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 linear, organized, 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!!