Hi fellow CMIOs, CNIOs, and other Applied Clinical #Informatics and #HealthIT friends,
I'm writing today to share some stories from my career path in Applied Clinical Informatics, and how I became a 'document whisperer' with regard to clinical workflow design. This post stems from a common question I get asked:
'If you care so much about clinical workflows - Then why do you seem to care so much about bylaws, policies, procedures, guidelines, protocols, bylaws, charters, order sets, and other documents? Why don't you just worry about the things inside the EMR?'
The reason is because all of these documents (whether they are inside or outside an EMR) work together to shape clinical workflow.
To explain, I need to first offer some context.
Back in 2007 when I first started my formal clinical informatics career, like most newcomers, I didn't yet have enough experience to fully understand my role. I figured my job was to 'help with the electronic medical record', so naturally, I focused mainly on the things that doctors interacted with inside the EMR.
After a while, however, I started to see challenges we had with some of our projects. There were order sets that, after we built them, didn't get used. There were order sets that created turbulence with other workflows when we rolled them out. I received complaints from doctors who felt the computer was 'too clunky' and that 'it takes too long to get things done'.
Initially, I wondered if this was simply a matter of an EMR just being more difficult to use. There were some people who told me, 'Oh, some doctors are just resistant to change' (which is partly true), and others who told me, 'Computers are just complicated and finicky' (which can also sometimes be true).
But I kept looking for a better answer - There must be some sort of symmetry here that I was missing.
And then, over the next 2-3 years, I experienced two important things :
- I once worked on a complex titration protocol, which required an extensive analysis to fully build out the protocol, and...
- One day, a Registered Nurse complained to me about a policy that would need to be updated, in conjunction with a project we were actively working on.
Trying to find more concrete answers, I looked to various potential sources, including various regulations, the International Standards Organization (ISO), the National Institute of Standards and Technology (NIST), the CMS web site, various HealthIT/Informatics societies, ITIL, and even Black's Law Dictionary, without much help.
"If we gathered every document in healthcare, both those sitting on desks and on hard-drives - what would they be, and what would they look like?"
Template (n.) - A tool used to standardize and expedite the creation of a document.
Document (n.) - A tool used to record and transmit information.
- Definitions can be used to create templates.
- Templates can be used to create documents.
- Documents can be used to store and transmit the information needed to support workflows.
- needed to be aligned with the workflows, goals, and mission above it, and...
- were shaped by the concepts contained in #5, #6, #7, and #8 below it.
- Workflow depends on all of these tools (above) for support.
- Changing workflow means changing all of the tools (both inside and outside the EMR) that are used to support the workflow.
- Clearly understanding each deliverable (tool) above.
- Identifying the deliverables (both inside and outside the EMR) that are needed (or need to change) to support the desired workflow.
- Quickly drafting those deliverables, to demonstrate to users and HealthIT professionals how the deliverables need to fit together,
- Reviewing those draft deliverables with clinical stakeholders, to confirm their needs/expectations before committing them to a formal build, and to help get their input and align expectations.