If your team has concluded that it is a business imperative to:
Integrate electronic health records (EHR) into your digital strategy
Integrate your data with claims or EHR data
Automate dispense as written (DAW)
Get new indications to show up faster within EHR care pathways
Deliver clinical decision-making advice at the point of decision within the clinical workflow
Integrate clinical pathways within EHR systems
Use EHR systems to alert prescribers of appropriate patients for your brand
Get patients back in the office for titration or to assess failure of first-line therapy
Use EHR data and/or capabilities to support a risk-based contract or value-based care arrangement
… in sum, if your team has concluded that an EHR strategy is a sensible imperative to safeguard brand preference and surface appropriate patients, now what?
One of the most consistent truths that we see when working with a new pharma client is that there isn’t a sufficient process in place to achieve an EHR strategy at scale. This might come as no surprise. It’s tough to have a documented rubric for something that no one within a company has ever really done before. But this matters. Success is tough to achieve, or efficiently achieve, without discipline around how success will be achieved.
Here’s the most important takeaway: If you are going to achieve your business objectives with an EHR-related strategy, you will need a structured process to guide your team from here to there.
What are the symptoms that your team might be experiencing when lacking a process model for its EHR-related efforts?
Symptom #1
You have an abundance of project plans or brand plan documents with EHR-driven objectives, but, no matter how much time goes by, the team only accomplishes what could be considered precursors to an implementation and not any actual implementations. There might be a whole lot of research reports. There might be slide decks and talk about population health management and clinical decision support in which EHR features prominently. An EHR training module may exist. There may have been EHR talks with individual target customers. Someone might have even gotten a meeting with Epic or Allscripts or maybe even built some kind of prototype. And all of these activities and information are important, maybe even essential. But while they inform the actual project work, in and of themselves they are not an implementation, integration, or execution. It’s a symptom of missing rigor if the team continues beyond a necessary point to work on things that are not going to directly lead to a business result.
Symptom #2
The business objective is not a true business objective if you think about it. We’ve been in more than one meeting over the past any number of years where we ask our client about their goal and their reflexive response is, “to get our messaging in the EHR system” or “to connect our app to EHR systems” or “to make sure our drug is in the order set.” These are not goals; they are possible ways to attain a goal.
In some cases, it might be pretty obvious what the endgame is. But when the actual goal remains unsaid, we take it as a sign that there’s quite possibly a gap in the model, because a robust strategic plan minimizes the tendency to sidestep goal statements and, as a common consequence, to get lost in the sauce.
Symptom #3
The team has approached customers, but these customers are not agreeing to collaborate and there is little or no team-wide rigor to understand the root of their disinterest and engineer a fix. Usually what we see instead are a lot of potentially true but generally indirect rationalizations: “The sales team isn’t …” or “The customer wants [insert fairly unattainable request here]” or “Med/Legal/Regulatory won’t approve.…” None of these things is a deal-breaking barrier, as long as there’s experience and rigor around how you put your plan together.
Make no mistake, it’s easy to get into any one of the above predicaments with the environment in Pharma today. This is probably why they’re such common scenarios. Sometimes, calling out the situation requires the backing and momentum of an external subject matter expert.
As you may have suspected, Aventria has a battle-tested process model to guide Pharma’s EHR-driven strategies in the market-access space. And we’ve found it essential to diligently use it. EHR strategies, for whatever reason, can magnify Pharma’s challenges. Let us know if you’ve noticed the same.
If you’ve realized that perhaps your team could use a little assistance in putting rigor around your EHR-related ambitions, you might be interested in the model we use here at Aventria. Our PASS (Pilot Assessment Success Strategy) Model™, as we call it, consists of five major stages:
1. Sub-Domain Exploration
EHR integration is bigger than just technology. We have identified 10 sub-domains that intersect with the EHR part of the equation. Each of these co-travelers must be present and accounted for if any strategy involving EHR is going to make it the whole way past go and on to achieving business objectives.
As an example, discipline around the how, when, and what of regulatory approvals is one of those sub-domains.
2. Customer Segmentation
Everyone knows that large organized customers are not homogeneous. There’s that old cliché, “You’ve seen one hospital … you’ve seen one hospital.” But it’s striking how many times, for whatever reason, strategies involving EHR assume that there is one big customer segment called “our target customers.” Occasionally, this is broken down into “our target customers with Epic,” but in our opinion, segmenting by EHR usually doesn’t help.
On the other hand, there’s a tendency to over-rotate in the opposite direction and consider every single customer as a unique n of one. The issue here is that any strategy developed has one big problem: It can’t scale.
We have been intimate with the inner workings of over 3000 sites of care, so we’re pretty well-qualified to contend that there are 4 major technology archetypes of customers you may encounter in the wild. It is important to understand and build for these archetypes or ones you have defined yourself.
3. Solution Construction
I prefer a methodology called “convex tinkering.” Start out with a direction built on opportunistic thinking and an understanding of exposure to risk. Then observe and refine.
Regardless of the methodology you use, I think the most important part about solution construction is constraint relaxation. I could, and might, write an article on this topic alone, but suffice to say here that it’s a critical element of any strategy that will actually work in the real world with the technology ecosystem that exists.
4. Technology Selection
First, you will need a core set of integration modules. Let me back up for a moment. Any company/agency/consultancy your pharma team chooses to engage to help build your EHR strategy should have at the ready a core set of EHR integration modules. And at this point in the industry’s technology evolution, these modules should be in use and working within enough provider or payer organizations that you can confidently assume they will work for you, too. (To be transparent, Aventria has a core set of EHR modules that are actively working well today.) I would be cautious of any agency that suggests they will devise an EHR strategy if they have not implemented an EHR strategy. This is often is the reason that some of the symptoms I listed above tend to occur.
After selecting the right strategic partner who should come complete with a set of baseline technology modules, you might need to augment with some specialized technology capabilities. A good strategic process will include a phase where potential specialized technology partners are filtered, vetted, and engaged. What matters here is the quality of the pool of potential candidates you start with and the systematic way that these candidates are assessed.
5. Commencement of the Minimum Viable Product (MVP)
The last step could also be the first step: Roll it out and get some fast results. Why?
Leadership usually appreciates results.
Here’s why this is important: Pharma tends to be risk averse. Many times this manifests in odd ways that are ultimately more risky than the risk of innovation or trying something slightly new. I would be bold enough to state that there’s more risk in spending too much money up front than there is in building a “no bells and whistles version” and testing it with customers.
My evidence basis for building a plan with an MVP endgame is backed by science as much as it is by personal experience. Humans, even the smartest among us, are frankly pretty awful at anticipating the 1st-order consequences of an action, let alone the 2nd or 3rd. No matter how much cognitive power or money we might throw at a solution stack, we will never be able to fully and accurately assess how all the dominos will fall. Being a practical type who reads a lot, the answer to me is clear. Figure out the minimum build. Measure success. Do the next right thing.
If you work for a pharma company and would like a free consultation, contact Dave Dierk.
— Stacey Richter is co-president of Aventria Health Group.
The views and opinions expressed are those of the author and do not imply endorsement by Aventria Health Group.
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