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Today on Town Hall

We always call it end users, which makes it sound like, they're the last thing that we need to worry about they're really, where we need to begin our focus, what we call the last mile of change. It's kind of the last mile of the marathon, right?

It's really the most important part because it is the finish line, and if you don't get through that last mile, nothing really is accomplished.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare.

Alright, let's jump right into today's episode.

Welcome to one more episode of This Week Health. My name is Carla Arzola, and I'm the CIO at Rocky Mountain Human Services. Today's guest is Bobby Zahr, Vice President of Healthcare Strategy at UberForm, and we will be talking about the complexities and strategies of driving EHR and other health IT changes over the last mile rollout.

In this episode, we will explore how you perform in its health system clients successfully scale operations, streamline onboarding for new hires, provide continuous education, and communicate changes effectively across the organization. Bobby, welcome. How you doing today?

I'm doing good. You said a mouthful.

I know it's hard.

Yeah, but there's a lot of things that we want to cover and talk about, and we super appreciate you sharing this space with us. But let's start with an introduction. And why don't you tell us about yourself, you perform, and your role in the organization.

Thanks. Yeah, we've been around for 25 years now.

Got our start on the enterprise side with user adoption for technology. And the way we work is we embed ourselves inside the application because that's where users learn technology mostly is inside the application. I started, I was going, had a Epic Go Live And needed to be able to scale our training very rapidly and had no solution to do it as quickly with no resources as we needed to do it.

And that's where I found uPerform. That was 10 years ago. I became a user, loved it so much. advocated for it that four years ago, just prior to the pandemic, I joined the company. And we then began to focus on healthcare, especially in the EPIC space. But we do, now all applications across the tech stack.

So it's been a great journey and a great ride and heart for healthcare, so making a difference in the lives of clinicians and providers in the healthcare space.

That's great. Isn't that why we all are in this industry? we want to make a difference. But just let's jump into it.

definitely want to learn about some of your experiences and what you perform has done. So, you talk about your, experience your 10 years of experience of the organization. and why don't you walk us through what are some of the best practices that you have seen help your organizations apply to effectively manage EHR updates and changes.

When we talk about updates and changes there's a lot of things that happen when a vendor implement something like that. And they just provide you with a ton of documentation, and you have to probably vet what's important and impactful for the clinician.

So, what are some of the techniques or best practices that you've applied?

Yeah, before we get into the nuts and bolts we kind of touched on the why. And I really want to drive home the why. Why I'm so passionate about effectively delivering change to end users or those users at the end of the keyboards.

We always call it end users, which makes it sound like, they're the last thing that we need to worry about out there because at their end. Well, they're really, where we need to begin our focus, unfortunately. What we call the last mile of change. It's kind of the last mile of the marathon, right?

It's really the most important part because it is the finish line, and if you don't get through that last mile, nothing really is accomplished. In most businesses, we tend to speak of change in technical and financial terms, but in healthcare, it's personal, right? As we talked about, that's you, me, our loved ones, our community being cared for by these folks dealing with the IT changes.

I can illustrate best by quick story of experience I had we had implemented EPIC in one of our clinics, the provider there, one of the providers with a friend of mine, we actually had kids playing baseball on the same team, so we were always saw each other, season after season well, after their implementation, about six months later, baseball season rolls around, and I'm at the ballpark, and I see his kids, and I see his wife on the sidelines, but not David, and uh, Hey, where's David?

And she says, he's still at the office. He's finishing charts. He just can't get through the day. He sees patients all day and then he's having to work inside of the EHR and dealing with all of that. And I was like, oh man, I hate that. But he really shouldn't be doing that. His load was no different.

He really should be able to get through his day. without it being a burden for him. So I scheduled some time, went in to see him, and in the course of an hour, we did some pretty simple and basic things that we would think would be basic as technology people. Oh, why didn't he think of, doing that?

Why isn't he using Dragon? Why doesn't he have shortcuts? Why doesn't he have, some of his smart phrases set up or his order sets customized and personalized? Why is he going through three screens to try to get to, one piece of information that he could have gotten there in one click?

So in the course of an hour We are able to save him, hours of time. In fact, that's backed up by class They've done a study where self guided e learning for a provider, if they dedicate 60 minutes to a piece of self guided e learning, it saves them 90 minutes a day. That's a huge ROI, and it bore itself out in this.

A couple weeks later, ballgames roll back around. We're playing each other, David's back in the sands. So, that's the why of why I do this and why I think this is so, important out there.

Thank you for connecting the dots. You're absolutely right. I feel like as technologists, we always have to be mindful about Which problem are we trying to solve?

Who is our client? And at the end of the day, it's we're serving our clinicians, making sure that we're providing them with the tools so they can serve the patients. They can actually also have a life and go back to their families and not spend all their time Trying to figure out the technology.

That's our job. We figure out the technology and we provide them with the options based on what their needs are. And like you mentioned, listening to what the problem are or what challenges they have. They're running into and then us coming into the picture and helping them out figure that piece.

It's super important. So I appreciate you bringing that back and providing us with that intro because you're absolutely right. That's why we're here. That's the most important piece.

So back to the question, in my experience, the most effective health systems manage those updates and IT changes through a combination of structured training programs continuous education, and then leveraging technology like you perform for example, in my previous job, we utilize you perform to rapidly create a central repository of training materials and real time.

Performance support. This allowed us to scale our education operations efficiently. Currently, one successful method is the use of microlearning. It's kind of a, tool that you say, hey, let's give you small focus snippets, focus training sessions that can easily be updated and managed and accessed, at your convenience.

uPerform platform supports that by providing the in application guidance and context sensitive help as well as, a quick recreation tool to do it. So it ensures users can adapt to new functionalities without expensive downtime. Now with the help of AI, it's pretty amazing because that content is created and delivered faster than ever.

Absolutely. And let's talk about the complexities of training. As we all know, , during the pandemic, after the pandemic healthcare systems, we all struggle with, turnover. And training people, it's very time consuming. Whenever we have new hires, that in itself it's a challenge because you're not only trying to train them on the IT component and the systems that they have to use.

They're learning the culture of the organization. They're learning the new processes. They're learning, so many things at the same time. And the organization is not going to stop for anybody, just to learn the IT piece and to do their work.

And so it is our responsibility, as you mentioned, as technologists to provide them with effective tools to make it easier, to make the IT part easier. And so how can healthcare system make you know, the IT part easier and ensure that. The latest EHR updates and and the health IT changes are incorporated into this new FHIR programs.

Yeah, to seamlessly incorporate the latest EHR updates, which are going to be constant. I don't think we'll ever change that. There's going to come a day that we're not doing anything changing the EHR. So that's got to be incorporated into the new training, as well as ongoing training. So health systems have to adopt a dynamic and flexible training approach.

The buzzword from that training approach is called adaptive. You've got to train the knowledge gaps. If the user needs an hour of training to get up to speed, give them an hour. Don't make them sit through 8 to 16 hours of training that wastes their time. Another strategy is to make your content comprehensive and consistent across the enterprise.

At uPerform, we enable our clients to train the entire tech stack not just EMR. Clinicians deal with their EHR The most of any other applications, but they also have other things they have to do. So we take a day in the life approach to onboarding. Let's give the learner the knowledge they need to hit the ground running day one.

That may include non clinical things like scheduling, payroll, staff resources, policies, procedures. We can deliver the content for clinical systems like pumps, monitors, call systems, and medication cabinets, in addition to role and organization specific workflows. So we train them not only how to use the technology, but what their day will look like when they hit, the floor for the first time.

And because it allows for that rapid creation, dissemination of updated content, new hires are always learning. They're always able to get the latest and greatest and best information at their fingertips rather than going back to the classroom.

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So one of the challenges obviously is when you are a new hire, but then we talked about this, right?

Multiple things are going to happen and changes and features are going to present and, and we still, it's not a one time thing. It's a continuous education process. So what are some of the recommendations that you. Would have for organizations to continue to provide that continuous education and update their material and navigate through the frequent changes and in the EHR systems.

Yeah, as we said, onboarding is just the start, right? I used to say the closest thing to a perfect employee was their first day on the job, and then it was up to management to, manage the expectations and how far they fell off after that because we got to get them right from the start. We got to continue that process, which then leads to continuous education.

And continuous education has to be an integral part of any health system strategy. Health systems generally do a good job of developing structured or compliance driven training. However, IT training is different. People learn IT applications by doing, and usually, honestly, they don't learn until they need to, right?

You can sit through a class that shows you everything you can do with Excel, but until you sit down and you start actually Figuring out, here's what I need to do, how do I do it, that's when you really learn. And so that's why embedding continuous education in the flow of work is critical. You've got to communicate the changes and deliver the learning where they live.

For a clinician that's usually in the EHR, class research has shown that EHR users with access to learning in the flow of work are 13 to 30 points more satisfied. That means the health system not only benefits when the systems they've invested in are utilized properly, but systems when big. When users are more satisfied.

A great example of this comes from one of our clients mHealth Fairview. We've even had a podcast and presentation about it, because I think it not only is a good marketing for us, but it drives home the solution and the value of that embedding learning in the flow of work. When hospitals make a shift in processes from paper to, electronic like they have done with e consent or consent workflows, the impact's felt by everyone.

Delays in procedures, delays in billing, delays in care, poor patient experience, and user dissatisfaction are kind of the norm. But by embedding uPerform in the eConsent workflow, Fairview saw their eConsent adoption go from 7 percent to 87 percent over a matter of days. I mean, that's a win for clinicians, patients, and finance.

Absolutely, and you touched on something super important. You said people, you can provide all the training and you can update the educational material, but people are not, like, clinicians are not going to use it until they need it. That's something you mentioned. And so engaging end users through change management, it's extremely important.

You mentioned effective communication. So, what are some of the techniques that organizations can apply to foster a sense of ownership and adoption amongst clinicians when we're going through implementing new functionality or just new technology in general?

Yeah, I wish there was a magic bullet.

Engaging users requires a multifaceted approach. One effective technique is to involve them early in the change process, involve them in your software development lifecycle all your planning, get them engaged early but that's usually always involves a small subset of users. And it's honestly, frequently the same people over and over again, and probably the people who would the technology anyway, right?

I've used email. Department, committee meetings, letters, flyers, face to face rounding. Heck, I could use smoke signal if I thought it'd help. The best I could get was, 50 to 60 percent readiness. That meant 50 percent of our users were not prepared. I participated in a class problem solving event about a year ago with one of our customers.

And change communication and readiness was the problem we were tasked to solve. Our customer came up with the idea of delivering change messaging and education inside of Epic. Our problem and solution idea was universally accepted as, I said that silver bullet, they called it the white whale, right?

We've got to chase this. We've got to figure out how to get this done so that when users are inside of Epic or any of their applications, they know what has changed. What they need to do right then we took those ideas back to our development team and created our Copilot technology. Our Copilot launches when a user logs into Epic and unobtrusively yet visibly notifies the user of changes directly affecting them.

We track whether the user reads, or more importantly, acts on the information. We also figured out that this was a great solution to deliver in application help via our AI based search. All of the content is user specific based on the user's role, location, specialty, and other EHR settings. The key is to deliver that information that's relevant to the user, when, where, and how they need it.

Using uPerformed, HealthScan systems can push out updates, training materials, and feedback EHR system. This keeps the user informed, engaged, But also, I love it because it fosters a sense of ownership, a sense of belonging and participation that they're just not out there on an island.

They're not just that set of hands at the end of a keyboard.

Absolutely. It kind of brought me back to my times working at the hospital , when I was trying to do the same thing, I'll go to a huddle, I will go rounding, and again, we have to get creative and use all the possible communication methods because clinicians are extremely busy we have to be mindful, right?

What is the right approach for us to be able to reach out to them in or make sure that they're, that they're getting the information that we're trying to provide. So, I'm excited to hear that we have developed new techniques to reach out to clinicians we come to them with information. They don't have to look for it anymore.

Then where they work.

Then, yeah, exactly. And so, but even then we can provide information and we all know that there's always feedback, right? People provide feedback on this is working, this is not working and we our responsibility is to gather that information and make sure that we're making those changes.

And because at the end of the day, they're the users of the tool, and they know what works effectively and doesn't work. What are some of the things that you have seen that organizations can implement to gather. and analyze the feedback and be able to make those and implement them.

I

mean, you've

Hit on it. Effective feedback mechanisms are essential. You've got to listen. A lot of times there are structured feedback loops that include surveys, focus groups, committee meetings, as we talked about. Any way you can, that's all great. But we're in a, I hate to say,

you know,

Amazon world, right?

Every interaction with Amazon, you've got an opportunity to leave feedback. Airbnb, same thing. Whatever you do today, and they're successful at gathering that feedback and using that feedback to drive their change and drive their platforms, because it's right then. It's immediate. It's right during when the interaction is fresh with them.

The last thing they want to do is open up a service ticket to have to go, tell somebody or give feedback on something. They want to do it right when they're, experiencing it, and they think of it as top of mind on that. So what we do is we integrate the feedback and even ratings and things into our software so that every interaction with the client, they get an opportunity to tell the training team to tell us how we did.

What was right, what was wrong, what was good, what could be better. And so it becomes that interaction and feedback right at the moment of use of the system. Rather than, oh, let's sit down and then start talking about that and

uh,

Who remembers? Do you remember all the Amazon products that you bought or, if you say it in Airbnb, it was great, but I don't remember all the details.

Capturing that information right there at the point of interaction is so important. And then, when you combine all of that with the EHR's own analytics of, how they've learned, what they've learned, what they've seen, what they've done, we can now start measuring their performance and see the correlations between, The content that they've consumed, the training that they've done, the interactions they've had with our teams out there, with how effective they are at utilizing the system.

So you get that closed loop of, okay, here's the change, here's how they enacted it, and here is the impact. Because if you're delivering a change without impact or without a measurable impact, why are you doing the change to begin with? So now we can get proactive and help you act on that. And as an end user, I love that, but as a manager, as a leader, I love the data and being able to say, here's a positive correlation, or possibly a negative correlation, between the change and what we expected.

Yeah, I absolutely love that because you're absolutely right. A lot of people don't even provide feedback if you have to go and open a ticket. And you, I mean, you, By the time you do all those things, you forget or you're like, I'm not even going to do that. I don't have time. So if you're able to provide feedback right on the spot, that is the most valuable information that you're going to get technologist on the other side to be able to act upon it.

Because it's the experience right at the moment. And that is it. 100 percent valuable. So I love that you guys are doing that. And so before we wrap up, what advice would you give to health organizations looking to better support their clinicians over the last mile of change?

There's lots of advice, lots of things that we could probably talk all day but I'll sum it up in a word.

Alignment. That's the number one problem I see today in delivering Your change over the last mile is we have frequently improper alignment. Clinical application training, especially EHR training should be aligned under the IT clinical applications or informatics team. Unfortunately, most organizations still see training as an HR function.

So, all training gets lumped into this one big bucket. out there and it's different. Again, an HR manager is worried about or somebody on that side of the fence. Rightfully so. They've got many things that they need to be concerned about from a compliance standpoint and organization development standpoint.

They've got their plate full with that but they're not responsible for that last mile. They're not responsible for those users with their hands on the keyboard, so that loop gets broken. By being able to deliver move training to, as we would say, closer to the actual implementation and development of the technology, you get a much better process out there.

It directly connects the subject matter experts to the training teams and learners. That is. Accelerates the needs analysis, the content creation, the delivery and feedback processes. It aligns the organization and actually reduces cost by allowing teams to be agile and effective in meeting the needs of users.

I mean, you can purchase or develop the greatest technology in the world, but if you don't get in the hands and adopted by the actual users, what we call the last mile, you've wasted your time.

Yeah. And more

importantly, you've wasted theirs.

Absolutely. We always talk about people, process, technology being the key for success.

So, I really appreciate your insights, your feedback and you sharing with us best practices and thank you so much again

for this time. Hey, thank you so much for the chat.

Enjoyed the conversation.

Same here, and we'll talk soon.

All right.

Take care.

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