Okay, time for Entry #2 -
It's all about the workflow analysis.
This concept is *very* hard to grasp, unless you practice clinically - Either as a nurse, a pharmacist, a doctor, or some other clinician.
"Workflow analysis - It's not just the software and training you have to worry about!"
This is the hidden part that nobody really tells you much about. And if they *do* try to tell you, you probably won't understand it until you're staring it in the face.
Here's the summary : When you go-live with an EMR, you have to re-think your workflows. Basically, if you've never had an IT strategy, you'll be inventing one, whether you like it or not.
It means you have to re-think :
1. What information do I need as a clinician? (Nurse? MD? Respiratory therapist? Dietitian? Pharmacist?)
2. What do I do with that information?
3. Where do I send that information?
4. What order do we do this in, as patients flow through our practice?
5. Who needs access to this information, and when?
The things you used to do on paper often don't translate to the electronic paradigm. And quite frankly, "making the computer do what you did on paper" is a lost opportunity to re-think your IT strategy.
So how do you do this? Who should do it? What governance do you need to do this?
Either, you can look for a CMIO to guide you, or a good consultant who understands this issue very well. Or, you can look to grow your own group of clinical workflow experts and IT training experts.
There's no good term for people who do this new role - Some of us have jokingly called them "Jedis", but they are the clinical operations experts that are hidden in your front-line staff. They are the people in your institution who understand this problem, and can help you understand and maintain the order of your universe.
The first step to taking control of this situation is to identify these allies. In each of your clinical areas you're looking to integrate, look for the person who is :
1. Politically neutral
2. Intellectually open
3. Embraces technology
4. Believes the phrase : "there is no substitute for hard work"
5. Is a respected leader in their clinical specialty
6. Is patient when teaching others.
7. Is *PASSIONATE* about their workflows - Not just "what does it take to be good?", but "What does it take to be good and what information do I need and what order do I need it in?"
8. Is creative
9. Understands the basics of interpretive statistics (Mean, mode, median, SD) and is amenable to some degree of database querying / Excel spreadsheet analysis.
10. Believes *strongly* in the art of negotiation - Nobody walks away from a negotiation unless everyone is happy.
Once you've found that person, hold onto them. They are your greatest asset.
Then start the discussion about "If we went electronic, what information would you need to do your job? What would you expect a doctor to do in a particular clinical scenario? What would you expect a nurse to do in a particular clinical scenario? What should a pharmacist do? etc..."
Start this discussion with the Clinical "Jedis" in one particular department. You will learn a lot about how your unit functions.
You can then work with your IT team to create an IT infrastructure that meets the needs of this new workflow. IT teams have a much better time understanding the clinical demands when the clinical demands are clearly defined.
Then after you agree upon the new paradigm, your "Jedi" can help bring the new workflow and education back to their clinical specialty. And when you "go-live", they can help reinforce good behaviors that fit the new paradigm.
And if your "Jedi" can understand the basics of data analysis (datamining, using Excel or another statistics package), make sure you share your raw EMR data with your Jedis - It will only help them understand your workflows better.
Again - A good CMIO or consultant can help you develop this sort of culture, but I hope I've communicated some of the work that's necessary to give adequate support to your EMR implementation. Please remember that "Jedi" is just an informal term - To avoid problems, you might call them "Clinical Samurai" or "ClinOps expert" or a term of your choice - In fact, I'd be curious if anyone has another term for someone who would fit this position.
Looking forward to hearing feedback. :)
What are we not doing that we are supposed to be doing?
EHR gets blamed for inefficiencies. In many cases it is because workflows have been redesigned to make sure 'illegal' workarounds are eliminated. Since everyone gets paid for throughput and not for quality, expect resistance!
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