption of an EPR solution should not be perceived by users as the opportunity to re-design software or radically change the functional behaviours – instead, the fitness for purpose of the service should have already been established during the procurement process. EPR programmes that get drawn into prolonged periods of system re-design run the very real risk of programme failure and/or significant cost and time overruns.
A well-developed user engagement plan should be tailored to reflect the make-up of the customer organisation and profile of the EPR solution being deployed, to provide a bridge between the functional capabilities of the solution and the day-to-day realities of end-users. A comprehensive engagement plan will at least cover the following seven aspects:
- Encourages Early Buy-In and Ownership
- By involving users early in the engagement process, they feel a sense of ownership over the solution being deployed (not re-designed!). When users feel their input matters, they’re more likely to champion the solution and become advocates, spreading positive feedback among their peers.
- Builds Trust and Addresses Concerns
- Continuous engagement allows organisations to address concerns proactively. For instance, healthcare providers may worry about data security or fear disruptions to existing workflows. Engagement efforts can provide clear answers and build trust, which is crucial for adoption in healthcare settings where stakes are high.
- Demonstrates Value through Feedback Loops
- Engagement plans that include feedback mechanisms help users see tangible results from their feedback, demonstrating the solution’s value. When users see how the solution is being configured (e.g., to mitigate priority risks / deliver workflow efficiencies) over time in response to their needs, it reinforces a positive user experience and increases the prospect of long-term positive adoption.
- Fosters a Culture of Change and Innovation
- A strong engagement plan can ease the transition from traditional to digital practices, making users more open to change. Encouraging a culture of innovation through regular communication, success stories, and peer recognition helps users become more comfortable with ongoing technological advancements.
- Provides Tailored Training and Onboarding
- Engagement plans that include tailored training can address specific needs and workflows of different user groups, enhancing comfort and confidence. Personalised onboarding helps users understand how the solution can directly improve their tasks, reducing resistance and accelerating adoption.
- Reinforces Continuous Learning and Support
- An effective engagement plan ensures that users have ongoing access to support and learning opportunities, which can prevent frustration. Regular check-ins, refresher training, and open communication channels help users feel supported, allowing them to fully leverage the solution.
- Measures Success and Identifies Improvement Areas
- Regular engagement helps track adoption rates, usage patterns, and user satisfaction, providing valuable data on the success of the solution. These insights allow for targeted improvements, ensuring that the solution continues to meet user needs and remains relevant.
Articulating Solution Value
The ability to articulate solution value to distinct groups of users, in-terms that resonate and have direct meaning for their day-to-day activities, is critical to supporting an effective user engagement programme.
Large-scale EPR and digital adoption programmes can often express value in relation to corporate-level benefits and outcomes – commonly those identified to support a business case. This can leave users to perform their own analysis to derive what these mean for their day-to-day, which may result in significant numbers not undertaking the analysis at all, or arriving at a partial or incorrect conclusion; all of which can present significant change management and user adoption barriers.
Persona profiles provide a valuable reference point for determining communications (content and format) with groups of healthcare professionals, to express solution value in terms that resonate with their professional responsibilities, whilst forming the relationship to be able to refine and define the value of the solution for their persona group. As such, persona profiles can provide a valuable tool in supporting the broader change management workstream and paving the way for positive user adoption from go-live.
A persona profile should, as a baseline, include the following aspects:
- Role Profile: a high-level summary of the persona role profile within the organisation, identifying any non-typical responsibilities for a role within a customer organisation.
- Goals and Objectives: The primary aspirations or outcomes the persona seeks. Aligning the digital solution with these goals ensures it meets their needs and adds value to their lives.
- Challenges and Pain Points: Specific problems or obstacles the persona faces. Identifying these allows the solution to address real issues, enhancing its relevance and effectiveness.
- Motivations and Drivers: The underlying factors that inspire the persona to take action, such as risk mitigation, efficiency, or effectiveness. Leveraging these motivations can increase engagement with the solution.
- Behavioural Traits and Technology Usage: Insights into how the persona interacts with technology, including their proficiency level and preferred devices. This information guides the design and functionality of the solution for optimal user experience.
- Preferred Communication Channels: The platforms or media through which the persona prefers to receive information. Using these channels promotes more effective communication and promotion of the solution.
- Persona Solution Pitch: The “elevator pitch” for how the value of the solution will be articulated to the persona considering the above factors matched with the functional capabilities of the EPR solution (but not in-terms of functions and features).
Identifying Your Strategic “True North”
A digital transformation programme on a scale represented by the deployment of an EPR solution, requires a clear and concise vision to define what the transformation is aiming to achieve. The definition of the organisation’s digital transformation “true north” is a critical foundation not only in shaping the EPR adoption programme, but also in informing an effective user engagement plan. The key ingredients of a Programme Vision that will help to communicate the programme’s “true north” are:
- Clear vision aligned with business strategy
- Patient-centric focus
- Leadership commitment and cultural change
- Technology enablement and innovation
- Data-driven decision making and clear metrics
- Stakeholder engagement and communication
- Risk management, compliance, and sustainability
Measuring Adoption
Having invested the time, effort, and resources to implement a user engagement plan, it is essential to have a means by which post go-live user adoption can be quantified and continually monitored as a bi-product of data derived from solution usage. The ability to quickly gain access to data insights relating to solution should be an integral requirement of the broader reporting/analytics capabilities of the EPR.
Figures 1 and 2 provide example illustrations taken from a library of solution adoption dashboards that enable an on-demand detailed analysis of solution usage in terms of discreet volumes, trends, workflows, activity, and persona profiles.
Figure 1 – Example solution adoption dashboard
Figure 2 – Example solution adoption dashboard
Whilst access to quantitative data is critical, the periodic collection of qualitative data from users is also an essential requirement to ensure that an accurate and insightful understanding of user adoption is maintained. End user surveys combined with planned observational studies can be effective approaches for the collection and analysis of qualitative data.
Summary
The positive and sustained end user adoption of an EPR solution is not only a key insight as to the success of a deployment programme; it is also mandatory if the EPR is to continue to adapt and evolve to maximise longer-term return on investment through the delivery of service and persona-level benefits and outcomes.
Key to this is a robust user engagement plan, which provides a strategic framework for fostering relationships, maintaining open communication, and ensuring that digital clinical solutions truly serve the end users’ needs. With consistent engagement, organisations can promote sustained adoption, higher satisfaction, and an overall positive impact on clinical workflows and patient outcomes.
Or in other words, and as Bananarama succinctly put it to music in the 1980’s: “It’s not what you do, it’s the way that you do it…”.
