For example, yesterday at the #CMIO forum, after listening to all of us share stories, it became clear that two of the important roles of a #CMIO are to be a thought leader and to be a cautious steward of disruptive innovation that really helps patients.
Of course, since I'm passionate about creating #Informatics platforms and well-designed tools that clinicians and administrators can use to work together, I thought : Could I look a step higher, and develop something that helps more than just the clinicians? Could we make something that helps healthcare efficiency on a national level?
And so for inspiration, I turned to a common theme in engineering and development : The three worlds of development.
A. THE THREE WORLDS
Engineers and software engineers are very familiar with this concept - Clinicians, administrators, and politicians generally aren't.
One of the fundamental tenets of good Informatics is understanding the way ideas come to fruition in a safe and organized way - By moving an idea through three different stages of organized development :
- The DEVELOPMENT stage
- The TESTING stage
- The LIVE (sometimes called "PRODUCTION") stage
Huh? What does this mean, exactly?
To help develop things in a safe, controlled, and predictable way, most engineers think long and hard about:
- How can I DEVELOP an idea safely?
- How can I TEST an idea safely?
- How can I make something go LIVE safely?
And so, most engineers and informaticists are familiar with these three different worlds and how to use them :
- "DEV" - (the "development" world) - Typically, used by people who help build/develop the idea
- "TEST" - (the "testing" world) - Typically used by those end-users who test the idea
- "PROD" - (the "live" world) - Typically used in real-life by those people who actually use the idea
So if you train your brain to think about these different stages of organized, controlled development, you will actually be better at developing things in an organized and predictable way.
The funny thing is that often these three worlds are used by engineers and Informaticists, but the rules actually apply to many, many other things we develop in real life, whether we realize it or not. For example, many people live in a house :
- "DEVELOPMENT PHASE" of House : Point where builder is building the house according to specifications
- "TESTING PHASE" of House : Point where safety inspector looks at house design and tests for adequate safety
- "PRODUCTION/LIVE PHASE" of House : Point where person moves into house
Or you might send an email :
- "DEVELOPMENT PHASE" - Point where you are writing and drafting the email
- "TESTING PHASE" - Point where you are proof-reading the email and checking the spelling
- "PRODUCTION/LIVE PHASE" - Point where you click "SEND" and make the email a reality
Or you might send a paper letter to someone :
- "DEVELOPMENT PHASE" - Point where you are writing and drafting the mail
- "TESTING PHASE" - Point where you proof-read the letter before putting it in the envelope
- "PRODUCTION/LIVE PHASE" - Point where you drop the letter in the mail to make it a reality
So I usually recommend to new Informaticists that they should become familiar with these three worlds, and :
- Who uses which world for what?
- What process will you use to transfer ideas from one world to the other?
It's also why I personally feel that some older healthcare change concepts like 'Test of Change' are kind of outdated - They only encourage crossing over from one world to the other without a formal process.
Again, a good Informaticist understands these three worlds, how to use them, and helps an organization define the standards by which tools will be moved through these three stages of development. Generally, with regards to Health IT development :
- Software engineers/analysts live in the "DEV" world (often with help of an Informaticist)
- Owners/End Users live in the "TEST" world (often with the help of an Informaticist), and
- Real-life people live in the "LIVE" world.
B. THE CONCEPT : SimHospital
So to help HIMSS and the ONC drive some really innovative thinking about bending the healthcare cost curve, I wondered - Could we actually use these common engineering/informatics principles to help more than just software engineers and informaticists? In other words, could we use these principles to help patients, administrators, clinicians, and politicians understand healthcare better? How would we do that?
So it dawned upon me, a great tool that could help improve healthcare management and delivery would be a robust TESTING GROUND for healthcare change. Enter the idea : SimHospital.
SimHospital would be a computer-modeled, virtual hospital where all of the basic characters in healthcare could live in a safe, virtual environment that allows for testing. Just like the popular SecondLife world or TheSims series, it would be a virtual hospital with virtual-reality avatars that are built to behave much like their real-life counterparts - E.g. virtual patients, doctors, nurses, pharmacists, respiratory therapists, couriers, and other hospital staff could all be designed to behave in fairly predictable manner, based on certain variables like :
- Allowed tasks
- Predicted compliance with tasks
- Clinical tools and communication to facilitate interactions between team members
- Contracts and Policies to guide behaviors
And I think in this virtual, simulated world, we could allow better testing of ideas like :
- How will changing a policy or regulation impact care?
- How will changing a clinical or administrative tool impact care?
- How will changing a workflow impact resources?
- How will adding/removing a department impact workflows?
This virtual world would also be an amazing training tool for clinicians, administrators, and politicians - If we commonly ask pilots to train hours in a flight simulator, maybe this SimHospital could be used to train healthcare leaders to understand their environments better.
It could also, if developed, be used as a tool to help do predictive modeling for healthcare outcomes - If the ACO movement is going to make organizations responsible for both the delivery and outcomes of healthcare, then SimHospital could be a very useful tool to predict the outcomes of a particular intervention.
And if we wanted to expand beyond the boundaries of the hospital, we could also develop SimHealthcare to model the hospital and outside PCPs and specialists, again, to help predict how a change in one or more variables will probably lead to what results.
I think it could be a pleasantly disruptive way of improving education for healthcare leaders and simultaneously help with the predictive modeling that will be required for ACOs to succeed.
As with many of my posts, I'd like to throw the idea out there, and would be interested in hearing comments. (Do I have any readership from SecondLife or TheSims programmers who want to use their skills to help reform healthcare?) :)
Remember : This blog is for education/discussion and brainstorming only. Your mileage may vary. Always interested in hearing your thoughts and comments!
Very cool idea. Thought you might be interested in this:
Dirk, great post. As a Computer Scientist and Medical Informaticist I would like to add an important phase to your list. That is, Requirement AKA, System Analyses as illustrated in the Systems development life cycle (SDLC).
This is the most important and most overlooked part of the development process. I cannot tell you how many times I have heard that HIT solutions are not what is needed by clinician. One reason is this important phase has been overlooked. Computer Scientist do no know what is needed until domain experts provide the requirements..
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