Expert provides guidance on assessing readiness for new technology

Assessment tool lays groundwork for change

Using new technology in a health care system is not as simple as buying state-of-the-art products and having the vendor install them.

There's a people factor that cannot be ignored, or else the millions spent on technological efficiencies will be wasted.

One of the biggest mistakes a health care system can make is not having taken the time to learn how the new technology will affect staff, says John Manzo, BS, PharmD, FASHP, managing consultant with IBM Healthlink Solutions of Armonk, NY.

So health systems need to assess how the new technology will affect staff and workflow, Manzo says.

Manzo offers these tips on performing a technology readiness assessment:

Understand your project's scope: Everyone involved in a hospital system technology change needs to understand what the scope is and what the organization is trying to accomplish.

"Once you've defined the scope, you document the scope that people agreed on, and you don't spend time assessing things that are not within that scope," Manzo says.

"So this helps you write your assessment questions and make sure they're not all over the place," he adds.

Initiate assessment process: "You need tools to do a current state assessment, asking questions you'd use to identify and tailor the project to your organization's needs," Manzo says.

The questions asked of hospital leadership will be different than those asked of a department head or front-line pharmacist, Manzo says.

"You need to get a good 360 degree perspective on the current state," he adds.

The goal would be to learn more about these issues:

  • What is your ultimate goal?
  • How do you see this technology transforming your business?
  • What are the workflows associated with this future state?

When interviewing hospital leadership, it works well to discuss their vision and higher-level goals, Manzo notes.

"When you interview the pharmacy leadership team, you can be a little more granular and ask more about operational issues, such as what keeps them up at night and what are the benefits they'd get from technology," he adds. "Then you take it down another layer to the end users, and you do that because you have more folks involved."

Interviews on this level could be done in focus groups with structured questions and different interviewing techniques, Manzo explains.

For instance, the assessment might include answers to these questions:

  • What are the cultural issues preventing you from being successful?
  • Walk me through a typical workflow;
  • How many people are involved in the process?

Develop gap analysis: "Then you compare your current state from the readiness assessment to a future state and develop a document or tool called a gap analysis," Manzo says.

The gap analysis looks at where an organization is today with technology and where it could be in the future with new technology, and it estimates what it will take to get from today's reality to tomorrow's goals.

"What will it take to get there?" Manzo says. "An example of a gap could be that we don't have enough computers, and we don't have enough people who know how to use computers well."

Another example might be in how medications are charged.

A hospital system might be planning a switch to electronic medication dispensing, where medication now is billed on administration. Previously, it had been billed when dispensed, Manzo says.

The gap analysis will look at the changes that have to be made to revise the billing practice and the charging mechanism.

"Traditionally, pharmacies charge when medication is dispensed, and then if some medication goes back they'll do a credit," Manzo explains. "With the electronic system they are set to charge on administration, which is more accurate since it charges for what the patient actually receives."

But the gap analysis might highlight logistic problems, such as how this change in charging practice will occur.

"Are we going to change charging practices and charge algorithms?" Manzo says. "Will this change the culture because much more is dispensed than what is given to the patient?"

When medication is charted on administration there is a more accurate record, but this may change revenue. So finance staff will need to be involved, he adds.

"You need to identify the differences in the gap and create a mitigation strategy for every one of those issues," Manzo says. "You should identify who will make these changes: is it your leadership, your administration? Who owns it, and when is it expected to be done?"

On the positive side, the hospital won't have to manage credits anymore for drugs that were charged and then returned, he adds.

"It creates a lot of gaps and deltas that need to be addressed," Manzo says. "Identify them and see who is going to talk with finance and revise pharmacy workflows, making sure they understand the diligence they need to have."

Create assessment tool: "You can create a simple word processing document or map it out with a flow diagram and process map," Manzo says.

"The diagram might identify a task, such as charge crediting, and show its 10-15 step process and then do the same thing for its future state after the technology change," Manzo says.

"You'll want to compare the flow diagram and process maps, and as a group identify which things are different and need to be addressed," Manzo explains. "Then you collect data, analyze data, and go back to the work group and say, 'This is what we found, and this is what it will take to get it done.'"

The analysis will include details about gaps, including where a resource no longer will be needed and where the organization might lose revenue, he adds.

"As you identify gaps, you put them in those groups, showing whether they are things that need to be mitigated or whether it's just interesting information," Manzo says. "One of the most important parts of a gap document is the mitigation column that includes issues that need to be removed or roadblocks that need to be addressed."

For example, suppose this is a nine-month project, the diagram might show what is expected to be done at month three and at month five, he says.

"Another thing is that new issues will come up that you might not have identified in the first go-round, so you'll use those check points and constantly review the document, identifying changes and revising as needed," Manzo explains.

People respond better to visual descriptions, so the assessment tool should include flow charts and visual timelines, he says.

A technology readiness assessment tool illustrates potential obstacles and expected benefits from a major technology change, and it is a dynamic process that can be adjusted when inevitable disappointments arise.

"You learn from your mistakes," Manzo says. "There might be tough problems that a tool like this can help you identify and at least make an attempt to clean-up."