Thursday, December 2, 2021

Engineering Healthcare : Through A Historical Lens

 Hi fellow CMIOs, CNIOs, Clinical Informatics, and other HealthIT friends,

I'm writing today to share a presentation I recently did, on engineering Healthcare through a historical lens.

Seems like a peculiar title - but it summarizes a lot of the lessons I've learned in my roughly 13 years of both direct clinical and clinical informatics experience.

Below is my slide deck I used - Sharing it in case any of the slides help you develop your presentations on clinical Change/Project Management or Applied Clinical Informatics.

First - My intro slide : 

... which brings me to a brief discussion of our human history of documentation

It was pretty profound to me, when I first fully grasped the magnitude of this simple documentation loop, between both reading and writing information : 

Unfortunately, despite being open for business for over 300+ years - Healthcare has never really had an opportunity to really 'pause' to 'fix the plane' - so a lot of changes have happened serendipitously over this long timeframe : 

... which tells us a few things : 

So how can we do better? We need to start thinking like designers and engineers, and plan our workflows and changes by examining those documents that users interact with every day : 

... and if we look at those documents more closely, we see that roughly half of them are contained inside an electronic medical record - And the other half are outside. This gives us the roughly 24 building blocks of all clinical workflows : 

So if we depend on those 24 documents to be the building blocks of all clinical workflows - How do we help make sure these documents are as functional as they need to be? It all starts with functional definitions - Both what it's called, and what it does.

Once you have those functional definitions, this helps you create a working glossary and document templates, to help you quickly develop high-quality documents to build your workflows from : 

And to help you further develop your documents, it helps to understand how to build them in the most robust way - Aligning the concepts > terminology > templates > documents > workflows > goals/regulations > mission/vision

Now that you know how to engineer these documents for maximum benefit, it's helpful to figure out how to move (change) from Point A (current) to Point B (future). The distance between these two points gives you a rough estimate of which tools you will need to get there, and the project scope - How much time, people, and resources it will take to get there

Once you have your stakeholders and deliverables identified, it's helpful to orchestrate your change in a linearorganized, thoughtful, and predictable manner. For this, I offer up a helpful general-purpose change management recipe

If you don't have an organized process for managing/engineering changes - you could fall into one of these engineering pitfalls, which can lead to unexpected outcomes

... all of which should be aligned to your policies and procedures, the standards of your organization : 

A few final tips and closing thoughts, about planning, infrastructure, and clinical operations :

... and my final thank you and advice : "Control your documents, before they control you."

I hope these slides help you develop your own presentations on Applied Clinical Informatics, and the importance of solid clinical leadership and clinical change / project management
Thank you!

Remember - This blog is for educational and discussion purposes only - Your mileage may vary!

Have any secrets about policy writing, workflow development, or project/change management? Feel free to share in the comments section below!!