The problem of "Feature Bleed"

Another common question I get asked is, "What can we do to prepare for 'going electronic'?"

Most hospitals will, in these times, gather their order sets, in the hope of "making them electronic".

It's then, that you may notice the first problem. I like to call it "Feature Bleed".

"Feature Bleed" is when you have order sets that have pieces of :

1. Order sets
2. Protocols
3. Documentation

This is VERY, VERY common - Most paper-based hospitals aren't disciplined enough to have their order sets and protocols and documentation well-separated.

Take a look at your paper order sets - See something called "Advance Diet as tolerated" or "Up ad lib" or "Do not start any other CNS depressants without checking with the anesthesiologist first"? These are all protocols!

Take another look at your paper order sets - See something like "Write patent's PTT here : ___ ___ ___" or "Write patient's neuro checks q6h here : ____ ____ ____" - These are all documents!

Take one last look at your paper order sets - Are they labelled something like "Alcohol Withdrawal Protocol / Order set / Flowsheet"? This is a sign that you may have feature bleed. (Ask yourself which tab in the paper chart you have been putting this order set into - If you're not sure, that's a warning sign of "Feature Bleed")

How does this happen, and why is it so common? In the paper world, it's very easy to make an order set where :

[ Order set ] = [ Order set ] + [ Documentation ] + [ Protocol ]

The problem is, when you go electronic, you will have different places ("buckets") where you need to organize those things.

1. The "Order set" bucket
2. The "Protocol" bucket
3. The "Documentation" bucket

And to organize this, it will mean :

1. Significant redesign of your paper order sets
2. Significant redesign of your clinical protocols
3. Significant redesign of your clinical documentation

And to handle this? You'll need to define, for each of these informational tools :

1. A good policy definition of the informational tool (to help guide builders in the right direction and prevent future "Feature Bleed")
2. How will the informational tool be built? (By who, and how? What format?)
3. How will the informational tool be tested before it "goes live"?
4. How will the informational tool be approved in your organization?
5. How will the informational tool be published
6. How will the informational tool be tracked.

If your organization was very disciplined in the paper world, and you have good policy definitions of these tools, your conversion to EMR will go a lot easier.

And if not, you're like about 80% of the places I talk to. :) Just be prepared to deal with this organizational redesign issue at some point - Preferrably earlier, rather than later.