The pitch decks are always compelling. The workflow diagrams look elegant and the vendor demonstrations run flawlessly. Enchanted by the possibilities and potential return on investment, health system leaders invest in the technology. The pilots go well and then the system goes live with the technology, but nothing changes.
This is one of health IT’s most persistent and least glamorous problems: adoption. It’s not a downstream concern, a training issue or a change management footnote; it’s the essential element dictating whether the investment becomes a success or failure.
“I define ROI for technology as a proven, measurable change in front-line behavior and outcomes, weighed against the full cost to implement and sustain,” said Bob Berbeco, CIO of Mahaska Health in Oskaloosa, Iowa. “The leading indicator I watch is time-per-unit improvement from current to future state as it confirms the workflow actually changes rather than the solution being deployed.”
He also quantifies “blue dollars” – time saved, rework avoided and capacity created–as well as “green dollars” – the hard savings or incremental revenue – to understand the true value and gauge the ROI against initial costs.
“The goal is to have this framework in place before we buy or build anything,” said Mr. Berbeco. “This means defining the business need and setting KPIs that serve as the scoreboard throughout rollout, training and continual optimization. Adoption and sustained use are critical gates that unlock ROI. A solution that gets employed but not used delivers no ROI.”
Conrad Gleber, MD, associate CMIO at the University of Rochester (N.Y.) Medical Center, put it in sharper terms. He sees big downstream returns through cost savings, efficiencies and added revenue for technology freeing clinicians up to spend more time on patient care. Then the health system can invest in the workforce. But first, they need adoption.
“No technology delivers ROI if it isn’t adopted. The most sophisticated tool on the market generates zero return sitting unused or underutilized,” he said. “Realizing value requires that the people closest to the work embrace and integrate the technology into their workflows. Organizations that treat implementation as an afterthought will consistently underperform on their technology investments, regardless of how sound the underlying solution is.”
The adoption problem is deceptively simple to describe and genuinely hard to solve. It requires technology that earns its place in a workflow rather than being imposed on one — a distinction that sounds obvious but is routinely ignored during procurement.
“I define true ROI by the technology that actually disappears into the workflow,” Bryan Traughber, MD, innovation chair at Rochester, Minn.-based Mayo Clinic, said. “If a solution doesn’t actively decrease the cognitive load on our providers, it isn’t an innovation — it’s technical debt.”
Defining the unadopted technology as “technical debt” shifts the blame for lackluster results on implementation design instead of cultural failure. The system added tools, steps, cognitive demands or workarounds that added cost to the system rather than easing burdens.
What changes when organizations take adoption seriously? The answer, according to Shruti Cruz, a director at Chicago-based Northwestern Medicine, is that they start measuring things they previously ignored.
“While we have a strong process in place for tracking hard ROI on technology investments, we tend to think of ROI as something we can point to on a financial statement,” she said. “What we’re seeing now is that many new technologies don’t fit that model, but they do ease burnout, make decisions happen faster and reduce risk. If we want to understand and track their value, we have to be able to measure these ‘softer’ impacts as well.”
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