Tuesday, September 15, 2009

Are Jedi Informaticists the solution to small IT staffs?

So I thought I'd write more about the "Jedi Informaticists" we're growing at our hospital.
(Yes, the "Jedi" title is informal, and makes everyone smile/cringe when you say it, but bear with me.) :)

I've recently come across CMIO types from larger hospitals who have robust informatics groups. Some have an entire informatics department. Others have large groups of physician champions, data analytics groups, report writers, workflow analysts, and multiple consultants helping to ensure the proper implementation of their EMR.

Smaller hospitals are often pressured to "do more with less", and don't have the budgets to support a large informatics staff.

Currently, we're piloting a group of "Jedi Informaticists" - Representatives from various clinical specialties who identify themselves as "Jedis". (Yes, we are looking for another name, but for some reason, people sort of enjoy the Jedi title - It keeps things informal, keeps it fun, keeps it light, and perhaps most importantly... They get to go home to their families at the end of the day and say "I'm now officially a Jedi." Oddly, this effect, so far, seems to inspire people to show up to meetings more regularly.)

So what is a Jedi, exactly?

A Jedi is a representative from a clinical specialty who :
  1. Is committed and passionate about good patient care.
  2. Is an excellent clinician (knows what it takes to be a good doctor, a good nurse, a good respiratory therapist, etc.)
  3. Knows and is passionate about understanding their *workflows* - Not only what it takes to be a good doctor/nurse/pharmacist/etc., but what information they need, what they do with that information, who they give that information to, and what order they interact with patients in a big-picture-type view.
  4. Is committed to "intellectual purity" - The same sort of purity that you get from having a curtain in a voting booth (so you can tell your family you're voting one way, but if you think it's really in the best interest of the country, you can vote the other way, as unpopular as it may be.)
  5. Is committed to political neutrality - Thinks mainly of "what is the best thing for the patient", and does not bring their political/emotional baggage to the negotiating table.
  6. Is committed to the art of negotiation - Nobody should walk away from a negotiating table unhappy, and *both* people have to be committed to making sure *the other* is happy before negotiations are done.
  7. Is IT-friendly, and knows the EMR software well.
  8. Is comfortable teaching their colleages (from their clinical tribe) about new workflows and software operations.
  9. Has basic "data-mining" capabilities - You provide them with raw data from your EMR, they can use Excel/Statistics packages, and a basic knowledge of descriptive statistics (e.g. gaussian distribution, mean, mode, median, etc.) to understand the functioning and efficiency of their clinical tribe.
Most often, these people are not the directors - But rather, front-line staff who work closely in conjunction with the clinical directors. (Jedis DO NOT replace directors - But they help the directors navigate the IT waters that sometimes can be time-consuming. Ultimately, all decisions are made by the clinical directors.)

Some people have asked me, "What's the difference between a 'Jedi' and a 'superuser'?"

I like to think of it as a Jedi has much more power than a superuser. (Yes, you can laugh. It's intended to be fun and informal.)

Most people think of superusers as clinical staff who know the software and can teach it to other people.

Clinical Jedis, I believe, fill some additional roles :
  1. Workflow experts and negotiators.
  2. Clinical Data Analytics / Data miners - They help perform CQI for the department.
  3. Information gatherers
  4. Workflow Trainers
  5. Translators : They speak IT for the clinical tribes, and speak their clinical tongue for the IT staff.
So far, our group has grown remarkably in size, and we are looking to "formalize" this position. Some challenges remaining include :
  1. Is there a more formal title we can call these people? How does that impact their HR positions?
  2. Is there a benefit to "not really being formal"?
  3. Where does this group fit in the traditional hospital hierarchy?
  4. Who will this group report to?
  5. How does one control the "mission creep" of such a group?
  6. How does such a group control the number of issues they are asked to tackle, from IT staff (e.g. looking to figure out what the immediate clinical needs are), Clinical staff (e.g. looking to develop IT systems to meet particular needs), Administrators (e.g. looking to increase efficiency in different departments), and Regulatory groups (e.g. looking to ensure that all compliance issues are being met.)
I'm currently helping to guide such a group, and proceeding cautiously and carefully as we start to navigate the twists and turns of meeting the rapidly-changing demands of a hospital going EMR in a modern healthcare environment.

Hopefully some of this will spur some ideas in other folks. Would love to hear from other hospitals about how they handled the governance issues involved in "going EMR".

Oh, and my advice : Don't use "Jedi" label - Not only does it potentially open up a can of worms, there's nothing harder than discussing a "Jedi Council" with a group of physician administrators. :)


Paul Roemer said...

this made me think of our first conversation when you said that the EHR was only 20% of the work.

Your description of the Jedi indicates their real job is that these men and women will determine the degree of functionality and acceptance the EHR receives. The Jedis do the heavy lifting for change management, work flows, and training,

Dirk Stanley, MD, MPH said...

Yep... Only trick is getting people to understand their role in the new paradigm. (You can't just have a bunch of Jedis move in and not expect some rumblings...) :)

Paul Roemer said...

that's why they have light sabers

Jeff Brandt said...

Love the Jedi title. very close to a superuser but very hard to find

Jeff Brandt