Hi fellow CMIOs, CNIOs, Applied Clinical Informaticists, and other HealthIT friends,
It's been a while since my last post - As you know, healthcare is very busy adapting to changes brought about by our global COVID-19 pandemic. While the pandemic has and continues to be a great source of sadness and tragedy, it also brings a lot of change - I think a lot of this change is going to be very good, and facilitate lots of innovative, new ways to deliver care.
So for this post, I thought I'd piggyback onto my last post, "Welcome to Healthcare", by showing how helpful it can be to use a standardized index of healthcare to optimize your organizational Intranet.
Why optimize your Intranet? It's the one 'filing cabinet' that everyone has access to, on their desktop, usually with one click. Imagine... Could your Intranet become a silo-busting, high-value tool that your employees use regularly to quickly find helpful information, that helps them troubleshoot problems, plan solutions, and easily learn about the people they work with? Could it also be an internal communication tool that invisibly teaches them about the structure of healthcare? I believe good indexing can do this, and I'll share why I believe this below.
But first - I'd like to provide some background, using one of my heroes, the brilliant Clinical Informatics pioneer Lawrence 'Larry' Weed, MD (1923 - 2017).
A treasured photo of me with the great Dr. Larry Weed,
at the 2014 HIMSS Conference.
If you've ever written a SOAP note, it's because of Larry Weed's 1968 New England Journal of Medicine article, "Medical Records that Guide and Teach" - This was the breakthrough article that changed the way the whole globe writes clinical documentation. A copy of his original article in .PDF format is available on the Washington University web site by clicking here.
It's a fantastic read. What amazes me is that his SOAP note template allowed us, as clinicians, to organize our thoughts and then share them with other clinicians. One could argue that the whole specialization of healthcare in the 1960s and 1970s was made possible through his contributions to clinical documentation!
In short - Larry Weed was right. You can't separate reading, writing and thinking - They are intrinsically connected. How you read and write shapes how you think. (By the way, if you'd like to learn more about him, you can also see his 1971 Grand Rounds at Emory University by clicking here.)
Now, borrowing from Dr. Weed's lessons that what we read and write shapes how we think - let's look back at the sample index we discussed in my last post. (Remember, your mileage may vary, depending on your institution's needs...)
Note : This [DRAFT] sample index may vary from institution to institution, depending on your needs.
Also, for clarity and brevity, it also does not reflect the Board of Directors.
This general-purpose index can help us make seven very helpful Intranet homepages that guide and teach (thank you Dr. Weed!), with landing pages specific to each operational area of your institution, but yet connected to each other logically by links and strategically-designed news/announcement links. For example, using this index :
1. The Administrative Enterprise (1) Homepage would look something like this :
Notice that in each of these pages, for institutional communication and awareness, there are three news banners for Administrative news local to this page, and also news from the other areas of the organization.
2. The Academic Enterprise (1.a) Homepage would look something like this :
Here again, for awareness - there are three news banners, connecting Academic users with the events happening in Administrative/Research/Clinical Enterprises, and also the clinical services.
3. The Research Enterprise (1.b) Homepage would look something like this :
Again, with its three news banners, the Research Enterprise Homepage connects users with Administrative, Academic, and Clinical Enterprise news.
4. The Clinical Enterprise (1.c) Homepage would look something like this :
While the first level of news banners here is focused on Clinical Enterprise news, the second level connects with Hospital-Based, Ambulatory-Based, and Off-Campus Services, followed by a third with Administrative, Academic, and Research News.
5. The Clinical Enterprise > Hospital-Based Services (1.c.i) Homepage would look something like this :
Here, the primary news links are related to Hospital-Based News, followed by General Clinical Enterprise and Ambulatory Clinical Service News, followed by Administrative, Research, and Academic News.
6. The Clinical Enterprise > Ambulatory-Based Services (1.c.ii) Homepage would look something like this :
Here, the news links will help connect Ambulatory Users to Ambulatory News, followed by General Clinical Enterprise and Hospital-Based news, followed by Administrative, Research, and Academic news/announcements.
7. Finally, the Clinical Enterprise > Off-Campus Services (1.c.iii) Homepage would look something like this :
Here, the news links help connect Off-Campus Clinical Services with Off-Campus News, followed by General Clinical Enterprise news, followed by Administrative, Research, and Academic News links.
Creating this sort of framework is not easy, and would require a significant investment in time and resources to implement and maintain this. One of the biggest challenges would be maintenance - How exactly would you maintain such a framework? Would there be one central 'webmaster' team, or would there be distributed 'webmasters' in different departments, each trained to maintain their area, links, news/announcements, and files?
That being said, I do believe there could be significant benefits to this sort of structure, by educating and empowering all of your employees to strategically find solutions within a few clicks of their landing page.
Either way - I hope this sample index and these designs help you think about how to strategically design and optimize your Intranet for your own institution.
Have any experience with Intranet optimization? See any areas for improvement? Feel free to leave them in the comments section below!
Remember, this blog is for educational purposes only - Your mileage may vary! Do not make any changes to your Intranet strategy without discussing, scoping, prioritizing, and approval from your own leadership teams!
2 comments:
Hi Dirk,
Great article! Just discovered your blog. I agree completely that integrating and communicating different areas and functions of a healthcare system is critical to optimization. As in SOAP noting, thought processes of the writer's assessments and plans must be integrated with the plain data of the patient's situation.
I had the privilege of working with Larry Weed back in 1985-87 as Director of R&D at Presbyterian/St. Luke's Medical Center in Denver. We worked on integrating my AI research into his PKC system (Problem-Knowledge Couplers), an early AI based clinical diagnostic and treatment helper for MDs that automatically integrated the latest clinical diagnostic and treatment concepts, providing an automated decision tree "assistant" for the MD. He was also one of the keynote speakers at my 1986 National Conference on Innovation in Health Care held in Denver. Great to know you knew him!
As in your Standardized Index of Healthcare, the PKC concept faced the challenge of updating all the new research and recommendations that are published each and every day, and communicating it effectively to the providers.
Technology back then (and in the 1990's, when DARPA funded an effort to use PKC for battlefield medic Just In Time diagnostic and treatment headsets) was not up to the humongous amount of input, processing, storage, and output (IPSO) power necessary to make the system useful in real time.
The current level of IPSO today is finally robust enough to support such an effort. My research is working on this problem (along with many others), and hope to have something to show in the near future.
As for creating and maintaining the framework, I have come to believe that the Cloud-based SAAP (System As A Platform) will evolve as the only realistic approach. This would allow a large investment in R&D and maintenance by a central vendor or consortium, with subscriptions spread out among thousands of customer healthcare organizations. Local authors (within an organization) would contribute content to the cloud-based dynamic framework.
Every employee would be able to modify and contribute, in a modified Wikipedia model. A relatively small dedicated group with the organization would coordinate and shepherd both the intranet's organization and content.
Both the Wall Street FinTech sector and the US government (especially the Pentagon via their new Thunderdome system), both first movers in advanced systems, have been evolving in this direction in the last year or two. Healthcare can do well to track and follow their leads.
Cheers,
Mark
Mark Casey
Miyian.com
mark@miyian.com
Hi Dirk,
Great article! Just discovered your blog. I agree completely that integrating and communicating different areas and functions of a healthcare system is critical to optimization. As in SOAP noting, thought processes of the writer's assessments and plans must be integrated with the plain data of the patient's situation.
I had the privilege of working with Larry Weed back in 1985-87 as Director of R&D at Presbyterian/St. Luke's Medical Center in Denver. We worked on integrating my AI research into his PKC system (Problem-Knowledge Couplers), an early AI based clinical diagnostic and treatment helper for MDs that automatically integrated the latest clinical diagnostic and treatment concepts, providing an automated decision tree "assistant" for the MD. He was also one of the keynote speakers at my 1986 National Conference on Innovation in Health Care held in Denver. Great to know you knew him!
As in your Standardized Index of Healthcare, the PKC concept faced the challenge of updating all the new research and recommendations that are published each and every day, and communicating it effectively to the providers.
Technology back then (and in the 1990's, when DARPA funded an effort to use PKC for battlefield medic Just In Time diagnostic and treatment headsets) was not up to the humongous amount of input, processing, storage, and output (IPSO) power necessary to make the system useful in real time.
The current level of IPSO today is finally robust enough to support such an effort. My research is working on this problem (along with many others), and hope to have something to show in the near future.
As for creating and maintaining the framework, I have come to believe that the Cloud-based SAAP (System As A Platform) will evolve as the only realistic approach. This would allow a large investment in R&D and maintenance by a central vendor or consortium, with subscriptions spread out among thousands of customer healthcare organizations. Local authors (within an organization) would contribute content to the cloud-based dynamic framework.
Every employee would be able to modify and contribute, in a modified Wikipedia model. A relatively small dedicated group with the organization would coordinate and shepherd both the intranet's organization and content.
Both the Wall Street FinTech sector and the US government (especially the Pentagon via their new Thunderdome system and others), both first movers in advanced systems, have been evolving in this direction in the last year or two. Healthcare can do well to track and follow their leads.
Cheers,
Mark
Mark Casey
Miyian.com
mark@miyian.com
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