tag:blogger.com,1999:blog-84340509317895720152024-03-17T09:54:58.076-04:00DirkMD - CMIO PerspectiveWeaving the DNA of #Healthcare. Learn about front-line applied clinical informatics, clinical workflow design, and EMR implementation with an experienced CMIO. Open discussion is encouraged, education is a priority. All opinions are strictly my own.Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.comBlogger149125tag:blogger.com,1999:blog-8434050931789572015.post-44410014738807451732024-03-17T02:25:00.007-04:002024-03-17T09:54:25.392-04:00Developing and Approving an Order Set<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, and other Clinical #Informatics and #HealthIT friends,</i></span></p><p><span style="font-family: helvetica;">Today I thought I'd share some helpful slides from a discussion that very few people write about - <b>Developing and approving order sets.</b></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3m1OfEtX8GpSeDW3U-EarLsyBpHKPiLfzwojQmBhDQFiMvyDsbMmgyVuGNIQYiQ0XJuUUZsZRMILDGNNn2VJdaIVE-FrjY9WR7ity34aLN_SdOHzPytZJ-xl2_njegULLZaSjZpmju-CgLOnw1HcXZZfev0_YQI4FF-gbik6eQURwb-j0DO9838HOed6Y/s1820/Slide1.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3m1OfEtX8GpSeDW3U-EarLsyBpHKPiLfzwojQmBhDQFiMvyDsbMmgyVuGNIQYiQ0XJuUUZsZRMILDGNNn2VJdaIVE-FrjY9WR7ity34aLN_SdOHzPytZJ-xl2_njegULLZaSjZpmju-CgLOnw1HcXZZfev0_YQI4FF-gbik6eQURwb-j0DO9838HOed6Y/w400-h300/Slide1.jpeg" width="400" /></span></a></div><p><span style="font-family: helvetica;">This is a topic where far too little has been shared openly, so many organizations struggle unnecessarily until they learn through repeated trial-and-error how to do this in a much more smooth, efficient way.</span></p><p><span style="font-family: helvetica;">Unfortunately, it also brings up the question about maintenance of order sets : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">Yes, order sets can help <b>save time, reduce clicks</b>, and <b>reduce unexpected pages</b> from staff, <i>but...</i></span></li><li><span style="font-family: helvetica;">They can also take a lot of work to develop, approve, monitor, and maintain.</span></li></ul><span style="font-family: helvetica;"></span><p></p><p><span style="font-family: helvetica;">So our agenda for today includes : </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2nS9O3ZyzuoCdiVcqwFaCPe3CCXld6biGpBm0xX-WF58zFIHVgUy1ZwxdEL6Max-zi9v3LYGyjlddvCpnV01ZYHThJdUbyXgxwzGRHxhyMceU9w_7OdDgKi0uQleXtCD8XIqyB-UZL3Pu_Ruei32hzkUELCWmkgh6IqZkgNE6ccOxG9FMaylciSb7ReGr/s1820/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2nS9O3ZyzuoCdiVcqwFaCPe3CCXld6biGpBm0xX-WF58zFIHVgUy1ZwxdEL6Max-zi9v3LYGyjlddvCpnV01ZYHThJdUbyXgxwzGRHxhyMceU9w_7OdDgKi0uQleXtCD8XIqyB-UZL3Pu_Ruei32hzkUELCWmkgh6IqZkgNE6ccOxG9FMaylciSb7ReGr/w400-h300/Slide2.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">First, what exactly do we mean by '<b>Order Sets</b>'?</span></p><p><span style="font-family: helvetica;"><b>Order sets</b> are sometimes referred to as '<b>Ordering Tools</b>', since different vendors use different terminology to describe these <b>collections of orders</b> that are used to standardize and expedite the ordering process for a <b>common, well-described clinical scenario</b>.</span></p><p><span style="font-family: helvetica;">Because they <b>look so similar</b> (<i><span style="color: #2b00fe;">and even share some of their definitions!</span></i>), <b>Order sets</b> are sometimes confused for <b>order panels,</b> <b>pick-lists, </b>and<b> clinical pathways</b><b>:</b></span></p><p></p><ol style="text-align: left;"><li><b>Order Set (</b><i>n.</i><b>) - </b>A collection of orders used to standardize the ordering process for a common, well-described clinical scenario (<i><span style="color: #2b00fe;">e.g. workup, treatment, admission, discharge, prep, postop, protocols, etc for pediatric and adult/geriatric patients.</span></i>)</li><li><b>Order Panel (</b><i>n.</i><b>)</b> - A collection of common orders of a specific type, typically designed for inclusion in order sets (<span style="color: #2b00fe;"><i>e.g. common pain meds, common GI meds, common labs, common nursing orders</i></span>)</li><li><b>Pick-List (</b><i><span style="color: #2b00fe;">aka 'Quick Preference List' or 'Convenience Panels'</span></i><b>) (</b><i>n.</i><b>) - </b>A collection of common orders of a specific type, typically designed for convenience only, that is <b>not</b> related to a specific, well-described clinical scenario (<i><span style="color: #2b00fe;">e.g. common pain meds, common IV fluids, common anti-emetics, common lab orders, common radiology orders, etc.</span></i>)</li><li><b>Clinical Pathway</b> <b>(</b><i>n.</i><b>)</b> - A collection of <b>order sets </b>used to standardize and expedite the daily ordering process (<i><span style="color: #2b00fe;">typically throughout the course of a planned hospitalization</span></i>) for a defined clinical condition, procedure, or surgery.</li></ol><p></p><p><span style="font-family: helvetica;">Order sets also typically come in <b>two types</b> : </span></p><p></p><ul style="text-align: left;"><li><b>Oncology Order Sets</b> - Typically broken out in a separate category, because of the unique, complex ordering needs for chemotherapy and biologic infusions (<span style="color: #2b00fe;"><i>e.g. monoclonal antibodies</i></span>)</li><li><b>All other Order Sets (</b><i><span style="color: #2b00fe;">General order sets</span></i><b>)</b> - Typically related to <b>working up</b> common chief complaints, <b>treating</b> common conditions/diseases, <b>admitting/discharging</b> to/from an inpatient area, <b>preparing</b> for a surgery/procedure, <b>recovering</b> from a surgery/procedure, and <b>special protocols</b> (<i><span style="color: #2b00fe;">to automate common, high-risk clinical scenarios where the benefits of standardization and timely delivery of care outweigh any known risks</span>)</i>.</li></ul><p></p><p><span style="font-family: helvetica;">For this purposes of this post, we will mostly be discussing the second category above - General order sets. (<i><span style="color: #2b00fe;">We could write a whole separate post about the unique needs of Oncology and biologic infusion ordering workflows.</span></i>)</span></p><p>So before we get to our <b>development</b> discussion, let's first start with our <b>approval</b> discussion - In a typical healthcare organization, who is best-suited to <b>approve</b> an order set?</p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP7aL-TAWCJsBqqYDcH2Dt2ICH9XbfQqWIBl3oFomkUdSNvUOegcxY4LcSei7Hnt1b13iqsdghae5e8tXW_Btca7vCGRqEzMAQN6fz9qqsU5fSNSuQ8H5aBfTuH9RMPVVqL0o_CJQxEir-JA50J_6wce5OflMegMG5iMrOKzGkXf8tPFm-BONBg-4FJxO3/s1820/Slide3.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP7aL-TAWCJsBqqYDcH2Dt2ICH9XbfQqWIBl3oFomkUdSNvUOegcxY4LcSei7Hnt1b13iqsdghae5e8tXW_Btca7vCGRqEzMAQN6fz9qqsU5fSNSuQ8H5aBfTuH9RMPVVqL0o_CJQxEir-JA50J_6wce5OflMegMG5iMrOKzGkXf8tPFm-BONBg-4FJxO3/w400-h300/Slide3.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p>Many organizations struggle with this question, because there's usually <b>no one person</b> who has all of the <b>time</b>, <b>expertise</b>, and <b>authority</b> needed to approve an order set. I sometimes describe this as the <b>'<i>Captain Kirk and Scotty</i>' paradox</b> : </p><p></p><ul style="text-align: left;"><li><b>Captain Kirk</b> = Has all the <b>authority</b>, but little <b>expertise</b></li><li><b>Scotty</b> <b>and engineers </b>= Have all the <b>expertise</b>, but little <b>authority</b></li></ul><p></p><p>So ultimately, the lesson here is : <b>Captain Kirk, Scotty, and the other engineers have to work <u>together</u></b> to <i>make the ship run</i>.</p><p>Some organizations chose to focus on expediency, by assigning one person or one team - sometimes a <b>clinical officer</b> (<i><span style="color: #2b00fe;">CMO, CNO, or both?</span></i>) or an <b>appointed committee</b> (<i><span style="color: #2b00fe;">chaired by a CMO, CNO, CMIO, and/or CNIO?</span></i>) - But is that enough? Are there any helpful regulations or published best practices, and if so, what do they say?</p><p>Unfortunately, <i>there's not much</i>. As of 2024, order sets are still a bit of a mystery to most regulatory agencies. Not only does CMS use the terms "<b>Standing Orders</b>", "<b>Order Sets</b>", and "<b>Protocols</b>" <i>interchangeably</i>, but there are very few published best practices openly available on the Internet. The <a href="https://www.clinfowiki.org/wiki/index.php/Main_Page" target="_blank">OHSU ClinfoWiki</a> has some helpful information about oversight and governance in these published pieces :</p><p></p><ul style="text-align: left;"><li>"<a href="https://www.clinfowiki.org/wiki/index.php/Creating_Order_Sets" target="_blank">Creating Order Sets</a>"</li><li>"<a href="https://www.clinfowiki.org/wiki/index.php/Making_Sense_of_Clinical_Practice:_Order_Set_Design_Strategies_in_CPOE" target="_blank">Making Sense of Clinical Practice: Order Set Design Strategies in CPOE</a>"</li><li>"<a href="https://www.clinfowiki.org/wiki/index.php/Enhancing_Physician_Adoption_of_CPOE:_The_Search_for_a_Perfect_Order_Set" target="_blank">Enhancing Physician Adoption of CPOE: The Search for a Perfect Order Set</a>"</li></ul>... but while there's some helpful information about oversight committees and mentions of templates, these articles don't contain much concrete detail about the exact development or approval processes, or samples of templates.<p></p><p>So the most concrete regulatory guidance seems to come from the <a href="https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-482/subpart-C/section-482.24" target="_blank"><b>Centers for Medicaid Services</b> (<i>CMS</i>) 42 CFR ยง 482.24</a>, under section (3) which states : </p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGWK2_QnUhSszckoPX2PfDj1C11GRsYupuajqa7xO-ytPfYCeGkKSdVjPuHEfoXTCRPH0t1wYMfb4NrmHfIXE-HZO54UOGJNE5Zlp0glQzj9Sx0vlaF7Fh3WcAaLQDW3yBmlAccHQOpyCQgZWOMge_z_ztQ6d9-jyIO9_k89HX7BCK-9zlm80s7NkKUJWm/s1820/Slide5.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGWK2_QnUhSszckoPX2PfDj1C11GRsYupuajqa7xO-ytPfYCeGkKSdVjPuHEfoXTCRPH0t1wYMfb4NrmHfIXE-HZO54UOGJNE5Zlp0glQzj9Sx0vlaF7Fh3WcAaLQDW3yBmlAccHQOpyCQgZWOMge_z_ztQ6d9-jyIO9_k89HX7BCK-9zlm80s7NkKUJWm/w400-h300/Slide5.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">So if CMS expects the <b><span style="color: #2b00fe;">Medical Staff</span></b> and the hospital's <span style="color: #6aa84f;"><b>Nursing</b></span> and <b><span style="color: red;">Pharmacy</span></b> leadership to be '<i>reviewing</i>' order sets - Does that mean <b>three committees</b> need to be involved in the review/approval process? (<i>E.g. <span style="color: #2b00fe;">Medical Board/Medical Executive Committee</span>, <span style="color: #38761d;">Nursing Council</span>, and <span style="color: red;">Pharmacy and Therapeutics</span>?</i>) Or should those committees delegate a <b>separate team</b> to just focus on order sets? Or should the <b>clinical leadership</b> of those areas (<i>e.g. <span style="color: #2b00fe;">CMO</span>, <span style="color: #38761d;">CNO</span>, and <span style="color: red;">VP of Pharmacy</span></i>) approve the order sets? Even if they have the time and expertise to <b>approve</b> order sets, do they have the time to <b>develop</b> them? And if they don't have the time and bandwidth to <i>'get into the weeds</i>' to <b>develop</b> them, how can they feel confident about <b>approving</b> them?</span></p><p style="text-align: center;"><span style="font-family: helvetica;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix233OnF6yYxeyG4WUYh80D5hFkwCt9SHi_l1rN5zpOcpGK8JTWcjikZA0cr4J5A4x5bepSB4Yoq-ejeM2bJ4yBe9Kt7GDjYAj0_GVspOpclrbP8lz5Z_x8qjjKBDk1j1bBRd-fLxR_7dpIijBXznGRmAN9rpfdKtjnTHjhqhGIvqw5FgVitwRBfW6J9vG/w400-h300/Slide6.jpeg" width="400" /></span></span></p><p>And what about the <b>other supporting departments</b> in a clinical enterprise - <span style="color: #800180;"><b>Laboratory</b></span>, <span style="color: #ffa400;"><b>Radiology</b></span>, and <span style="color: #666666;"><b>other ancillary services</b></span>? When the <a href="https://www.clinfowiki.org/wiki/index.php/Main_Page" target="_blank">OHSU ClinfoWiki</a> article on "<a href="https://www.clinfowiki.org/wiki/index.php/Creating_order_sets" target="_blank">Creating Order Sets</a>" says, "<i><span style="background-color: white;">They have their needs thoroughly examined by their practice management oversight group, nursing, support staff and </span><span style="background-color: #fcff01;">anyone who might be affected by the order set</span></i><span style="background-color: white;">," who exactly might be affected by the order set? After all, don't doctors just <b>write</b> orders, and other people in the organization have to <b>execute/follow-through </b>with them?</span></p><p><span style="background-color: white;">Well, <i>it's not that simple</i>. Clinical staff affected by the order set include <b>both</b> : </span></p><p></p><ul style="text-align: left;"><li>The staff <b>writing/creating</b> orders (<span style="color: #2b00fe;"><i>typically <b>Ordering Providers</b>, including Attendings, Residents/Fellows, Advanced Practice Providers/APRNs/PAs/CRNAs etc.</i></span>)</li><li>The staff <b>following/executing</b> orders (<i><span style="color: #2b00fe;">commonly <b>everyone else</b> in a clinical enterprise, including Nursing, Pharmacy, Lab, Radiology, Bed Management, Case Management, Dietary/Nutrition, and other ancillary support services</span></i>)</li></ul><p></p><p>Some doctors initially <b>bristle</b> when they learn that other specialties are involved in reviewing and approving their order sets. <i>But if we take a step back</i> - Order sets create <b>patterns of clinical care and utilization</b> that have an impact across the <b>whole organization</b>, so it shouldn't be a surprise that other people are involved in reviewing the best practices, and planning utilization and resource needs to execute and follow-through with those orders.</p><p>So how do we make sense of this? It helps to imagine a '<b>pyramid</b>' of delegation and oversight, one that helps to connect <b>Captain Kirk</b> (<i><span style="color: #2b00fe;">all authority, little expertise</span></i>) with <b>Scotty</b> and <b>his engineers </b>(<i><span style="color: #2b00fe;">all expertise, little authority</span></i>)<b> :</b></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw98XV2MDETsNvceIFZboIEznUvq4r7oMCyChQzfq78WF_NPRQ3toxNSeWZFdjYDUAwoBVx4j85DwjFVnM-STBfZyeAKZ8BietafLxTFe_tJ8FPgH2rEHxYVX8NuNtL4yPAoEUFYSlHwqCkhlHRB-6XPh05XnfQTAjMTZKrNKCWwGD0FcQN06wxmeFzsjg/s1820/Slide8.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw98XV2MDETsNvceIFZboIEznUvq4r7oMCyChQzfq78WF_NPRQ3toxNSeWZFdjYDUAwoBVx4j85DwjFVnM-STBfZyeAKZ8BietafLxTFe_tJ8FPgH2rEHxYVX8NuNtL4yPAoEUFYSlHwqCkhlHRB-6XPh05XnfQTAjMTZKrNKCWwGD0FcQN06wxmeFzsjg/w400-h300/Slide8.jpeg" width="400" /></a></div><p></p><p>... which is a <b>very basic operational unit</b> that can be employed in developing a process for reviewing and approving order sets. So in a typical clinical enterprise, there is a <b>similar pyramid</b> for the major clinical disciplines involved in the delivery of care (<i><span style="color: #6aa84f;"><b>Nursing</b></span>, <span style="color: red;"><b>Pharmacy</b></span>, and <span style="color: #2b00fe;"><b>Physicians</b></span></i>):</p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvHk3SYsh1UuiA4NvcpIy-FMGRO9ZjH-TDRPOUcJXN36I864iSxwsMRkbrFxEgL6E-XMBpyJJeafR4EHG6ayv8hRkO0bg1SpP_FVTrmD5sKEAASLIS5NoCUKA4nAeQwzYy0zuQe5EwG-7sCC2t2HH2zpo2xMy8evU1pVLhoCJo0KK9XvMLWtHl_hjj1zm5/s1820/Slide7.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvHk3SYsh1UuiA4NvcpIy-FMGRO9ZjH-TDRPOUcJXN36I864iSxwsMRkbrFxEgL6E-XMBpyJJeafR4EHG6ayv8hRkO0bg1SpP_FVTrmD5sKEAASLIS5NoCUKA4nAeQwzYy0zuQe5EwG-7sCC2t2HH2zpo2xMy8evU1pVLhoCJo0KK9XvMLWtHl_hjj1zm5/w400-h300/Slide7.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">There are also similar pyramids for <span style="color: #800180;"><b>Lab</b></span>, <span style="color: #e69138;"><b>Radiology</b></span>, and <span style="color: #999999;"><b>other Ancillary Services (</b><i>such as Physical Therapy, Occupational Therapy, Dietary/Nutrition, Case Management, Social Work, etc.</i><b>)</b></span> :</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtiyRvR7ae_cvWrSO20TJrhUQmp2KRF2lE1EUnCdmYbnzNhPBxsavpSTM4MAAofB3VghyphenhyphenrVb3VJcrS3RXPK1l4-0zozqRWJh2UkZQIXjLqekmmCXdHrgqpk7U0vwsFlHRvID4SQe-bREFuVLGOewmExXRxHF2WnDZOHSQBxWp01e8ECP3-EDbRrKSikhUO/s1820/Slide8.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtiyRvR7ae_cvWrSO20TJrhUQmp2KRF2lE1EUnCdmYbnzNhPBxsavpSTM4MAAofB3VghyphenhyphenrVb3VJcrS3RXPK1l4-0zozqRWJh2UkZQIXjLqekmmCXdHrgqpk7U0vwsFlHRvID4SQe-bREFuVLGOewmExXRxHF2WnDZOHSQBxWp01e8ECP3-EDbRrKSikhUO/w400-h300/Slide8.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">So now, let's see if we can answer the question : <i><b>Who exactly is affected</b> by an order set</i>? Well it depends largely on the <b>complexity</b> of your order set. <b>Small, short order sets</b> typically have <i>fewer</i> stakeholders, and <b>larger, complex order sets</b> typically have <i>more</i>. </span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjF5LuJBBeO_PkCcpevmeVr7schnyIkJQDlWK9Pxe4H_A3HH0Z_1TkFQRXETTxcxQlua8C8fzSxaIyKRDf5qYrQlvtTRQ0Ez8SqTVF5JBagpvSzvE2v7YMrQa6EXQWPxEVISKNbZl4g33q6j3XphrJjU9-t7vbc6QC_K1agXiBSM0nm1hAgONSKnvqbtGVF/s1820/Slide9.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjF5LuJBBeO_PkCcpevmeVr7schnyIkJQDlWK9Pxe4H_A3HH0Z_1TkFQRXETTxcxQlua8C8fzSxaIyKRDf5qYrQlvtTRQ0Ez8SqTVF5JBagpvSzvE2v7YMrQa6EXQWPxEVISKNbZl4g33q6j3XphrJjU9-t7vbc6QC_K1agXiBSM0nm1hAgONSKnvqbtGVF/w400-h300/Slide9.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;"><b>Exactly who</b> needs to participate in the discussion will depend on the <b>type(s) of orders</b> in your order set. You can create a <b>very helpful order set development template</b> by identifying and aggregating your <b>most common order types</b>. Most healthcare organizations can divide up all patient care orders into one of <b>sixteen</b> (16) <b>groups</b> : </span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRb-Eixi6EG6mSgRTRjg3aQGwdXck2zFe8kWHwVZACGdcUWKe935CbaUFI2snq5uyiskN3n57BJWJ1ovIVSmtkCqM96QSn9_rrmBaaaUPII912HPl0bLyGT3UNRpevaNRbIx9tynh_wFfwaqWm6mMoOYj5c0u4moitA2RJSzcQUAXSvklqtCMonLoy5DGJ/s1820/Slide10.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRb-Eixi6EG6mSgRTRjg3aQGwdXck2zFe8kWHwVZACGdcUWKe935CbaUFI2snq5uyiskN3n57BJWJ1ovIVSmtkCqM96QSn9_rrmBaaaUPII912HPl0bLyGT3UNRpevaNRbIx9tynh_wFfwaqWm6mMoOYj5c0u4moitA2RJSzcQUAXSvklqtCMonLoy5DGJ/w400-h300/Slide10.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Since each order type has a <b>unique function</b>, usually executed/performed by a <b>unique stakeholder</b> - You can then take these sixteen (16) order types, import them into a spreadsheet, and next identify the <b>common stakeholders </b>for each<b> order type</b> : </span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiT9nEoBpI2bo3wii9VGCZq3jhGcypgHqLt0uuQppJtLTrCIZwB_9PbvzjqGF4XoNVg5vvqq4W0LnvQw6TJ9DkulKeo_SsqX-kLFNMu85hGX9k6hCmvNIZu-mup73FllYD9bwU7Fan8Qz48cRXxd-0Dg2ThtE3zz-Ypaqn6VQQ-e5Qtrd0guGEpj8qZdcb5/s1820/Slide11.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiT9nEoBpI2bo3wii9VGCZq3jhGcypgHqLt0uuQppJtLTrCIZwB_9PbvzjqGF4XoNVg5vvqq4W0LnvQw6TJ9DkulKeo_SsqX-kLFNMu85hGX9k6hCmvNIZu-mup73FllYD9bwU7Fan8Qz48cRXxd-0Dg2ThtE3zz-Ypaqn6VQQ-e5Qtrd0guGEpj8qZdcb5/w400-h300/Slide11.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Once you've identified the <b>common stakeholders</b> for each <b>order type</b>, you can then create a <b>standardized order set template</b>, that not only helps define <i>expected standards</i> for each order type (<i>e.g. medication orders with medication doses, routes, frequencies, etc.)</i>, but also the stakeholders necessary to participate in the review and approval of the order set :</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQ6t9QmfMh9C9Urmo0-NA5lZtxzx64PyDjTZC71-3Ak5hh5y6HM5w0f5ffSFSiPOuk77kpsIii88gZNUXnm8x7VHe7hPzTVRYLWLJ6HhntPtR3F6qIqa7-78lJjwLSYFAlNZLNJX2XEajbPYd0ScQp-0Sdf1PLS-MES0LMHTCjR48PrTk4zRdoiPkd94k0/s1820/Slide12.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQ6t9QmfMh9C9Urmo0-NA5lZtxzx64PyDjTZC71-3Ak5hh5y6HM5w0f5ffSFSiPOuk77kpsIii88gZNUXnm8x7VHe7hPzTVRYLWLJ6HhntPtR3F6qIqa7-78lJjwLSYFAlNZLNJX2XEajbPYd0ScQp-0Sdf1PLS-MES0LMHTCjR48PrTk4zRdoiPkd94k0/w400-h300/Slide12.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Once you have this template, you can first try it out with a <b>simple</b> order set, say, with just a <b>Procedure</b> order, some <b>Activity</b> and <b>Nursing</b> orders, some <b>Diet</b> orders, and some <b>IV fluid orders</b> :</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvsROmCfokzLMvNiI41YnNOFnb5e7WkV_2TipoZzz_uaAs5Mf6fpAhO3qNdOMIIG0PC51aIRa0M3fBkYnyrpaXvhSg9O5fH81wEf70DyomFrWYs2M1K_0wv3JXI9W9l2-jGlS4rZIJuVO9ChM2M4fvjOtPy0Il8guZCw5NLhBI8v9YlRWxbzh8I9S4u3cY/s1820/Slide13.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvsROmCfokzLMvNiI41YnNOFnb5e7WkV_2TipoZzz_uaAs5Mf6fpAhO3qNdOMIIG0PC51aIRa0M3fBkYnyrpaXvhSg9O5fH81wEf70DyomFrWYs2M1K_0wv3JXI9W9l2-jGlS4rZIJuVO9ChM2M4fvjOtPy0Il8guZCw5NLhBI8v9YlRWxbzh8I9S4u3cY/w400-h300/Slide13.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p>Or, you can try it with a more <b>complex</b> order set, one that includes : <b>ADT orders</b>, <b>Code Status orders</b>, <b>Procedure orders</b>, <b>Activity orders</b>, <b>Blood Bank orders</b>, <b>Nursing orders</b>, <b>Diet orders</b>, <b>IV Fluid orders</b>, <b>Medication orders</b>, <b>Laboratory orders</b>, <b>Diagnostic Radiology orders</b>, <b>Consult/Referral orders</b>, and <b>Discharge Education orders</b> -</p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtH2l3yMhjCmNUu7l2VXvGEQIhLj5-V6IcUGA37NayUT3AJjhBu8cJynophHrQfMSBjGDlhA7HFjGPrgIJk3mjIgVboVIOBapNBua_AsNIuE4GO7lOOonMRSsW42gXjn-XmM7NpuHTrIPw4ig05ZUUkmBU_7t9jcftfx6p8svw-7Ip_eJd5jZbQPSwcY12/s1820/Slide14.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtH2l3yMhjCmNUu7l2VXvGEQIhLj5-V6IcUGA37NayUT3AJjhBu8cJynophHrQfMSBjGDlhA7HFjGPrgIJk3mjIgVboVIOBapNBua_AsNIuE4GO7lOOonMRSsW42gXjn-XmM7NpuHTrIPw4ig05ZUUkmBU_7t9jcftfx6p8svw-7Ip_eJd5jZbQPSwcY12/w400-h300/Slide14.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">This is helpful when trying to plan new order sets, so you can identify who to invite to your build discussions.</span></p><p>Now, since I'm discussing order sets, I thought it would be helpful to mention the surprising importance of <b>solid, well-planned <u>naming conventions</u></b>. </p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfqOKCUXOMSWeMvk6UAZXOO1AAvtzrlrMVnHMm2pyQzTM2jYChEylv7SC7XyB8zmFaVw7T0kACE7fGfF_LmVJ39j4pziW-8IoNmyQLqnB-g0PC5UJieANPeucdOtSFOZJMdhbIBPKRJzVClCaVUhY1rLUEFGYlUwYO4YR4OasvfVZl9tsX0NZf2P0cRIux/s1820/Slide15.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfqOKCUXOMSWeMvk6UAZXOO1AAvtzrlrMVnHMm2pyQzTM2jYChEylv7SC7XyB8zmFaVw7T0kACE7fGfF_LmVJ39j4pziW-8IoNmyQLqnB-g0PC5UJieANPeucdOtSFOZJMdhbIBPKRJzVClCaVUhY1rLUEFGYlUwYO4YR4OasvfVZl9tsX0NZf2P0cRIux/w400-h300/Slide15.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Early in my Informatics career, I would have <i>never have guessed</i> the importance of <b>naming conventions</b>. A few people warned me, but at first I was <i>skeptical</i>. I actually once said something like this : "<i>What does it matter, what you call it? As long as they can find it!</i>"</span></p><p><span style="font-family: helvetica;">What I didn't know at the time (<i><span style="color: #2b00fe;">and learned with experience</span></i>) is that <b>naming conventions</b> : </span></p><p></p><ul style="text-align: left;"><li><b>Determine the <u>size</u> of your order set library</b> - <i>More <b>coarse/vague</b> naming conventions result in <b>fewer</b> order sets, and more <b>specific/granular</b> naming conventions result in <b>more</b> order sets</i>.</li><li><b>Determine</b> <b>how easy</b> it will be for your users to <b><u>find</u></b> (<i><span style="color: #2b00fe;">and bookmark</span></i>) the order set.</li><li>Help determine whether you are clearly building a time-saving <b>order set - </b>Or if you are confusing it for a <b>Pick-List</b>, <b>Order Panel</b>, or <b>Clinical Pathway</b>. </li><li><b>Strongly influence</b> the <b><u>number of clicks</u></b> and <b><u>unexpected pages</u></b> your users will experience - The <b>more clear and specific</b> the naming convention is, the more you can <i>pre-configure</i> and <i>pre-click</i> default settings (<span style="color: #2b00fe;"><i>so your users don't have to!</i></span>)</li></ul><div>Knowing that well-described, <b>scenario-specific</b> <b>order sets</b> help reduce clicks and unexpected pages more than general <b>Pick-Lists</b> (<i><span style="color: #2b00fe;">aka '<b>quick preference lists'</b> or '<b>convenience panels'</b></span></i>), I thought I'd share one way to <b>index</b> your order set catalog, based on your most common patient types, common chief complaints, common treatments, common surgeries and procedures, and common protocols :</div><p></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEishxQO_PHV4QGU3Y7ed3G8UzZCfjY5QzFRwIUUX_m7MQcPabRPgc1xmQhA9v10TJ1YOzfk4M2520j9NXhLNeZXzqi5ib48ZYXOd8oA6qMv673PEj6xBkh53uxluXobHHurYlu8YrIBaSHewOpiwuXREaWpXhC5vT8QNLnIsPwL_WyUfu79IiWX6If2TYHx/s1820/Slide16.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEishxQO_PHV4QGU3Y7ed3G8UzZCfjY5QzFRwIUUX_m7MQcPabRPgc1xmQhA9v10TJ1YOzfk4M2520j9NXhLNeZXzqi5ib48ZYXOd8oA6qMv673PEj6xBkh53uxluXobHHurYlu8YrIBaSHewOpiwuXREaWpXhC5vT8QNLnIsPwL_WyUfu79IiWX6If2TYHx/w400-h300/Slide16.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">So with that - First, some <b>helpful take-home reminders</b> : </span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8gFwv-t_iAt2P0ZcdkjxiuTWB773WLAArSr_nxDKnsqzLWeZ5Dy0i_x3GaSNA8cMugFgTipZyBumMB1Fc3R7encCB6WOVPh0KHiq0N1uNGj9WMTwgXFHFmc_zarMPt8XhZw_mlDixPKOerASSbEDVxpDzqUNUTv2LDCtdqtcERYi_j7mL_P58olJjV6nA/s1820/Slide17.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8gFwv-t_iAt2P0ZcdkjxiuTWB773WLAArSr_nxDKnsqzLWeZ5Dy0i_x3GaSNA8cMugFgTipZyBumMB1Fc3R7encCB6WOVPh0KHiq0N1uNGj9WMTwgXFHFmc_zarMPt8XhZw_mlDixPKOerASSbEDVxpDzqUNUTv2LDCtdqtcERYi_j7mL_P58olJjV6nA/w400-h300/Slide17.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p>... and a few more to consider as you create and develop your governance and order set <i>development</i>, <i>review</i>, and <i>approval</i> processes with your Clinical, Legal, Compliance/Regulatory, Finance, and other leadership :</p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHuocMs1UvPc5kDV2MEy7QRPjrbpm91DEg9I7Oq8YnkrphO4dcyWk0cWtx52uu8UQzJMzzjyWVIrIRU5vZzrn4Mu-dxNA5s6JGOIDF28i1mCLTldJ1mIwCdlvYU2vxD7_9Y0ezrpmoHoYwyXzl57_6LbWDs7G1PpbqNUVI7v7ODudrU8CCjnd7lA2SVrd5/s1820/Slide18.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHuocMs1UvPc5kDV2MEy7QRPjrbpm91DEg9I7Oq8YnkrphO4dcyWk0cWtx52uu8UQzJMzzjyWVIrIRU5vZzrn4Mu-dxNA5s6JGOIDF28i1mCLTldJ1mIwCdlvYU2vxD7_9Y0ezrpmoHoYwyXzl57_6LbWDs7G1PpbqNUVI7v7ODudrU8CCjnd7lA2SVrd5/w400-h300/Slide18.jpeg" width="400" /></span></a></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">I hope this quick review has been helpful and provides some helpful food for thought for your own team discussions! Since there is not much written about this subject, please feel free to share feedback in the comments section below.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>Remember, this blog is for educational and discussion purposes only - <b>Your mileage may vary</b>!</i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>Have any experiences building order sets, leading order set teams, or creating or an order set development and approval process? </i></span><i style="font-family: helvetica;">Feel free to share any helpful feedback or experiences in the comments section below! </i></div><div class="separator" style="clear: both; text-align: left;"><i style="font-family: helvetica;"><br /></i></div><p></p>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-76481610940639932022024-02-23T02:12:00.003-05:002024-02-24T09:42:43.083-05:00Why Healthcare needs Clinical Architects<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, and other Clinical Informatics friends,</i></span></p><p><span style="font-family: helvetica;">Some of you might already be familiar with <a href="https://twitter.com/hashtag/blueprintsbeforebuild" target="_blank">#BlueprintsBeforeBuild</a>, the hashtag I started several years ago (<i><span style="color: #2b00fe;">on X/Twitter, LinkedIn, and elsewhere</span></i>) to help create awareness of the need for good workflow design in healthcare technology. </span></p><p><span style="font-family: helvetica;"><span>You might also be aware of the value of having an </span><b>Applied Clinical Informatics</b><span> (</span><i><span style="color: #2b00fe;">'Clinical Architecture'</span></i><span>) team in Healthcare, to assist with things like : </span></span></p><p></p><ol style="text-align: left;"><li><span style="font-family: helvetica;"><b>Project Intake or Procurements</b> that require additional support or workflow evaluations, to help ensure the technology does not already exist, and to help ensure proper scoping, budgeting, stakeholder identification, resource allocation, necessary safety, compliance, and regulatory reviews, and expected outcomes.</span></li><li><span style="font-family: helvetica;"><b>Special Event Workflow Planning</b> (<span style="color: #2b00fe;"><i>e.g. Planned upgrades and maintenance, unplanned downtimes, project go-lives, etc.</i></span>)</span></li><li><span style="font-family: helvetica;"><b>Complex IT Tickets</b> that require workflow updates or modifications (<span style="color: #2b00fe;"><i>which often span multiple areas with multiple stakeholders</i></span>)</span></li><li><span style="font-family: helvetica;"><b>Complex Projects</b> that require clinical translation, terminology work, stakeholder alignment, or other workflow updates/modifications</span></li><li><span style="font-family: helvetica;"><b>Ongoing Maintenance of existing configuration / workflows</b> to meet CMS/TJC regulations, that require continuous staff engagement with multiple stakeholders across different areas and specialties. </span></li><li><span style="font-family: helvetica;"><b>Helping to ensure clinical workflows are aligned</b> with the Clinical, Administrative, HIM, Regulatory/Compliance, coding/billing, and revenue capture needs of the organization. </span></li></ol><div><span style="font-family: helvetica;">So while my last post helped to ask and answer the question, "<a href="https://www.dirkstanley.com/2023/11/wheres-clinical-informaticist.html?spref=tw" target="_blank"><i>Where is the Clinical Informaticist?</i></a>", this month's post is related to my support of an easy way to make Applied Clinical Informatics <b>more familiar and tangible</b> <i><span style="color: red;"><b>for newcomers</b></span></i> - Instead of "<span style="color: #2b00fe;"><i>Clinical Informatics</i></span>", consider using the synonyms "<b><span style="color: #2b00fe;">Clinical Architect</span></b>" and "<b><span style="color: #2b00fe;">Clinical Architecture</span></b>" :</span></div><div><span style="font-family: helvetica;"> </span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZzOPlNtF5Uif2DVJgKBAQ5r2qzTqWv9DgBW_xenicNbbBNKqPgn5nq5PaMK9avRJoMdI-GaTE4TP0qspxZuzyCY9IJ4iRnbaYGRqcO6LRU-q86_mNz05fsaceuOvYI1raMP6x94iRPPzbwHhWKsTzUvlpmSEAcUWxhLREzsT2QyLGwsjgi4OsQPke85r0/s1820/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZzOPlNtF5Uif2DVJgKBAQ5r2qzTqWv9DgBW_xenicNbbBNKqPgn5nq5PaMK9avRJoMdI-GaTE4TP0qspxZuzyCY9IJ4iRnbaYGRqcO6LRU-q86_mNz05fsaceuOvYI1raMP6x94iRPPzbwHhWKsTzUvlpmSEAcUWxhLREzsT2QyLGwsjgi4OsQPke85r0/w400-h300/Slide2.jpeg" width="400" /></a></span></div><p></p><p><span style="font-family: helvetica;">While some organizations have clinical staff (<i><span style="color: #2b00fe;">MDs, RNs, APRNs, PAs, Pharmacists, Lab/Radiology staff, and others</span></i>) who are trained to <b>configure</b> computers, other healthcare administrators might question the reasons for paying a clinical team member to do this sort of configuration (<i><span style="color: #2b00fe;">building</span></i>) : </span></p><p><span style="font-family: helvetica;"></span></p><blockquote><p><span style="font-family: helvetica;"><b><span style="color: #cc0000;">Q : "</span></b><i><b><span style="color: #cc0000;">Why should we pay a <u>doctor</u> (</span></b><span style="color: #2b00fe;">or RN, APP, or other clinical role</span><b><span style="color: #cc0000;">) to do this?"</span></b></i></span></p><p></p></blockquote><p><span style="font-family: helvetica;">In addition to the six deliverables mentioned above, there are other good reasons to pay clinical staff to be involved in your EMR go-live, configuration, and ongoing maintenance, including :</span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">Improved <b>user satisfaction and workflow design (</b><i><span style="color: #2b00fe;">See <a href="https://www.ama-assn.org/practice-management/physician-health/ehr-driver-burnout-s-why-it-must-be-table#:~:text=Far%20too%20many%20American%20physicians,on%20what%20matters%E2%80%94patient%20care." target="_blank">this recent AMA article</a> for a success story from TSPMG on the benefits of improved user engagement!</span></i><b>)</b></span></li><li><span style="font-family: helvetica;"><span>Improved <b>upkeep of technology</b> (</span><i><span style="color: #2b00fe;">to reflect continuously-changing medical literature and other clinical, regulatory, and billing standards</span></i><span>)</span></span></li><li><span style="font-family: helvetica;">Improved <b>utilization</b> (<span style="color: #2b00fe;"><i>ROI</i></span>) <b>and stewardship</b> of your technology</span></li><li><span style="font-family: helvetica;">Improved <b>quality metrics and revenue capture</b></span></li><li><span style="font-family: helvetica;">Improved <b>patient care</b></span></li><li><span style="font-family: helvetica;">Improved <b>patient satisfaction</b></span></li></ul><div><span style="font-family: helvetica;">... where clinical staff play an essential role in experiencing and understanding their workflows, translating their workflows, and maintaining their workflows. </span><span style="font-family: helvetica;">The questions then become : </span></div><div><ul style="text-align: left;"><li><span style="color: #cc0000; font-family: helvetica;"><b>Q</b> : "Do we need clinical staff to <b><i><u>build</u> configurations</i></b>?" (</span><span style="color: #2b00fe; font-family: helvetica;"><i>'Clinical <b><u>Builder</u></b>'</i></span><span style="color: #cc0000; font-family: helvetica;">)</span></li><li><span style="color: #cc0000; font-family: helvetica;"><b>Q</b> : "Or do we need them to <b><i><u>architect</u> clinical workflows</i></b>?" (</span><span style="color: #2b00fe; font-family: helvetica;">'</span><span style="color: #2b00fe; font-family: helvetica;"><i>Clinical <b><u>Architect</u></b>'</i></span><span style="color: #cc0000; font-family: helvetica;">)</span></li></ul><div><span style="font-family: helvetica;">While many clinical staff <i><b>begin</b></i> their HealthIT journeys focused on <b>build</b> - I would argue that there is a value in focusing their efforts on clinical <b>architecture</b>, rather than <b>construction</b>. <i>Here's why.</i></span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Effective, predictable change management generally begins with a <b>ten step process</b> :</span></div></div><div><span style="font-family: helvetica;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7CCg0GXLVaCq6TFwJTLzi0BJZzBaQSxmAdeWu4q22omMIYAWjPV5uG6Y2c86SgwU3Wx_jSWb5WzcEgcyQfmdugSLuOQH4mGxFAvWeNPhS1R2vIi2QDLD-DbyIBVoXooW-mbfFCvErFU6SuvKyOv0byPMNRNgJz-24lR21xYUXB40KrFtJXkiduBPtY8Xj/s1820/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7CCg0GXLVaCq6TFwJTLzi0BJZzBaQSxmAdeWu4q22omMIYAWjPV5uG6Y2c86SgwU3Wx_jSWb5WzcEgcyQfmdugSLuOQH4mGxFAvWeNPhS1R2vIi2QDLD-DbyIBVoXooW-mbfFCvErFU6SuvKyOv0byPMNRNgJz-24lR21xYUXB40KrFtJXkiduBPtY8Xj/w400-h300/Slide2.jpeg" width="400" /></a></div></div><div><div><span style="font-family: helvetica;"><br /></span></div><span style="font-family: helvetica;">Generally speaking, these <b>ten steps</b> include : </span></div><div><ol style="text-align: left;"><li><span style="font-family: helvetica;">Documenting and understanding the change.</span></li><li><span style="font-family: helvetica;"><b>Analyzing, evaluating, designing, and scoping the change</b>.</span></li><li><span style="font-family: helvetica;">Prioritizing and approving the change project.</span></li><li><span style="font-family: helvetica;">Building the project team (<span style="color: #2b00fe;"><i>including stakeholders, deliverables, and timelines</i></span>).</span></li><li><span style="font-family: helvetica;"><b>Designing blueprints for all EMR/Non-EMR deliverables</b> (<span style="color: #2b00fe;"><i>for discussions, tabletop exercises, edits, and to secure necessary buy-in and approvals</i></span>)</span></li><li><span style="font-family: helvetica;"><b>Building the change</b> (<i>Analyst</i>)</span></li><li><span style="font-family: helvetica;">Testing and approving the change (<span style="color: #2b00fe;"><i>future-state workflow</i></span>)</span></li><li><span style="font-family: helvetica;">Communicating and educating (<span style="color: #2b00fe;"><i>training</i></span>) the change</span></li><li><span style="font-family: helvetica;">Implementing the change</span></li><li><span style="font-family: helvetica;">Monitoring and supporting the change</span></li></ol></div><div><span style="font-family: helvetica;">After reviewing these steps, the questions then become : </span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><i><b>Who</b> supports each of these steps?</i></span></li><li><span style="font-family: helvetica;"><i>Do your <b>IT Analysts</b> typically support step <b>#6</b>?</i></span></li><li><span style="font-family: helvetica;"><i>If so, are your <b>clinical staff</b> then more useful in step <b>#6,</b> or in steps <b>#2 </b>and <b>#5</b>?</i></span></li><li><span style="font-family: helvetica;"><i>Could any analyst time be saved in <b>#6</b> with more informatics time spent in <b>#2</b> and <b>#5</b>?</i></span></li></ul></div><div><span style="font-family: helvetica;">This may seem somewhat paradoxical at first, since many clinical staff initially gravitate towards <b>building</b> when they first get involved in healthcare technology. After all, it seems like a good way to get involved, learn about data structures, and get some control over the systems they use to deliver care to patients. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">But on closer inspection, I believe there's real value in focusing your clinical staff on <b>architecture</b>, rather than <b>construction</b> (<i><span style="color: #2b00fe;">build</span></i>) : </span></div><div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQFa6Dw8EgkRn_OHcFQhnH5BjKV7PY_Bhd5pUeJuNRGwNJTTKfIJ_9eW38uL1algUnffGxpnT-H-yvvtnkR41i4kw3ESb9x0pLd05y7w1Nssuni-D9F6yVPJgbkU5uUl5gGkqgYj_Ca-cRlcj2pNx97nFOzp8oco6eWhw3n5Ty9ahtu_wXlY6e-lpyLn_p/s1820/Slide4.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQFa6Dw8EgkRn_OHcFQhnH5BjKV7PY_Bhd5pUeJuNRGwNJTTKfIJ_9eW38uL1algUnffGxpnT-H-yvvtnkR41i4kw3ESb9x0pLd05y7w1Nssuni-D9F6yVPJgbkU5uUl5gGkqgYj_Ca-cRlcj2pNx97nFOzp8oco6eWhw3n5Ty9ahtu_wXlY6e-lpyLn_p/w400-h300/Slide4.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>From Wikipedia : <a href="https://en.wikipedia.org/wiki/Architecture" target="_blank">Architecture</a> is the art and technique of designing and building, as distinguished from the skills associated with construction. And what connects architecture to construction is <b><span style="color: #2b00fe;">blueprints</span></b>. (<i><b>Note</b> : For more about architecture, please also see <a href="https://www.britannica.com/topic/architecture/Expression-of-technique" target="_blank">this helpful Brittanica article</a>.</i>)</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">So for most clinical staff first getting involved in HealthIT, having some experiences with construction is very helpful. Unless they have some kind of a background in computer science, it's still <b>very helpful</b> (<i><span style="color: #2b00fe;">foundational</span></i>) to learn about data structures, relational databases, indexing, and coding. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">But once they have this foundational understanding, I personally think their bigger value comes from using their clinical expertise to <b>architect</b> workflows using <span style="color: #2b00fe;"><b>blueprints</b></span>, rather than <b>building</b> (<i><span style="color: #2b00fe;">configuring</span></i>) workflows. <i>Here's why</i> : The value of <span style="color: #2b00fe;"><b>blueprints</b></span> in construction is typically underestimated :</span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><span style="color: #2b00fe;"><b>Blueprints</b></span> allow you to <b>quickly mock up deliverables</b> (<i><span style="color: #2b00fe;">e.g. the EMR and non-EMR deliverables that work together to support your desired workflow</span></i>)</span></li><li><span style="font-family: helvetica;">They let you share your mockups with other clinical staff, to discuss, review, create tabletop exercises, make edits, and <b>secure necessary buy-in </b>and<b> formal approvals</b>.</span></li><li><span style="font-family: helvetica;">They let you then share your approved <b><span style="color: #2b00fe;">blueprints</span></b> with your <b>IT analysts</b> (<span style="color: #2b00fe;"><i>who can then quickly create the electronic deliverables in your EMR, e.g. orders, order sets, clinical documentation, alerts, charges, etc.)</i></span></span></li><li><span style="font-family: helvetica;">They let you share your approved mockups with <b>other Clinical Leaders</b> (<i><span style="color: #2b00fe;">who can then help create the non-EMR deliverables, such as policies, guidelines, protocols, schedules, training, budgets, etc.</span></i>)</span></li><li><span style="font-family: helvetica;">Finally, <span style="color: #2b00fe;"><b>blueprints</b></span> can also help save analyst time while synchronizing your <b>electronic</b> (<span style="color: #2b00fe;"><i>EMR</i></span>) <b>deliverables</b> with your <b>paper deliverables</b> (<span style="color: #2b00fe;"><i><b>downtime forms</b></i></span>).</span></li></ul></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBCMwXaLGndj0WGxdSNdg9yRsDfXJ_Fuwil_U6ZxtSawwT4nWip0Nu_Zf98UExY4XIwUYa77aBOmCrsqwlWKNEcEBhXd6ADH9JL4ENx9ugxY1TavGuAPCe98QOVLO6Ud-2Q4nhNniMXgr5pFq1Usyz-ckxDvnPKMqeVkV1juman1LrUZ8_4KtlQHsX6Xc2/s1820/Slide5.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBCMwXaLGndj0WGxdSNdg9yRsDfXJ_Fuwil_U6ZxtSawwT4nWip0Nu_Zf98UExY4XIwUYa77aBOmCrsqwlWKNEcEBhXd6ADH9JL4ENx9ugxY1TavGuAPCe98QOVLO6Ud-2Q4nhNniMXgr5pFq1Usyz-ckxDvnPKMqeVkV1juman1LrUZ8_4KtlQHsX6Xc2/w400-h300/Slide5.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">How can <span style="color: #2b00fe;"><b>blueprints</b></span> help save analyst time, while synchronizing your electronic and paper deliverables (<span style="color: #2b00fe;"><i>for planned EMR maintenance / unplanned EMR downtimes</i></span>)? They can do this because <span style="color: #2b00fe;"><b>blueprints</b></span> help to create clear understanding and discussions, and allow clear edits and revisions, that are necessary <b><i>before</i></b> you can secure the necessary <b>buy-in</b> and <b>final approvals</b> - Not just from your <i>clinical staff</i>, but also from your <i>Legal/Compliance/Regulatory staff, Pharmacy staff, Nursing staff, Radiology staff, Laboratory staff, HIM staff, Billing/Coding staff, Clinical Leadership, IT leadership, etc. </i></span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Having that level of clarity, understanding, and buy-in is very difficult to achieve <i><b>after</b></i> something has been built. (<i><span style="color: #2b00fe;">This is a common reason for IT Analyst complaints of having to build and re-build something before it's right.</span></i>) So why not put your <b>Clinical Architects</b> (<span style="color: #2b00fe;"><i>Clinical Informaticists</i></span>) to work on <span style="color: #2b00fe;"><b>blueprints</b></span>, rather than <b>build</b>?</span></div><div><br /></div><div>And so once your <b>IT analysts</b> are working on the <b>electronic (</b><i><span style="color: #2b00fe;">EMR</span></i><b>) deliverables</b>, <span style="color: #2b00fe;"><b>blueprints</b></span> are then also very easy to convert to paper <b>downtime forms</b> :</div><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiChX6qhkOQ1iIKQZopuW_IOe-CuorJRW_9fV5xPWj6nKPcfXkfEmzWYgZ532zN5QEjfSez9l8-f7cea74xoEkqWsiQkCFU6SY1gccb9pieGKhYXAFmBrgJ63i9Dz8o8sJQVEq-B2RHIj1CP3I7-K_msN3hB1AtzUP7YpKchVCE8gunEfI-fJfWc4_cZYKQ/s1820/Slide6.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiChX6qhkOQ1iIKQZopuW_IOe-CuorJRW_9fV5xPWj6nKPcfXkfEmzWYgZ532zN5QEjfSez9l8-f7cea74xoEkqWsiQkCFU6SY1gccb9pieGKhYXAFmBrgJ63i9Dz8o8sJQVEq-B2RHIj1CP3I7-K_msN3hB1AtzUP7YpKchVCE8gunEfI-fJfWc4_cZYKQ/w400-h300/Slide6.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">So that process for creating synchronized <b>EMR deliverables</b> (<span style="color: #2b00fe;"><i>from an IT Analyst</i></span>) and <b>paper downtime forms</b> (<span style="color: #2b00fe;"><i>from a Clinical Architect / Clinical Informaticist</i></span>) can then look like this : </span></div><div><br /></div></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_8OvYesGJcFeSQDH6ZRfbithIIVkCKUJM3-4CN5jp8ceB9amRopToqxXY5Iui6WaqEor9_rkayaubRZK0fKjzRLMxkTxF4lsh4J4vxjbLFRXZ9MEp3_LV8B5tsv9uswQ_3CgBD-ITATgGjc58scQByiEZQqrg1EqU1GYYK53dmry1VyOAzldK0P9Au1A_/s1820/Slide7.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="1365" data-original-width="1820" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_8OvYesGJcFeSQDH6ZRfbithIIVkCKUJM3-4CN5jp8ceB9amRopToqxXY5Iui6WaqEor9_rkayaubRZK0fKjzRLMxkTxF4lsh4J4vxjbLFRXZ9MEp3_LV8B5tsv9uswQ_3CgBD-ITATgGjc58scQByiEZQqrg1EqU1GYYK53dmry1VyOAzldK0P9Au1A_/w400-h300/Slide7.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><u>How to use <span style="color: #2b00fe;"><b>blueprints</b></span> to create matching paper and electronic tools : </u><br /><ol style="text-align: left;"><li><b>Clinical Architect</b> (<span style="color: #2b00fe;"><i>Clinical Informaticist</i></span>) will study and design the desired (<span style="color: #2b00fe;"><i>future-state</i></span>) workflow. </li><li><b>Clinical Architect</b> (<span style="color: #2b00fe;"><i>Clinical Informaticist</i></span>) will use templates to quickly mock-up <b><span style="color: #2b00fe;">blueprints</span></b> for all deliverables. </li><li><b>Clinical Architect</b> (<i><span style="color: #2b00fe;">Clinical Informaticist</span></i>) will use <span style="color: #2b00fe;"><b>blueprints</b></span> to review and share with staff and other stakeholders, conduct tabletop exercises, lead clear discussions, make necessary edits/changes based on feedback, and secure the necessary buy-in and approvals.</li><li><b>Clinical Architect</b> (<span style="color: #2b00fe;"><i>Clinical Informaticist</i></span>) will share and discuss approved <span style="color: #2b00fe;"><b>blueprints</b></span> with <b>IT Analyst</b>, for building and testing of <b>electronic deliverables</b>.</li><li><b>Clinical Architect</b> (<span style="color: #2b00fe;"><i>Clinical Informaticist</i></span>) will convert <span style="color: #2b00fe;"><b>blueprints</b></span> to paper <b>downtime forms</b>.</li></ol></span></div><div><span style="font-family: helvetica;">So to summarize, some key take-home points from today's discussion :</span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;">There is <b>real value</b> in having (<i><span style="color: #2b00fe;">some</span></i>) clinical staff engaged in the development and ongoing maintenance of your EMR and downtime processes (<i><span style="color: #2b00fe;">e.g. improved outcomes, improved user and patient satisfaction, improved quality metrics, improved revenue capture, etc</span>.</i>) </span></li><li><span style="font-family: helvetica;"><b>Clinical architecture</b> (<i><span style="color: #2b00fe;">Clinical Informatics</span></i>) is the art and technique of designing and building clinical workflows, a specialty distinct from (<i><span style="color: #2b00fe;">but intrinsically related to</span></i>) <b>IT Analysts </b>(<span style="color: #2b00fe;"><i>who commonly focus their primary efforts on construction</i></span>).</span></li><li><span style="font-family: helvetica;"><b>Clinical staff</b> commonly <i>begin</i> their HealthIT career journey focused on <b>building</b> in an EMR, but their value can increase when they focus their efforts on <b>clinical architecture (</b><i><span style="color: #2b00fe;">Clinical Informatics</span></i><b>) </b>and <b><span style="color: #2b00fe;">blueprint</span></b> development.</span></li><li><span style="font-family: helvetica;"><span style="color: #2b00fe;"><b>Blueprints</b></span> can help save project and IT analyst time by creating the necessary discussions, understanding, buy-in, and approvals <i>before</i> beginning <b>construction</b>.</span></li><li><span style="font-family: helvetica;"><span style="color: #2b00fe;"><b>Blueprints</b></span> can also help synchronize your electronic deliverables with your paper downtime forms (<i><span style="color: #2b00fe;">by making it easy to create downtime forms with the same appearance, format, and cadence as your electronic deliverables</span></i>).</span></li><li><span style="font-family: helvetica;">An easy way to improve clinical workflow design, improve outcomes and user satisfaction, save time, create clarity and understanding, and develop smooth downtime processes is to develop a <b>Clinical Informatics</b> (<i><span style="color: #2b00fe;">Clinical Architecture</span></i>) team, and remember the hashtag <a href="https://www.twitter.com/hashtag/blueprintsbeforebuild" target="_blank">#BlueprintsBeforeBuild</a>!</span></li></ul></div><div><span style="font-family: helvetica;">For many of you, this discussion is probably just a refresher. For others, I hope this was a helpful discussion, for you and/or your clinical informatics teams. Please let me know your experiences, and feel free to leave comments and feedback in the comments section below!</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><i>Disclaimer : Remember, this blog is for educational, discussion, and information-sharing purposes only - As always, your mileage may vary! Remember to always have your clinical leadership, IT, and legal/compliance teams review any changes to processes before you initiate them. Have any related experiences, or other suggestions for improving clinical workflow design? Leave your comments and feedback below!</i></span></div><div><span style="font-family: helvetica;"><i><br /></i></span></div><p></p>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-27182099298205148562023-11-27T01:14:00.012-05:002023-11-27T15:11:24.562-05:00Where's the Clinical Informaticist?<p><span style="font-family: helvetica;"></span></p><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: left;"><i style="font-family: helvetica;">Hello fellow CMIOs, CNIOs, and other Applied Clinical Informatics friends,</i></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">This month I'd share some cool discoveries I've made with some friends recently, in a helpful blog post about finding the <b>Clinical Informaticist(s)</b> in your organization, and/or identifying the need for them.</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixDcP_dtN3liPxqf-wgetgh16VVHMhUE1n5uAt_EWDEJRsEdIw1niYPDy69iXeiZamlS1PJKiOKVJbSo4sVAq6NfvNa4JZ99XcdA4VYo5AnyS0u6B29yaROlSRLFc4JGVWlMUui0Nko8rOsIuIbpMI8dZ8lxqRtWVKOvOPgmOaD-up5WLDaKsq-wxbG8Zn/s1820/Slide1.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1820" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixDcP_dtN3liPxqf-wgetgh16VVHMhUE1n5uAt_EWDEJRsEdIw1niYPDy69iXeiZamlS1PJKiOKVJbSo4sVAq6NfvNa4JZ99XcdA4VYo5AnyS0u6B29yaROlSRLFc4JGVWlMUui0Nko8rOsIuIbpMI8dZ8lxqRtWVKOvOPgmOaD-up5WLDaKsq-wxbG8Zn/w640-h360/Slide1.jpeg" width="640" /></a></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">One of the common challenges of <b>Applied Clinical Informatics</b> is that Informaticists can sometimes be <i>hard to find</i>. Typically due to a number <b>Human Resources</b> (<i><span style="color: #2b00fe;">HR</span></i>) and other industry issues, they can sometimes be hidden behind : </span></div><div class="separator" style="clear: both;"><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b>FALSE NEGATIVES</b> - E.g. People who actually <b>do Clinical Informatics</b> work, but aren't necessarily titled "Clinical Informaticist" in their job title, or aren't recognized as doing Clinical Informatics work at all.</span></li><li><span style="font-family: helvetica;"><b>FALSE POSITIVES</b> - E.g. People who are called "<i>Clinical Informaticist</i>", when they don't necessary do the work that might commonly fall under the domain of the Clinical Informaticist (<span style="color: #2b00fe;"><i>or they only do a specialty branch on the larger 'tree' of Applied Clinical Informatics - See below.</i></span>)</span></li></ul></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">While some have tried to tackle these HR challenges, concrete job descriptions are hard to find since there is such a wide variation of practice, in the general 'tree of Informatics' - which spans a number of disciplines related to both <b>data storage</b> (<span style="color: #2b00fe;"><i>'data in'</i></span>) and <b>data retrieval</b> (<span style="color: #2b00fe;"><i>'data out'</i></span>) functions : </span></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpZTZg_DGTNpM3py7dRCj349ybqXZyVH2KyVsVr3eEL59VlVPl0U4I6DwAI-Iaxpnld89MXP739wSgKhEIL9u2fl4YXurJSxtUD8OP4QZ0mJqWi3xnu2VyOF7z1h4uvdF3moqT-EFg13Pjs0H5gcYOvlZEPq_SERnh-6OwDor9vs01bsyKl9FUZx83in7h/s1015/Informatics%20Tree.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="761" data-original-width="1015" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpZTZg_DGTNpM3py7dRCj349ybqXZyVH2KyVsVr3eEL59VlVPl0U4I6DwAI-Iaxpnld89MXP739wSgKhEIL9u2fl4YXurJSxtUD8OP4QZ0mJqWi3xnu2VyOF7z1h4uvdF3moqT-EFg13Pjs0H5gcYOvlZEPq_SERnh-6OwDor9vs01bsyKl9FUZx83in7h/w400-h300/Informatics%20Tree.jpeg" width="400" /></a></div><br /></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">If your search for a Clinical Informaticist turns up negative, you will probably need to establish the need to hire one (<span style="color: #2b00fe;"><i>or more</i></span>) to help with your clinical workflow analysis and development. Historically, there have been <b>two common approaches</b> to doing this in #Healthcare - the <b>'Clinical Choir'</b> approach, and the <b>'Executive/Financial'</b> Approach: </span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwOz_iM95_5m2lu8kooESJbu8qtzmekQjrT7b19rsAUbfH9UMwWZvvXQZEN061zSbM8Em5J3zLwtQuF7yKgwWVLQWj7ZG8PEcJ9PEjLFgtkPbTP2K_PPM1RMSBUpSN9QZSii6ajfmp-S_0RopXYdFTwnRof9E9lZcO26ffNBgnmnoOlRAzxIaKwxGVboZ5/s1820/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1820" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwOz_iM95_5m2lu8kooESJbu8qtzmekQjrT7b19rsAUbfH9UMwWZvvXQZEN061zSbM8Em5J3zLwtQuF7yKgwWVLQWj7ZG8PEcJ9PEjLFgtkPbTP2K_PPM1RMSBUpSN9QZSii6ajfmp-S_0RopXYdFTwnRof9E9lZcO26ffNBgnmnoOlRAzxIaKwxGVboZ5/w640-h360/Slide2.jpeg" width="640" /></a></div><br /></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">Each of these historic approaches come with some pros and cons : </span></div><div class="separator" style="clear: both;"><ol style="text-align: left;"><li><span style="font-family: helvetica;"><b>The 'Clinical Choir' Approach</b> - Where the Clinical Staff recognizes the need for workflow updates and redesign, and collectively asks for Applied Clinical Informatics resources. <span style="color: #6aa84f;"><b>PROS</b> : Support from clinical end-users can be very helpful to support the allocation of FTE(s) for Clinical Informatics</span>. <span style="color: red;"><b>CONS</b> : Difficult to execute. Most clinical end-users aren't familiar with the potential role of Applied Clinical Informatics in their day-to-day workflows, so it's not easy to get them to ask for it by name</span>. </span></li><li><span style="font-family: helvetica;"><b>The Executive / Financial Approach</b> - Where the Executive / Finance teams recognize the need for improved Return on Investment (ROI) and overall improved stewardship of technology investments, and so they collectively ask for Applied Clinical Informatics resources. <span style="color: #6aa84f;"><b>PROS</b> : Support from Executives and Finance officers can also be helpful to support the allocation of FTE(s) for Clinical informatics</span>. <span style="color: red;">CONS : Most ROI from workflow design and improvement falls under the category of 'soft ROI' which could easily be attributed to other departments, or it falls into the category of cost reduction rather than revenue improvements. (</span><span style="color: #2b00fe;"><i>Both will help your organization, but one is easier-to-identify</i>.</span><span style="color: red;">) So putting a hard number to ROI or cost reduction that stands up to scrutiny will require some real pre-planning before you execute your improvement projects</span>.</span></li></ol></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">So for today, I'd like to share a <b>new approach</b> that I recently discovered, when I worked with some of my trusted Project management and Compliance colleagues (<i><span style="color: #2b00fe;">Jim McGennis and Elle Box</span></i>) to combine <a href="https://www.dirkstanley.com/2018/07/easy-recipe-for-baking-gourmet-workflow.html" target="_blank">my 10-step change management recipe</a> with a <a href="https://en.wikipedia.org/wiki/Responsibility_assignment_matrix" target="_blank">Responsibility Assignment (<i>RACI</i>) Matrix</a> :</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxRW7oEHAvQIHZZnMuKtQdqmTLBDFOmqwEFLWlRfBGmzCEJPHLj1HRmQyXwUa8FBB3w75t6PtxSwqGEQkcFCQvbcv9PgH7V_dCOn-hRtOjjuBpd0h5x1uEYBpwdxgMpK2IVggORp7nB3h3oPDPsnqp1inQD8Eay3tImayIJiJ0JmQ1y-XDKJUsHeK-fT6P/s1820/Slide3.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1820" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxRW7oEHAvQIHZZnMuKtQdqmTLBDFOmqwEFLWlRfBGmzCEJPHLj1HRmQyXwUa8FBB3w75t6PtxSwqGEQkcFCQvbcv9PgH7V_dCOn-hRtOjjuBpd0h5x1uEYBpwdxgMpK2IVggORp7nB3h3oPDPsnqp1inQD8Eay3tImayIJiJ0JmQ1y-XDKJUsHeK-fT6P/w640-h360/Slide3.jpeg" width="640" /></a></div><br /></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">First, a brief reminder that my <a href="https://www.dirkstanley.com/2018/07/easy-recipe-for-baking-gourmet-workflow.html" target="_blank">recommended ten steps for clinical change management</a> (<i><span style="color: #2b00fe;">originally published back in 2018</span></i>) helps to create <b>consistent outcomes</b> through the thoughtful analysis, scoping, development, and planning of workflow changes (<i><span style="color: #2b00fe;">both big and small</span></i>) :</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzk6xgKmKOjAbZedF2VZEG4d9fmwYUnL-6-y2lZ1nK9VglaS2IkLkbGWQ7gmQKjn7Wmcfq1uMPDD9QFKYrq6b1jVeHAHQl2WzA0DCDJ7Dpnyg8SbSxkT7PT3wKFTilzv5U6jaD9ehP-JvRiIIewqinALfgzxqvq3AFNm1N-PbEr4iKhVattcIag5OKFDKU/s2096/DRAFT%20-%20PROCEDURE%20-%20Change%20Management%20-%20Updated%2011-26-2023.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2096" data-original-width="1658" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzk6xgKmKOjAbZedF2VZEG4d9fmwYUnL-6-y2lZ1nK9VglaS2IkLkbGWQ7gmQKjn7Wmcfq1uMPDD9QFKYrq6b1jVeHAHQl2WzA0DCDJ7Dpnyg8SbSxkT7PT3wKFTilzv5U6jaD9ehP-JvRiIIewqinALfgzxqvq3AFNm1N-PbEr4iKhVattcIag5OKFDKU/w506-h640/DRAFT%20-%20PROCEDURE%20-%20Change%20Management%20-%20Updated%2011-26-2023.png" width="506" /></a></div><br /></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">After combining these <b>ten change steps</b> (<span style="color: #2b00fe;"><i>above</i></span>) with a <b>Responsibility Assignment</b> (<span style="color: #2b00fe;"><i>RACI</i></span>) <b>Matrix</b> (<i><span style="color: #2b00fe;">typically used by experienced Project Managers for assigning responsibility for various tasks</span></i>), <b>new discoveries were made</b> and <b>additional</b> <b>clarity was achieved</b>. (<span style="color: #2b00fe;"><i>Note : If you're new to Responsibility Assignment / RACI matrices, please see <a href="https://en.wikipedia.org/wiki/Responsibility_assignment_matrix" target="_blank">this Wikipedia article</a> for a helpful introduction. And special thanks to PM guru <b>Jim McGennis</b>, for introducing me to this powerful tool.</i></span>)</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">The basic premise of a <b>RACI matrix</b> is that you create a grid (<span style="color: #2b00fe;"><i>spreadsheet</i></span>) of <b>roles</b> versus <b>steps</b>, and then assign these four categories in each step : </span></div><div class="separator" style="clear: both;"><ul style="text-align: left;"><li><span style="font-family: helvetica;"><span style="background-color: #fcff01;">(<b>R</b>)ESPONSIBLE</span> (<i><span style="color: #2b00fe;">also recommender</span></i>) - The one (<span style="color: #2b00fe;"><i>or more</i></span>) person(s) who are responsible to complete the task.</span></li><li><span style="font-family: helvetica;"><span style="background-color: red;">(<b>A</b>)CCOUNTABLE</span> (<i><span style="color: #2b00fe;">also approver or final approving authority</span></i>) - Who is ultimately answerable for the correct and thorough completion of the deliverable or task, who also ensures the prerequisites of the task are met, and delegates the work to those responsible.</span></li><li><span style="font-family: helvetica;"><span style="background-color: #cfe2f3;">(<b>C</b>)ONSULTED</span> (<i><span style="color: #2b00fe;">sometimes consultant or counsel</span></i>) - Those whose opinions are sought, typically subject matter experts (SMEs), and with whom there is <b>two-way</b> communication</span></li><li><span style="font-family: helvetica;"><span style="background-color: #d9ead3;">(<b>I</b>)NFORMED</span> (<i><span style="color: #2b00fe;">sometimes informee</span></i>) - Those who are kept up-to-date on progress, often only on completion of the task or deliverable, and with whom there is just <b>one-way</b> communication.</span></li></ul></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">Putting my <a href="https://www.dirkstanley.com/2018/07/easy-recipe-for-baking-gourmet-workflow.html">2018 clinical change management recipe</a> together with the <a href="https://en.wikipedia.org/wiki/Responsibility_assignment_matrix" target="_blank">RACI matrix</a> has been <i>remarkably helpful and enlightening</i>. And with some help from Compliance colleages (<span style="color: #2b00fe;"><i>thanks to Compliance guru Elle Box for her help reviewing and refining the descriptions</i></span>), the first thing I began to notice was the <b>number of </b>roles that participate in one or more steps of change management : </span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i>Roles that participate in one or more steps of clinical change management</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_iNNHTMMicONapYdVjBb-KgroiS9SkLCbDjyTRyW0S8UncR34mOlZT9Pt8yqPiD-MsQORGjNy4_LOvljIVDGmoBlNTuwvEq0D_-muPA1pwYrPkODUjmDGUeytTF-uXfvyikRw9OU8LBHZnxvu-otJ-KzmDmKF2biQ08W8lSXhc3Q_e2dZznDXpzBxrLms/s1582/Common%20roles%20involved%20in%20change%20management.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="642" data-original-width="1582" height="260" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_iNNHTMMicONapYdVjBb-KgroiS9SkLCbDjyTRyW0S8UncR34mOlZT9Pt8yqPiD-MsQORGjNy4_LOvljIVDGmoBlNTuwvEq0D_-muPA1pwYrPkODUjmDGUeytTF-uXfvyikRw9OU8LBHZnxvu-otJ-KzmDmKF2biQ08W8lSXhc3Q_e2dZznDXpzBxrLms/w640-h260/Common%20roles%20involved%20in%20change%20management.png" width="640" /></a><i> </i></div><div class="separator" style="clear: both; text-align: center;"><i>Roles that participate in one or more steps of clinical change management</i></div></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">... as well as the details of exactly who is <span style="background-color: #fcff01;">(<b>R</b>)esponsible</span>, <span style="background-color: red;">(<b>A</b>)ccountable</span>, <span style="background-color: #cfe2f3;">(<b>C</b>)onsulted</span>, and <span style="background-color: #d9ead3;">(<b>I</b>)nformed</span> at each step. (<i><span style="color: #2b00fe;">*Note : In the slide above, you'll notice that the </span><span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span><span style="color: #2b00fe;"> already has a different set of roles and responsibilities than the </span><span style="color: red;"><b>Clinical IT Analysts</b></span><span style="color: #2b00fe;">. More to come on this shortly...</span></i>)</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">When we look at the <b>first phase</b> of the change recipe (<span style="color: #2b00fe;"><i>documentation of request and expectations, or intake</i></span>) it's easy to see who has primary and secondary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> - Both the <b>clinical end-user</b> and the <b>official requestor</b> - <i>their <b>supervisor</b>, <b>director</b>, <b>chair</b>, or <b>chief</b></i> - who needs to help <b>support the request</b> : </span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>First phase of change</b> : Documentation of Request and Expectations ('Intake')</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUi20uMsr_8Jw0z3JpexzSLtfZoJ_T-gZq8GLZYHZWoQD7Qk3Ry0IEEa7cKJblK0kyG6K7oQh26c_9j-czmFMipP0FVTeW_yt_FWdAS6qJAqnTBoOv8CmBwNQ7mU86pr-hl7x0v9BqSuJ-NvscITLCMI18p7aeJ_6b4PVijqEKCG7k6vLV9Q1WVx_ppPZ8/s1790/Screenshot%202023-11-26%20at%2011.36.00%20PM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="634" data-original-width="1790" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUi20uMsr_8Jw0z3JpexzSLtfZoJ_T-gZq8GLZYHZWoQD7Qk3Ry0IEEa7cKJblK0kyG6K7oQh26c_9j-czmFMipP0FVTeW_yt_FWdAS6qJAqnTBoOv8CmBwNQ7mU86pr-hl7x0v9BqSuJ-NvscITLCMI18p7aeJ_6b4PVijqEKCG7k6vLV9Q1WVx_ppPZ8/w640-h226/Screenshot%202023-11-26%20at%2011.36.00%20PM.png" width="640" /></a></div></div></i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>First phase of change</b> : Documentation of Request and Expectations ('Intake')</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">As we move to the <b>second phase</b> of the change management recipe (<span style="color: #2b00fe;"><i>Analysis, scoping, prioritization, resource allocation, and project approval</i></span>), we can see that suddenly the <b>Chief Information Officer</b> picks up <span style="background-color: red;">(<b>A</b>)ccountability</span>, while the <span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span> has primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> for the <i>literature search, sponsor identification, workflow gap analysis, workflow development, scoping of deliverables</i>, and <i>identification of stakeholders</i>. Together with a number of <span style="background-color: #cfe2f3;">(<b>C</b>)onsultants</span> including <span style="color: red;"><b>Clinical IT Analysts</b></span>, Medical Librarians, Compliance, Regulatory, and Finance, they will also help review regulations and estimate a <b>Total Cost of Ownership</b> (<i><span style="color: #2b00fe;">TCO</span></i>) and <b>Return-on-Investment</b> (<span style="color: #2b00fe;"><i>ROI</i></span>), providing much more helpful information for Senior Executives who will need to prioritize and approve this project before it can be assigned. (<i><span style="color: #2b00fe;"><b>*Note</b> : By serving this important workflow analysis role, the </span><span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span><span style="color: #2b00fe;"> will also become a subject matter expert (SME) for other experts who will be <span style="background-color: #fcff01;">(<b>R</b>)esponsible</span> for later steps in the change recipe.</span></i>)</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Second phase of change</b> : Analysis, scoping, prioritization, resource allocation, and project approval</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaXF1sMQIhxqqg6CaUawUYXXKvrz6CZnLP8EThfK_U9lQn6H3zxk7pr_hXXayC40LAW8chqsGTTnE-GCkln2l6FK4WFJLpnCcIejX3ETAzugR3V6NyCThm5vVtz2F4pjVqkkgLxHqyK9QhXpxHGcWfjp9TwfGHzzkiF8mEM_oJgrK_m8R1XMdGx0SHi5m_/s1520/Screenshot%202023-11-26%20at%2011.42.30%20PM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1116" data-original-width="1520" height="470" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaXF1sMQIhxqqg6CaUawUYXXKvrz6CZnLP8EThfK_U9lQn6H3zxk7pr_hXXayC40LAW8chqsGTTnE-GCkln2l6FK4WFJLpnCcIejX3ETAzugR3V6NyCThm5vVtz2F4pjVqkkgLxHqyK9QhXpxHGcWfjp9TwfGHzzkiF8mEM_oJgrK_m8R1XMdGx0SHi5m_/w640-h470/Screenshot%202023-11-26%20at%2011.42.30%20PM.png" width="640" /></a></div></i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Second phase of change</b> : Analysis, scoping, prioritization, resource allocation, and project approval</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">When we arrive in the <b>third</b> (<span style="color: #2b00fe;"><i>Project Planning</i></span>) <b>phase</b>, now the <b>Executive Sponsor</b> has picked up <span style="background-color: red;">(<b>A</b>)ccountability</span>, while the <b>Project Manager</b> has primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> for working with the <span style="color: #38761d;"><b>Applied Clinical Informaticist</b></span>, <span style="color: red;"><b>Clinical IT Analyst</b></span>, and others to plan the necessary parts of the project, including <i>Gantt charts, RACI Matrices</i>, and/or <i>other formal project plans</i> :</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Third phase of change</b> : Project Planning and RACI Matrix / Gantt Chart Development</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCaA_Z1F1HOvtkj6C9uHPCY5sUNIwa9itJS8ZMCihc_Qjq9Eg80V3lse6p1Ep60yvOKio9mltAvOfupJz-P9rDY8H0-gvc1ZPvOy0tNLcj9l38Z7SJCmTkSu_Y-Ox1X7KTjJ8alt1oRlXMEm5jf9_9FddrErQ7HYHtPEAZfeKHAHBDQY9qMWE6O1YmLMEq/s1782/Screenshot%202023-11-26%20at%2011.50.38%20PM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="882" data-original-width="1782" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCaA_Z1F1HOvtkj6C9uHPCY5sUNIwa9itJS8ZMCihc_Qjq9Eg80V3lse6p1Ep60yvOKio9mltAvOfupJz-P9rDY8H0-gvc1ZPvOy0tNLcj9l38Z7SJCmTkSu_Y-Ox1X7KTjJ8alt1oRlXMEm5jf9_9FddrErQ7HYHtPEAZfeKHAHBDQY9qMWE6O1YmLMEq/w640-h316/Screenshot%202023-11-26%20at%2011.50.38%20PM.png" width="640" /></a><i> </i></div></i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Third phase of change</b> : Project Planning and RACI Matrix / Gantt Chart Development</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">Assuming all of the above phases have been completed, this now brings us to the <b>fourth phase </b>of change - The <b>drafting of workflows</b>, for which the <span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span> has primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span>, typically in conjunction with the <span style="color: red;"><b>Clinical IT Analyst</b></span>, Compliance, and the <b>End-users</b>. </span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Fourth phase of change</b> : Drafting of Workflows</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7NJK0AKvLGtVITIcswgdBZvynwkfrLhc_S4Cy0t1GaD0NsIIXzz2bN0xd187olts1hxIG5lW_RZuAfrl3Y7fTjK0Klj3KdPgPI4k2bcgAS7_D8eWMDnI_CAXLNrNO1X9HcW6J5zEpVFaYs0L4tlEOqRnYSs03V36jBUZkFdoz0izgFFsZxQxU0m_Dpbgu/s2400/Screenshot%202023-11-27%20at%2012.01.14%20AM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="332" data-original-width="2400" height="88" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7NJK0AKvLGtVITIcswgdBZvynwkfrLhc_S4Cy0t1GaD0NsIIXzz2bN0xd187olts1hxIG5lW_RZuAfrl3Y7fTjK0Klj3KdPgPI4k2bcgAS7_D8eWMDnI_CAXLNrNO1X9HcW6J5zEpVFaYs0L4tlEOqRnYSs03V36jBUZkFdoz0izgFFsZxQxU0m_Dpbgu/w640-h88/Screenshot%202023-11-27%20at%2012.01.14%20AM.png" width="640" /></a></div></i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Fourth phase of change</b> : Drafting of Workflows</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">While some organizations may not yet have implemented blueprints in their development process, this step can be very helpful because :</span></div><div class="separator" style="clear: both;"><ul style="text-align: left;"><li><span style="font-family: helvetica;"><span style="color: #2b00fe;"><b>Blueprints</b></span> help to create understanding, align clinical stakeholders, let you conduct tabletop workflow discussions and reviews, and obtain preliminary approvals <i><u>before</u></i> the <span style="color: red;"><b>Clinical IT Analysts</b></span> begin their build (<i><span style="color: #2b00fe;">in the next step</span></i>).</span></li><li><span style="font-family: helvetica;">Once approved, and with a few small changes, <span style="color: #2b00fe;"><b>blueprints</b></span> can also become your <b>downtime forms</b>, in case your electronic system is ever down for planned maintenance or other unplanned reasons.</span></li></ul></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">This now brings us to the <b>fifth and sixth phases</b> of change, the building of deliverables and testing of workflows, where the <span style="color: red;"><b>Clinical IT Analyst</b></span> now has primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> to build and test the deliverables, typically in conjunction with the <span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span> and the <b>End User</b> (<span style="color: #2b00fe;"><i>for end-user acceptance testing</i></span>).</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Fifth and sixth phases of change</b> : Building of deliverables and testing of workflows</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSNpB-0phBw7CM3_fVRx4LvlbtHbR2Xqu_9qZ6H3MZZ6omZxuPkVd2lLPSV8OG8TOZBT89CaxL6nEq5Ft1blc5EcZvfkT_JKUCLKMhmIlHyrDMM_ldinfkG-OCKwth8tUQQIjneBuK_CQWEBk7xgV7cs_kQCNKekrMB6osNc80nPW7ruqYzxwP8q9tit3V/s2662/Screenshot%202023-11-27%20at%2012.12.03%20AM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="618" data-original-width="2662" height="148" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSNpB-0phBw7CM3_fVRx4LvlbtHbR2Xqu_9qZ6H3MZZ6omZxuPkVd2lLPSV8OG8TOZBT89CaxL6nEq5Ft1blc5EcZvfkT_JKUCLKMhmIlHyrDMM_ldinfkG-OCKwth8tUQQIjneBuK_CQWEBk7xgV7cs_kQCNKekrMB6osNc80nPW7ruqYzxwP8q9tit3V/w640-h148/Screenshot%202023-11-27%20at%2012.12.03%20AM.png" width="640" /></a><i> </i></div></i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Fifth and sixth phases of change</b> : Building of deliverables and testing of workflows</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">For the <b>seventh phase of change</b> (<span style="color: #2b00fe;"><i>Final workflow approval</i></span>), the<span style="color: #6aa84f;"> <b>Applied Clinical Informaticist</b></span> now assumes primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> and works to secure the necessary final approvals in conjunction with <b>Senior Leadership</b> and a <i>number of other stakeholders</i>. (<span style="color: #2b00fe;"><i>*Note that the Executive Sponsor still has <span style="background-color: red;">(<b>A</b>)ccountability</span> for this step.</i></span>)</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Seventh phase of change</b> : Final Workflow Approvals</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh68DrIRURx6z6D0YLxE4USP_IUZMq3k4q1-lcvHs37bvsw5Sppe_TH3_g1sf9rj07r40akZgloTHhWRAtTMvFsG1jiEDUc__p8PonNMHqsnNIrn49oFaQFMz6pJ8QS1SVj6OwmyRm6wr11IbRtTLBZIF81Xtao1cNzLTCyaOsr_GaYyBEoBbGowGgsUTDu/s2650/Screenshot%202023-11-27%20at%2012.17.59%20AM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="336" data-original-width="2650" height="82" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh68DrIRURx6z6D0YLxE4USP_IUZMq3k4q1-lcvHs37bvsw5Sppe_TH3_g1sf9rj07r40akZgloTHhWRAtTMvFsG1jiEDUc__p8PonNMHqsnNIrn49oFaQFMz6pJ8QS1SVj6OwmyRm6wr11IbRtTLBZIF81Xtao1cNzLTCyaOsr_GaYyBEoBbGowGgsUTDu/w640-h82/Screenshot%202023-11-27%20at%2012.17.59%20AM.png" width="640" /></a><i> </i></div></i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Seventh phase of change</b> : Final Workflow Approvals</i></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"> </span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">Finally, for the <b>eighth phase</b> (<span style="color: #2b00fe;"><i>Communication and Education/Training</i></span>), <b>ninth phase</b> (<span style="color: #2b00fe;"><i>Implementation/Publication</i></span>), and <b>tenth phase</b> (<span style="color: #2b00fe;"><i>monitoring and support</i></span>) of change, the <b>Clinical IT trainers</b>, <b>Clinical Education / Training team</b>, <b>Communications Team</b>, and <b>End-Users</b> now all share <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span>, and typically do their steps in conjunction with the <span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span> and the <span style="color: red;"><b>Clinical IT Analysts</b></span>.</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Eighth, ninth, and tenth phases of change</b> : Communication, Education, Implementation, Monitoring, and Support</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioU1_Y4dA2EpmBl2uh1pKMzl9sHC8MuHfqyuuIJBjakxKepPuQj8z8xXSDRuK2OEhLLdsXaxa3jUUyVBV4PRgEFDkKql7_IdUArOLKP5Lt6QYCSdTq11iwbqG5jfZ2GRkrZnOIKIA0DvYUFHBhyqCVM7exCeWUlpdMtV0uP7FfKre13RzYcPCzfJRsg0nM/s2278/Screenshot%202023-11-27%20at%2012.23.41%20AM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="386" data-original-width="2278" height="108" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEioU1_Y4dA2EpmBl2uh1pKMzl9sHC8MuHfqyuuIJBjakxKepPuQj8z8xXSDRuK2OEhLLdsXaxa3jUUyVBV4PRgEFDkKql7_IdUArOLKP5Lt6QYCSdTq11iwbqG5jfZ2GRkrZnOIKIA0DvYUFHBhyqCVM7exCeWUlpdMtV0uP7FfKre13RzYcPCzfJRsg0nM/w640-h108/Screenshot%202023-11-27%20at%2012.23.41%20AM.png" width="640" /></a><i> </i></div></span></div><div class="separator" style="clear: both; text-align: center;"><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><i><b>Eighth, ninth, and tenth phases of change</b> : Communication, Education, Implementation, Monitoring, and Support</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><b><u>IN CONCLUSION :</u></b> </span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">What does this exercise (<i><span style="color: #2b00fe;">combining change management recipe with a RACI responsibility assignment matrix</span></i>) teach us? Five helpful take-home points : </span></div><div class="separator" style="clear: both;"><ol style="text-align: left;"><li><span style="font-family: helvetica;"><b>Clinical change management</b> is a <b>team sport</b> that requires the participation of a <i>large number of stakeholders</i> to work together in a <i>clear, highly-detailed, highly-coordinated fashion</i>, where different roles will be <span style="background-color: red;">(<b>A</b>)ccountable</span> for some steps, have primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> in some steps, serve as a <span style="background-color: #cfe2f3;">(<b>C</b>)onsultant</span> in other steps, and need to be <span style="background-color: #d9ead3;">(<b>I</b>)nformed</span> of other steps.</span></li><li><span style="font-family: helvetica;">The roles of the <span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span> and <span style="color: red;"><b>Clinical IT Analyst</b></span> are separate and distinct roles that <i>often work together</i>, but serve in <i>distinct and unique capacities</i>, and thus should have <i>separate and distinct</i> job titles and descriptions.</span></li><li><span style="font-family: helvetica;">Before projects are approved, the <b><span style="color: #6aa84f;">Applied Clinical Informaticist</span></b> has primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> for the analysis, scoping, prioritization, and resource allocation, typically in conjunction with <span style="background-color: #cfe2f3;">(<b>C</b>)onsulting</span> expertise from the <span style="color: red;"><b>Clinical IT Analyst</b></span>, End-users, Compliance, Regulatory, Finance, Executive Sponsor(s), and Senior Leadership.</span></li><li><span style="font-family: helvetica;">The <span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span> also has primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> for the drafting of workflows (<span style="color: #2b00fe;"><i>blueprints of deliverables</i></span>), typically in conjunction with <span style="background-color: #cfe2f3;">(<b>C</b>)onsulting</span> expertise from the <span style="color: red;"><b>Clinical IT Analysts</b></span>, Compliance, and End-Users. These <b><span style="color: #2b00fe;">blueprints</span></b> will help to create understanding and alignment, and later serve as downtime forms in the event of a planned or unplanned downtime. </span></li><li><span style="font-family: helvetica;">The <span style="color: red;"><b>Clinical IT Analyst</b></span> often provides <span style="background-color: #cfe2f3;">(<b>C</b>)onsulting</span> expertise during earlier analysis and scoping phases of the change, but then assumes primary <span style="background-color: #fcff01;">(<b>R</b>)esponsibility</span> for the building and testing of electronic deliverables, before providing additional <span style="background-color: #cfe2f3;">(<b>C</b>)onsulting</span> expertise during the <b>implementation phase</b> of the change. </span></li></ol></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">I know there's a lot to unpack here, but I hope this review helps to demystify the process, and helps you look at your own change recipe and the roles that are <span style="background-color: red;">(<b>A</b>)ccountable</span> for, <span style="background-color: #fcff01;">(<b>R</b>)esponsible</span> for, <span style="background-color: #cfe2f3;">(<b>C</b>)onsulting</span> on, and <span style="background-color: #d9ead3;">(<b>I</b>)nformed</span> of each step. I also hope it helps to dispel the misunderstandings and confusion about the roles of the <span style="color: #6aa84f;"><b>Applied Clinical Informaticist</b></span> and the <span style="color: red;"><b>Clinical IT Analyst</b></span>, two important roles that <i>often work together</i> but each of which require their own <i>skill sets, job titles, job descriptions</i>, and <i>support</i>.</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="color: #2b00fe; font-family: helvetica;"><i>Remember, the above is all a [ DRAFT ] and this blog is for educational and discussion purposes only - Your mileage may vary! Have any feedback or experiences you would like to share? Please feel free to leave comments in the comment section below!</i></span></div><div class="separator" style="clear: both;"><span style="color: #2b00fe; font-family: helvetica;"><i><br /></i></span></div></div></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-37310879817518287722023-08-31T00:35:00.005-04:002023-08-31T00:39:11.246-04:00Strong Recommendations for new Applied Clinical Informaticists, Part 2 of 2<p><span style="font-family: helvetica;"> <i>Hi fellow CMIOs, CNIOs, and other Applied Clinical #Informatics and #HealthIT friends,</i></span></p><p><span style="font-family: helvetica;">Today, I thought I'd share the <b>second half</b> (<i><span style="color: #2b00fe;">next ten suggestions</span></i>) of my general advice to new Applied Clinical Informaticists, and other people interested in smooth clinical #workflow design. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg11HSuShRF15phFNzi5UCrk_Z-6QKy9VdR0D4xZsh26vr1iw1HnjCH5UnPRNr9y2G6lqmCbQhjncZozbkF8d_4COzIPL1e6HfH5Zp9mQPes4lI_5VlVMa1hg5f28Pd4xoU6I5J9X0hQwlY2KUaQfIuO6kM4AmjwS8gXeZoyGvXspdgG3ZJJ9KtcQENjisF/s960/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg11HSuShRF15phFNzi5UCrk_Z-6QKy9VdR0D4xZsh26vr1iw1HnjCH5UnPRNr9y2G6lqmCbQhjncZozbkF8d_4COzIPL1e6HfH5Zp9mQPes4lI_5VlVMa1hg5f28Pd4xoU6I5J9X0hQwlY2KUaQfIuO6kM4AmjwS8gXeZoyGvXspdgG3ZJJ9KtcQENjisF/w640-h360/Slide2.jpeg" width="640" /></a></div><p></p><p><span style="font-family: helvetica;">Strong recommendation #11 (<i>of 20</i>) below involves understanding the inseparable, symbiotic relationship between <b><a href="https://en.wikipedia.org/wiki/Information_technology" target="_blank">Information Technology</a></b> (<i>IT</i>) and <b><a href="https://en.wikipedia.org/wiki/Information_science" target="_blank">Information Science</a></b> (<i>IS</i>), the discipline that drives <b>Applied Clinical Informatics</b>. While it's tempting to think only one is more necessary or relevant than the other, they are both <b>equally necessary and relevant</b> - <i>You</i> <i>cannot have one without the other</i>. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4fxhaqdoavuI2pENKCmlhlZDSl0y2p0IeUC4CgXSwuJx0A351Mn4LQdyUS1Y_5rjDX3tiJAUQ8JR5jhEh7bkm0VnCWVW0kDKys2h7LGpvEgJnYc7eoKK53JD2ezKQeDBBU5nSlohFnmD2tNbgtDC7UsRM7nImY1YMb-7CjGMbsmiS9brD7571bZZkTJgG/s960/Slide12.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4fxhaqdoavuI2pENKCmlhlZDSl0y2p0IeUC4CgXSwuJx0A351Mn4LQdyUS1Y_5rjDX3tiJAUQ8JR5jhEh7bkm0VnCWVW0kDKys2h7LGpvEgJnYc7eoKK53JD2ezKQeDBBU5nSlohFnmD2tNbgtDC7UsRM7nImY1YMb-7CjGMbsmiS9brD7571bZZkTJgG/w400-h225/Slide12.jpeg" width="400" /></span></a></div><p><span style="font-family: helvetica;">Coming in at #12 is the strong recommendation (<i><span style="color: #2b00fe;">below</span></i>) to understand the difference between the '<b><i>seeds</i></b>' of good ideas, and the '<b><i>soil</i></b>' (<i><span style="color: #2b00fe;">operational infrastructure</span></i>) necessary to grow those seeds. While operational infrastructure is not always a high priority, neglected infrastructure can lead to frequent project delays, project failures, and inability to move forward. Take some time every year to look carefully at operational infrastructure, and make sure you devote the time and resources necessary to be able to grow the seeds of good ideas. </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNJ2Dc2r4NP80WW2_1Z9P4XzrN9sxKfxlXukIIDTHy916-TBuSeFTxH-LJK-VLo4vKd-o7-WbMAZWswUE-M7XT-NUejLxb7uRKY62hN64PNJE_Y5RjMU7P0uSkXcwjVWfmE4uoamm9IZXS3v1vrzf-Ni7AH9eMj9n5kyesnWTp80DWyiy8jwvqc47Ja2mt/s960/Slide13.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNJ2Dc2r4NP80WW2_1Z9P4XzrN9sxKfxlXukIIDTHy916-TBuSeFTxH-LJK-VLo4vKd-o7-WbMAZWswUE-M7XT-NUejLxb7uRKY62hN64PNJE_Y5RjMU7P0uSkXcwjVWfmE4uoamm9IZXS3v1vrzf-Ni7AH9eMj9n5kyesnWTp80DWyiy8jwvqc47Ja2mt/w400-h225/Slide13.jpeg" width="400" /></span></a></div><p><span style="font-family: helvetica;">Strong recommendation #13 (<i><span style="color: #2b00fe;">of 20</span></i>) below sometimes becomes more visible after a few years in Applied Clinical Informatics, but it addresses the relationship between <b>inconsistent or incomplete workflows</b>, and <b>burnout (</b><i><span style="color: #2b00fe;">moral injury</span></i><b>)</b>. Especially in routinely high-risk, high-stress operations, your clinical teams will always appreciate having a smooth, predictable, well-understood pathway (<i><span style="color: #2b00fe;">workflow</span></i>) from problem (<span style="color: #2b00fe;"><i>point A</i></span>) to solution (<span style="color: #2b00fe;"><i>point B</i></span>). Tangled, confusing, or incomplete workflows only create stress and confusion. Having well-designed, well-developed templates will help you make sure you're covering all of your bases, and that every step of your workflow is <i>well-planned</i>, <i>clear</i>, and <i>complete</i>.</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjCX9SxW1MAlENaQgnhJIYA1J2dDWlEdlpUU8nNGJVIhtuILe9PVFI03vvl_hQSJGyrZUFJhL9jL__64Tghxl9MUkeDWcvgtB7rJe1msoaP3mPopFW93S3qKJI1S9TuvRgtcibbxHcKFJScZ3I5aKnxyURfSwqIbROxY9mQbsxni12CD_C7EXUBLKkuGVF/s960/Slide14.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjCX9SxW1MAlENaQgnhJIYA1J2dDWlEdlpUU8nNGJVIhtuILe9PVFI03vvl_hQSJGyrZUFJhL9jL__64Tghxl9MUkeDWcvgtB7rJe1msoaP3mPopFW93S3qKJI1S9TuvRgtcibbxHcKFJScZ3I5aKnxyURfSwqIbROxY9mQbsxni12CD_C7EXUBLKkuGVF/w400-h225/Slide14.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p>My next strong recommendation (<i><span style="color: #2b00fe;">#14 of 20</span></i>) below is just to be prepared to answer common questions about "<i><b>Why do we need an interdisciplinary Applied Clinical Informatics team?</b></i>" While there are many reasons, six of the most common include :</p><p></p><ol style="text-align: left;"><li><span style="color: #cc0000;"><b>Project Intake / Procurements</b></span> that require additional support or <span style="color: #2b00fe;"><b>workflow</b></span> analysis / evaluation to help ensure the technology doesn't already exist (<span style="color: #2b00fe;"><i>in your organization</i></span>), and to help ensure proper scoping, budgeting, stakeholder identification, resource allocation, alignment with safety or compliance needs, and expected outcomes. </li><li><b><span style="color: #cc0000;">Special Event </span><span style="color: #2b00fe;">Workflow</span><span style="color: #cc0000;"> Planning</span></b> (<i>e.g. Planned maintenance or unplanned downtimes, planned upgrades, or project go-lives</i>)</li><li><b><span style="color: #cc0000;">Complex IT Tickets</span></b> that require <span style="color: #2b00fe;"><b>workflow</b></span> updates / modifications (<i>often span areas with multiple stakeholders</i>)</li><li><b><span style="color: #cc0000;">Complex Projects</span></b> that require clinical translation, terminology work, stakeholder identification and alignment, or <span style="color: #2b00fe;"><b>workflow</b></span> updates/modifications.</li><li><b><span style="color: #cc0000;">Ongoing maintenance</span></b> of existing configuration / workflows to meet CMS/TJC regulations (<i>and other payer and user requirements</i>), that requires continuous staff engagement with multiple stakeholders across different areas/specialties. </li><li><b><span style="color: #cc0000;">Helping to ensure clinical </span><span style="color: #2b00fe;">workflows</span><span style="color: #cc0000;"> are aligned</span></b> with the clinical, HIM, coding/billing, and revenue capture needs of the organization.</li></ol><p></p>To have the skills and expertise necessary for these common functions, you will need an Applied Clinical Informatics team. Knowing some good reasons to have such a team will help support the discussions about how to build one. </span><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDr0y0OhwdoGEcv3q3kEgouLPAuBUMMW7uEPlnSpmOR-Sa2JjqI6JRgaDB4A_GUihyIv44uz-XU9qMLHnAC3QPyIS9hqSDr2A411AdU9YdQQVO2b17SG_pbZjpoHUytRqpF1Nm-KBg7q3qvL4tORYXFZGJXzeF3DKPjRNAaboaDrpMVU0K2E2eBFoG3e0q/s960/Slide15.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDr0y0OhwdoGEcv3q3kEgouLPAuBUMMW7uEPlnSpmOR-Sa2JjqI6JRgaDB4A_GUihyIv44uz-XU9qMLHnAC3QPyIS9hqSDr2A411AdU9YdQQVO2b17SG_pbZjpoHUytRqpF1Nm-KBg7q3qvL4tORYXFZGJXzeF3DKPjRNAaboaDrpMVU0K2E2eBFoG3e0q/w400-h225/Slide15.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Strong recommendation #15 (<i><span style="color: #2b00fe;">of 20</span></i>) for new Applied Clinical Informaticists (<i><span style="color: #2b00fe;">below</span></i>) is to really <b>care about design</b>. Cooking food is not enough, you need to care about cooking <b><i>great</i> food</b>. While discussing details is sometimes seen in healthcare as '<i>getting too into the weeds</i>', our clinical teams <b>need</b> you to care about the details, so that you can develop the complete blueprints that will help technical teams to build great workflows. <b>Also</b> : Try to resist the urge to use <i>short-term solutions</i> for <i>long-term problems</i> - While they might temporarily help, they usually create workarounds that then need even more work to fix.</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq_SVIQ_MQhkI_m0mTwiiWxQsnnA-sH5jkyPfGqA5b002Ywjn2vT-mL7K_vcOCx3S4kW9HFQOzUz_2xS3_rbFDY8XHxnxc1t3JXargsX_nVNq0jbFt2MUh-fvj6MkEhZEP4jba0vgJznGZmSk-5gDITnqBRC2JbWyddP7E1hZcxiVHVxwA_HoAJnZsPBt0/s960/Slide16.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq_SVIQ_MQhkI_m0mTwiiWxQsnnA-sH5jkyPfGqA5b002Ywjn2vT-mL7K_vcOCx3S4kW9HFQOzUz_2xS3_rbFDY8XHxnxc1t3JXargsX_nVNq0jbFt2MUh-fvj6MkEhZEP4jba0vgJznGZmSk-5gDITnqBRC2JbWyddP7E1hZcxiVHVxwA_HoAJnZsPBt0/w400-h225/Slide16.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p>At #16 is my strong recommendation (<span style="color: #2b00fe;"><i>below</i></span>) to <b>know the</b> <b>sixteen</b> (16) <b>most common</b> (<span style="color: #2b00fe;"><i>CPOE</i></span>) <b>order</b> <b>types</b>. <i>These are the basic building blocks that work together to build all of your clinical worfklows</i>. It's very helpful to know what they are, what they do, how they work together, and when to use them. Many incomplete workflows come from not including one or more of these order types in an order set, order panel, or other ordering tool, so you can help improve workflow design by including all sixteen order types in an order set template, and then using that to guide the development of all of your order sets. *<b>Note</b> : <i>Not every order set will use all sixteen order types, and you will only use the ones you need to address your desired clinical scenario</i>. Having all sixteen types in a template (<i><span style="color: #2b00fe;">for developing your order set blueprints</span></i>) will help create consistency and completeness for your clinical teams. </p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglm1-Di1_6ce80nhM2s-rqEgaIveSfpDeNgjnNg4t_xjhrz0rXEEZmtozbVfh5PNdQQdvfIxbZmT7MlF_BLugyeX_o7i9Eh4mTwqp14El4gF7XSMxJd4YipAOowakAGCZYPSqnfaYL39EnEdBSOgPYGoQUlhcO2-1NeAA4pPkMKyHEc9WNBjk0868lbKvt/s960/Slide17.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglm1-Di1_6ce80nhM2s-rqEgaIveSfpDeNgjnNg4t_xjhrz0rXEEZmtozbVfh5PNdQQdvfIxbZmT7MlF_BLugyeX_o7i9Eh4mTwqp14El4gF7XSMxJd4YipAOowakAGCZYPSqnfaYL39EnEdBSOgPYGoQUlhcO2-1NeAA4pPkMKyHEc9WNBjk0868lbKvt/w400-h225/Slide17.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">My strong recommendation #17 (<i><span style="color: #2b00fe;">of 20</span></i>) below is simply <b>not to minimize the complexity of ordering tool (</b><i>'<span style="color: #2b00fe;">order set'</span></i><b>) requests</b>. I'm often fascinated by the small requests that have the largest operational impact, and thus require more time and effort to plan and execute than most people have budgeted for. Setting realistic expectations is the first step to good planning, so do your worfklow (<i><span style="color: #2b00fe;">gap, current-state-future-state</span></i>) analysis early, and be prepared to inform your requestor when a project is larger than originally anticipated. </span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-vtTxM6DG8Gmp3BT__G3hk1gOIJR0FNm846ws0nE5K2bGgJTkZfwGA5yxSeywD5hiokK6G_aii6yHBiVim7_7X5SnDmESs_nM0tvW5SkZlfCF5-GTf1Up2IsChpJopN9lsrxQu7CQOlseXIgLvubMEys7R7oaqqF5eZBqT7ITffvpZBmA57Xh68Ex-b9d/s960/Slide18.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-vtTxM6DG8Gmp3BT__G3hk1gOIJR0FNm846ws0nE5K2bGgJTkZfwGA5yxSeywD5hiokK6G_aii6yHBiVim7_7X5SnDmESs_nM0tvW5SkZlfCF5-GTf1Up2IsChpJopN9lsrxQu7CQOlseXIgLvubMEys7R7oaqqF5eZBqT7ITffvpZBmA57Xh68Ex-b9d/w400-h225/Slide18.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Strong recommendation #18 (of 20) below is simply to consider <b>how you will manage the intake of maintenance tickets and new project requests</b>, from a <i>variety of stakeholders</i>. Navigating HealthIT (<i><span style="color: #2b00fe;">and Applied Clinical Informatics</span></i>) often means managing the competing interests of : </span></p><p></p><ul style="text-align: left;"><li>Software vendors</li><li>Patient/Caregiver input/feedback</li><li>User input (from multiple stakeholders)</li><li>Contracting and Payer Updates</li><li>Formulary Updates</li><li>Practice Onboarding</li><li>Institutional Decisions</li><li>Federal, State, and Department of Public Health regulations</li><li>Evidence-based best practices</li><li>Institutional policies and bylaws</li><li>Privacy and Security Needs</li><li>Quality Reporting</li><li>External advisory organizations (<i>e.g. The Joint Commission, Leapfrog, etc.</i>)</li><li>Vendor choices</li></ul><p></p><p><span style="font-family: helvetica;">... so you will want to consider all of these potential sources of change in your intake and prioritization processes.</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiCRABmS1Jl7pg9eahVGgJ4hdw95w7fMFzZWrnRqos4GuVQtiH6pRrnjEjk8uOPEw6qcfc5_J1YAjsH93-6atjsTYqb0ZCHVvdnms_d-1Kn9lPiP8SU-4KR9vmP4jWGHzELwmDRmqwVEBpFUg1C9wHWlulaPLaDH72AwABDr2z7K6wmySRk1kraBMmkAdn/s960/Slide19.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiCRABmS1Jl7pg9eahVGgJ4hdw95w7fMFzZWrnRqos4GuVQtiH6pRrnjEjk8uOPEw6qcfc5_J1YAjsH93-6atjsTYqb0ZCHVvdnms_d-1Kn9lPiP8SU-4KR9vmP4jWGHzELwmDRmqwVEBpFUg1C9wHWlulaPLaDH72AwABDr2z7K6wmySRk1kraBMmkAdn/w400-h225/Slide19.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p>Nearing the end, my strong recommendation #19 (<span style="color: #2b00fe;"><i>of 20</i></span>) below is to learn the most common types of <b>Computerized Provider Order Entry</b> (<i><span style="color: #2b00fe;">CPOE</span></i>) <b>order modes</b>. Ideally, providers would always enter their own orders, but there are some very important, very legitimate reasons (<i><span style="color: #2b00fe;">clinical scenarios</span></i>) why they sometimes <b>cannot</b> (<span style="color: #2b00fe;"><i>without delaying necessary patient care</i></span>). Understanding these reasons (<span style="color: #2b00fe;"><i>and scenarios</i></span>) will help you create and support compliant and safe order entry workflows all across your organization.</p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqk-P-4J_V4DwDNaXinHcpJPPjM8e8BmETfgoKBeuG3EwMloOyLBvu5WlJGqUe-jrrKyP3VsbT7cdkYwJasbR166FUkXDi4UGJncssoVPqJ9dWvfBz1KvMrMMlT34NuI7M9odgotZ3OHS38sQ6qDhJ9JosqoEjldZ1nJFLvPNZzRlDUT1lqDLm5UhEi_oG/s960/Slide20.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqk-P-4J_V4DwDNaXinHcpJPPjM8e8BmETfgoKBeuG3EwMloOyLBvu5WlJGqUe-jrrKyP3VsbT7cdkYwJasbR166FUkXDi4UGJncssoVPqJ9dWvfBz1KvMrMMlT34NuI7M9odgotZ3OHS38sQ6qDhJ9JosqoEjldZ1nJFLvPNZzRlDUT1lqDLm5UhEi_oG/w400-h225/Slide20.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Finally, my strong recommendation #20 (<span style="color: #2b00fe;"><i>of 20</i></span>) below is simply to <b>empower a clinical leader</b>. Whether they are a nursing leader, physician leader, APP leader, radiology leader, laboratory leader, pharmacy leader, or other ancillary staff leader - <i>they are all important and deserve your support. </i>Usually, they are already great clinicians - Help them learn leadership skills, and they will be better leaders, and help you solve more problems. Skills like : </span></p><p></p><ul style="text-align: left;"><li>Reading a bylaw / policy</li><li>Writing a bylaw / policy</li><li>Reading a budget</li><li>Planning a budget</li><li>Writing a charter</li><li>Chairing a committee</li><li>Planning an agenda</li><li>Project and change management basics</li><li>Documentation and coding basics</li><li>Hiring a staff member</li><li>Managing a staff member</li></ul><div>... can go a long way to long-term success for any leader. If you see a new clinical leader, make sure you reach out to them and support them as they grow - This will help empower leaders to retain staff and solve problems.</div><p></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2lCeo923Ny8lJ6AM3Jx3SJ7spXIxQZs2qUHFPt272FeZHHa-PaEXgRMyGxUjbmfLyiZVHkhWH9HMvh4sDePKcWfG8tULwvhLFRdrj_qNvchhECKhd5Gp1g7iE1NRAAYI8n4ZWOVv6jfHRhhMFP9ZXx0AVSL2tuuKG1onBPs6D4Uxj5XQLS6A4vMoJM0hX/s960/Slide21.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2lCeo923Ny8lJ6AM3Jx3SJ7spXIxQZs2qUHFPt272FeZHHa-PaEXgRMyGxUjbmfLyiZVHkhWH9HMvh4sDePKcWfG8tULwvhLFRdrj_qNvchhECKhd5Gp1g7iE1NRAAYI8n4ZWOVv6jfHRhhMFP9ZXx0AVSL2tuuKG1onBPs6D4Uxj5XQLS6A4vMoJM0hX/w400-h225/Slide21.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div></span><div style="font-family: helvetica;">Okay, along with my <a href="https://www.dirkstanley.com/2023/08/strong-suggestions-for-new-applied.html?spref=tw " target="_blank">first ten recommendations</a>, I think these additional ten above cover my<b> top twenty</b> (20) <b>strong recommendations</b> for new Applied Clinical Informaticists seeking to design smooth workflows. If you have other suggestions, please leave them in the comments section below!</div><div style="font-family: helvetica;"><br /></div><div style="font-family: helvetica;"><i>Remember - This blog is for educational and discussion purposes only, and is not formal advice - your mileage may vary. Have any other helpful ideas, suggestions, or experiences you'd like to share? Feel free to leave them in the comments section below!</i></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-43614719078558111952023-08-18T21:32:00.004-04:002023-08-18T21:47:00.814-04:00Strong Recommendations for new Applied Clinical Informaticists, Part 1 of 2<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, and other Applied Clinical Informatics and #HealthIT friends,</i></span></p><p><span style="font-family: helvetica;">Today I thought I'd share the <b>first ten</b> (<i>of 20</i>) <b>strong suggestions</b> I put together into slides for other Applied Clinical Informaticists, or those considering a career in Applied Clinical Informatics. I'm hoping this helps shed light on the importance and value of this role in modern healthcare, and how it helps to evaluate, implement, and maintain clinical technology and content. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEio3pnULhQ1pkXJOkeMYOLd4ThN0y4dRce_DYhNRs3ZeIjCwOCv7EShIy6aeXXM2V0mDubCobffsJqW6YYQS_7Fn0CFM87Crj-ImnNZWb9vl8MYbKjDHzb-mrsf9S2ZE5mN1vM6bTxYkV8kyT-ZKWwiMxsyZ4mvU1YNeOmvY3SwaqIyuLgSBNt5qs1jN73R/s960/Slide1.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEio3pnULhQ1pkXJOkeMYOLd4ThN0y4dRce_DYhNRs3ZeIjCwOCv7EShIy6aeXXM2V0mDubCobffsJqW6YYQS_7Fn0CFM87Crj-ImnNZWb9vl8MYbKjDHzb-mrsf9S2ZE5mN1vM6bTxYkV8kyT-ZKWwiMxsyZ4mvU1YNeOmvY3SwaqIyuLgSBNt5qs1jN73R/w400-h225/Slide1.jpeg" width="400" /></span></a></div><p></p><p><span style="font-family: helvetica;">First, my #1 advice to newcomers - Always map the CURRENT-STATE and FUTURE-STATE workflows. While some might argue this is an unnecessary step, this exercise will benefit you in some very important ways : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">It will help you <i>understand and relate to your end-users</i>.</span></li><li><span style="font-family: helvetica;">It will help you determine just <b>how much work</b> it takes to get from your <b>CURRENT STATE</b> (<i><span style="color: #2b00fe;">Point A</span></i>) to your <b>FUTURE STATE</b> (<span style="color: #2b00fe;"><i>Point B</i></span>), which is necessary to help plan and allocate resources.</span></li><li><span style="font-family: helvetica;">Finally, it will help you develop <b>blueprints</b>, develop <b>downtime forms</b>, <b>identify stakeholders,</b> and <b>scope/prioritize</b> your projects. </span></li></ul><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhinU-63hLFEQ1pegWgyJdu9X4_O_xyfXtCHfYANqrHoK4cXeGeCsXUHLy9J7kk8dzd0CWUrj7JKOXNRNMe_gtQ_Ez-LTtl-3khfg1Jtola_gWKZFWDANoc9OuWEFdez0NVe1AWK619Nbh6St0THW9KjnWm0fuMrp3ZIEsD6_Tt37tN_6-sGFN9Wqc4Sl6o/s960/Slide1.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhinU-63hLFEQ1pegWgyJdu9X4_O_xyfXtCHfYANqrHoK4cXeGeCsXUHLy9J7kk8dzd0CWUrj7JKOXNRNMe_gtQ_Ez-LTtl-3khfg1Jtola_gWKZFWDANoc9OuWEFdez0NVe1AWK619Nbh6St0THW9KjnWm0fuMrp3ZIEsD6_Tt37tN_6-sGFN9Wqc4Sl6o/w400-h225/Slide1.jpeg" width="400" /></span></a></div><p><span style="font-family: helvetica;">Next, for my strong recommendation #2, I'd like to share how to write a good <b>task</b>, and then a good <b>procedure</b>. Learning to write a good task and procedure are so instrumental in building or untangling workflows, that it can even be used as a quick substitute for swimlane diagrams (<span style="color: #2b00fe;"><i>e.g. when trying to quickly document a workflow during a video chat with clinical end-users</i></span>) :</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFsKet4DYojfbxxWY4WibvFpTxuSsw3LvNMR07Z-0-JvbAnXh87_feIiAPpdXSnUFo4BNW_xMZV0rX5_lxdKd_uTLyvUmjr-a_PhcanUnQYksddsbeP67yMbuQ_FSySMdSt8-zWdYiizCTUR0dbOssgl02CxFE7rcYaKXZ4xApGoJVwTAiCissKjqCyy_U/s960/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFsKet4DYojfbxxWY4WibvFpTxuSsw3LvNMR07Z-0-JvbAnXh87_feIiAPpdXSnUFo4BNW_xMZV0rX5_lxdKd_uTLyvUmjr-a_PhcanUnQYksddsbeP67yMbuQ_FSySMdSt8-zWdYiizCTUR0dbOssgl02CxFE7rcYaKXZ4xApGoJVwTAiCissKjqCyy_U/w400-h225/Slide2.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Strong recommendation #3 involves something that sounds dull, until you learn about how it impacts your infrastructure and operations - <b>Document management</b>. Learning how to create, edit, and archive documents can actually be a very powerful way of shaping or augmenting workflows in your electronic medical record. My mantra for newcomers : "<i>Learn to control your documents, before they control you</i>."</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis5RKQvvTP045NMPD50usHcxUPhU6oko0B7XoFqJnOkhQ9LRyhjMFCiPdGNufD4eNYwN2E6B0ouPpMoOZH7MEpzbr53vg4fkJFbkPdgh4XICp1wZ-4yzacakRI65ElFFHpJPZHAGSbXg7F0wcIci4a2HPffnwvL6_NiUWcy7Q87IDO8IXWorkjIDPorTRF/s960/Slide3.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis5RKQvvTP045NMPD50usHcxUPhU6oko0B7XoFqJnOkhQ9LRyhjMFCiPdGNufD4eNYwN2E6B0ouPpMoOZH7MEpzbr53vg4fkJFbkPdgh4XICp1wZ-4yzacakRI65ElFFHpJPZHAGSbXg7F0wcIci4a2HPffnwvL6_NiUWcy7Q87IDO8IXWorkjIDPorTRF/w400-h225/Slide3.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">My next strong recommendation #4 is to learn the basic structure of healthcare operations, by understanding the relationship between Administrative, Academic, Research, and Clinical Enterprises (<span style="color: #2b00fe;"><i>Note : Smaller community hospitals typically only have Academic and Clinical enterprises.</i></span>) <b>In short</b> : Administration supports the needs of the Academic, Research, and Clinical Enterprises. Learning how to navigate the people in these areas will help you break down silos, untangle workflows, and improve collaboration.</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1XCF1BC5FCwzFOzpG8-iFbZxwxar3IwvZJatMn9MmpTTl0ga4HqofS-Peci4ecDgFVDIOVrynOZn5eNErfQ0uddeU0-5AN5zMZaYQ6W7qJsjdMxeHNYT-fRc1PKc-AzODp8JuGbsGECkLmzamK13KEKqRx1brvR81Tu-yy4JRheGk9oj3HAipfPQEfiAW/s960/Slide4.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1XCF1BC5FCwzFOzpG8-iFbZxwxar3IwvZJatMn9MmpTTl0ga4HqofS-Peci4ecDgFVDIOVrynOZn5eNErfQ0uddeU0-5AN5zMZaYQ6W7qJsjdMxeHNYT-fRc1PKc-AzODp8JuGbsGECkLmzamK13KEKqRx1brvR81Tu-yy4JRheGk9oj3HAipfPQEfiAW/w400-h225/Slide4.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Coming in at #5 is my strong recommendation to care about hard work, details, and precision. "<i>In Healthcare, there are no shortcuts</i>." While timelines are often short, and there is often pressure to move ahead, try to resist the temptation to serve workflows that are not complete. (<i>They may get you across your project finish line, but you risk having to do the whole project again, especially if end-users are not satisfied with the results</i>.)</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-_9A_15AM10_uIFGHm01B6OKenmTRYRyvkip2gATlliAkAO7JRjuPfLYC3_sLmwfS8SEA7RioOS7i1AoRlMz3DXKdKhS23mA6gbzNkOCJjuKn7GvcRzXycNYkdvUj5p_4p4GGXeOL4VXXu_vdcXSyc7-rGp8as5wm9Vr1nzbXfGrzIzJeFxxlGAweb018/s960/Slide5.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-_9A_15AM10_uIFGHm01B6OKenmTRYRyvkip2gATlliAkAO7JRjuPfLYC3_sLmwfS8SEA7RioOS7i1AoRlMz3DXKdKhS23mA6gbzNkOCJjuKn7GvcRzXycNYkdvUj5p_4p4GGXeOL4VXXu_vdcXSyc7-rGp8as5wm9Vr1nzbXfGrzIzJeFxxlGAweb018/w400-h225/Slide5.jpeg" width="400" /></span></a></div><p style="font-family: helvetica;"><span style="font-family: helvetica;">Strong Recommendation #6 might be a surprise to some : When working in a team, <b>file naming conventions really matter</b>. Group files should be both <i>easy-to-find</i> and <i>easy-to-identify</i>. My own personal favorite is :</span></p><p></p><blockquote><span style="color: #2b00fe; font-family: trebuchet;">DRAFT/FINAL - ARCHETYPE - Descriptor - Created/Updated/Approved mm-dd-yyyy.ext</span></blockquote><p></p><p style="font-family: helvetica;"><span style="font-family: helvetica;">Where : </span></p><p style="font-family: helvetica;"></p><blockquote><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b>DRAFT / FINAL</b> = Use DRAFT for documents in development, FINAL when approved</span></li><li><span style="font-family: helvetica;"><b>ARCHETYPE</b> = Describes the file type (<span style="color: #2b00fe;"><i>e.g. Education, Budget, Order Set, Catalog, Index, Contract, Policy, Protocol, Guideline, Schedule, Bylaws, Notes, Slide, Screenshot, etc.</i></span>)</span></li><li><span style="font-family: helvetica;"><b>Descriptor</b> = Describes a unique identifier for the file (<span style="color: #2b00fe;"><i>e.g. "ICU DKA Treatment Discussion", "Meeting with Dr. Smith", "Malaria Workup", etc.</i></span>)</span></li><li><span style="font-family: helvetica;"><b>Created/Updated/Approved</b> = Use CREATED when first creating a file, UPDATED when updating a file, and APPROVED when creating a final version</span></li><li><span style="font-family: helvetica;"><b>mm-dd-yyyy</b> = Describes when the file was created, updated, or approved</span></li><li><span style="font-family: helvetica;"><b>ext</b> = File extension (<span style="color: #2b00fe;"><i>e.g. ".docx" or ".PDF", etc.</i></span>)</span></li></ul></blockquote><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLczTgCvNvHuvjKIWF73fR1JN5M56hfLmz7IJ0nvRamLxbyNtH5jTge0H3pl5UU9awwiHFGwV0UZkAZKxSusTV3B7C5vXrCGASrmGOzfheGkHTPoAZZ0raX_6KXNaeav22RuIc1fV4MxVNqFlXoJzkidBJqUHgSFaRVFLRVeQnEdD-FJpISG794KlmtSSz/s960/Slide6.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLczTgCvNvHuvjKIWF73fR1JN5M56hfLmz7IJ0nvRamLxbyNtH5jTge0H3pl5UU9awwiHFGwV0UZkAZKxSusTV3B7C5vXrCGASrmGOzfheGkHTPoAZZ0raX_6KXNaeav22RuIc1fV4MxVNqFlXoJzkidBJqUHgSFaRVFLRVeQnEdD-FJpISG794KlmtSSz/w400-h225/Slide6.jpeg" width="400" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">My next Strong Recommendation #7 is to <b>learn the twenty-four</b> (<span style="color: #2b00fe;"><i>24</i></span>) <b>basic tools that shape all clinical workflows</b> - Twelve (<span style="color: #2b00fe;"><i>12</i></span>) are typically outside of the electronic medical record, and the other twelve (<span style="color: #2b00fe;"><i>12</i></span>) are found inside the electronic medical record. Understanding the basic functions and design of each of these tools will help you to better plan projects, identify deliverables, identify stakeholders, and create smooth, complete clinical workflows : </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiF0R_D1w1Qk9GBRTpC9THlHR1xh2Lup_rjYQIIepzXyVq1LsPhV6Ywq4-SmO4o4atikDUV_UZlcxbaAEWOmyIAtsbRqa8tPeIyXKPqNaLMZawnWJjT51olmVyZW4a7v1AuCE5Lod7Y4e00_pYf7I__CRzd18A-yvbeSuOpaG_KVY38IL2bleMz4iZML04k/s960/Slide7.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiF0R_D1w1Qk9GBRTpC9THlHR1xh2Lup_rjYQIIepzXyVq1LsPhV6Ywq4-SmO4o4atikDUV_UZlcxbaAEWOmyIAtsbRqa8tPeIyXKPqNaLMZawnWJjT51olmVyZW4a7v1AuCE5Lod7Y4e00_pYf7I__CRzd18A-yvbeSuOpaG_KVY38IL2bleMz4iZML04k/w400-h225/Slide7.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Coming in at #8 is my general recommendation to all Applied Clinical Informaticists to care about the <b>entire</b> '<b>Informatics tree'</b>, including both the '<b><i>Data In</i></b>' and '<b><i>Data Out</i></b>' branches. While most people will gravitate toward one area, understanding the whole tree will broaden your perspectives and skill sets, and overall help you plan workflows :</span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKx9EwGeV7VmNYOWOBo7FZqDRcS4nCi3ChjgkA5SOPDXhGxHcoYMkFdZgsOckfVEqA2j3AOw_aBz05uf2ypz3OVIb7aLxO3OjUyhhQroL1GMnRXhcg2wD1fnjhsFfLEGtuoL7JedTPQfmwzc0K36KFsOqESYgJ-o7amNN7yFMTB4ejEVo8X-QBrCKjzioi/s960/Slide8.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKx9EwGeV7VmNYOWOBo7FZqDRcS4nCi3ChjgkA5SOPDXhGxHcoYMkFdZgsOckfVEqA2j3AOw_aBz05uf2ypz3OVIb7aLxO3OjUyhhQroL1GMnRXhcg2wD1fnjhsFfLEGtuoL7JedTPQfmwzc0K36KFsOqESYgJ-o7amNN7yFMTB4ejEVo8X-QBrCKjzioi/w400-h225/Slide8.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p>Strong Recommendation #9 for Applied Clinical Informaticists seeking to design smooth workflows comes from <a href="https://www.dirkstanley.com/2015/11/the-informatics-domain-and-workflow.html" target="_blank">this 2015 blog post</a>, where I recommend learning the relationship between concepts, terminology, templates, documents, and workflows. <i>In general</i> : </p><p></p><ul style="text-align: left;"><li><span style="color: red;"><b>Organizational Support</b> (#8)</span> is necessary to...</li><li>identify the <span style="color: #e69138;"><b>concepts and ontologies</b> (#7)</span> that help you...</li><li>develop the <span style="color: #bf9000;"><b>definitions, terminology, and standards</b> (#6) </span>that you need to...</li><li>develop the <span style="color: #6aa84f;"><b>templates and archetypes</b> (#5) </span>that will help you...</li><li>create the <span style="color: #0b5394;"><b>documents and tools</b> (#4)</span> that, combined, will help to...</li><li>create and support the <span style="color: #800180;"><b>workflows and processes</b> (#3) </span>that, if designed properly, will...</li><li>align with your <span style="color: #674ea7;"><b>goals and regulations</b> (#2) </span>which should...</li><li>align with your <span style="color: red;"><b>Mission and Vision</b> (#1)</span>.</li></ul><p></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4oEeM12IPxqI7zRyT0UkccvLygiOhHUdZk273JP0MaHJ6vvLzXwtaAG6pR4tqJpiQRVDMbtfyy6Hvn7JpYT9aU_LlyyTkNltXrsOE-9YgR24dpOso4tHTqZ6jo1-6cYrYuK_jkTMSGTp32Q9pHSQLCUNnCzcMTJIdWb-5QCypgHAiY2p55LdAPnWKSGDy/s960/Slide9.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4oEeM12IPxqI7zRyT0UkccvLygiOhHUdZk273JP0MaHJ6vvLzXwtaAG6pR4tqJpiQRVDMbtfyy6Hvn7JpYT9aU_LlyyTkNltXrsOE-9YgR24dpOso4tHTqZ6jo1-6cYrYuK_jkTMSGTp32Q9pHSQLCUNnCzcMTJIdWb-5QCypgHAiY2p55LdAPnWKSGDy/w400-h225/Slide9.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Typically, after first understanding #2, Applied Clinical Informaticists will concern themselves with aligning levels #7-#3 of this pyramid. (<i><span style="color: #2b00fe;">Learning how pyramid levels #8-5 impact the documents in #4 can help you troubleshoot even the most complicated workflows in #3.</span></i>)</span></p><p><span style="font-family: helvetica;">Finally, my Strong Recommendation #10 for Applied Clinical Informaticists seeking to design smooth workflow is to <b>care deeply about change management</b>. While <a href="https://www.kotterinc.com/methodology/8-steps/" target="_blank">Kotter's 8-step change management model</a> is an excellent foundation, I recommend beginning with a <a href="https://en.wikipedia.org/wiki/Waterfall_model" target="_blank">standard, linear waterfall project model</a> and then expanding it slightly for healthcare purposes, to include :</span></p><p></p><ol style="text-align: left;"><li>Conception, Determination, and Documentation of Need for Change</li><li>Evaluation, Analysis, Scoping, Presentation, Prioritization, and Approval for Change</li><li>Project Planning</li><li>Drafting of Change</li><li>Building of Change</li><li>Testing of Change</li><li>Final Approval of Change (<span style="color: #2b00fe;"><i>go / no-go discussion</i></span>)</li><li>Communication and Education of Change</li><li>Implication / Publication (<span style="color: #2b00fe;"><i>'Go-Live'</i></span>) of Change</li><li>Monitoring and Support of Change</li></ol><p></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhywBrB-ONUFL1H-Zdhwq24HvQKrZYy46D3XKqIOxijGHBNKPcs_-B2sp1qASFNkkMOU49Oy_jV07AJbIz-wkQmdxyAvQT0YZzxempMXkQShmOqrnTmSQdQmWyoMHNF3bjewSY4-_CSPcUye_yexsz4mcu8xROPMqlGlSTHzyg2rOoTfikBtMCR-9ykc5z9/s960/Slide10.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhywBrB-ONUFL1H-Zdhwq24HvQKrZYy46D3XKqIOxijGHBNKPcs_-B2sp1qASFNkkMOU49Oy_jV07AJbIz-wkQmdxyAvQT0YZzxempMXkQShmOqrnTmSQdQmWyoMHNF3bjewSY4-_CSPcUye_yexsz4mcu8xROPMqlGlSTHzyg2rOoTfikBtMCR-9ykc5z9/w400-h225/Slide10.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><br />Once you have these ten steps laid out, you can begin looking at the tasks beneath each step, and developing your own '<i>waterfall-meets-healthcare</i>'-type change management strategy.</span><p></p><p><span style="font-family: helvetica;">I hope this is a helpful set of slides for newcomers to Applied Clinical Informatics. Feel free to leave comments below with any thoughts or feedback. In my next post, we will look at <b>another ten </b>(<span style="color: #2b00fe;"><i>10</i></span>) of my strong recommendations for <b>Applied Clinical Informaticists</b> seeking to design smooth workflows!</span></p><p><span style="font-family: helvetica;"><i>Have any helpful advice for newcomers to Applied Clinical Informatics? Are there any tips or tricks that were important to you? Please feel free to leave in the comments section below!</i></span></p>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com1tag:blogger.com,1999:blog-8434050931789572015.post-89785405687508539222023-07-10T23:59:00.004-04:002023-07-14T13:22:36.416-04:00Definitions, Templates, Documents, and Workflow Design - the Video!<div style="text-align: left;"><i><span style="font-family: helvetica;">Hi fellow CMIOs, CNIOs, and other Informatics friends,</span></i></div><div style="text-align: left;"><span style="font-family: helvetica;"><br />I'm writing today to share a video adaptation of a lecture I did last year for a <b>Physicians in AMIA</b> meeting (<i><span style="color: #2b00fe;">thanks to Dr. Richard Schreiber!</span></i>), where I shared a bunch of the lessons I've learned during my 16-year career as an Applied Clinical Informaticist and CMIO. </span></div><div style="text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div style="text-align: left;"><span style="font-family: helvetica;">If you're interested in Applied Clinical Informatics or workflow design, I think you'll like this video. My adapted version is about 26 minutes long, but it contains as much information and background as I could fit. And with a standard YouTube format, you can now pause and resume on any slide!</span></div><div style="text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div style="text-align: left;"><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/DaLuXd7jmqI" width="320" youtube-src-id="DaLuXd7jmqI"></iframe></div></div><div style="text-align: left;"><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;">(<span style="color: #2b00fe;"><i>Click above icon to open</i></span>)</span></div></div><div style="text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div style="text-align: left;"><span style="font-family: helvetica;">So if Applied Clinical Informatics, workflow design, or reducing clicks and burnout are your thing, I hope this video helps you. Please feel free to leave questions or feedback in the comments section below!</span></div><div style="text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div style="text-align: left;"><span style="font-family: helvetica;">And for those of you who prefer printed slides, instead of video - I'm also working on a printed version of this presentation shortly!</span></div><div style="text-align: left;"><br /></div><div style="text-align: left;"><span style="font-family: helvetica;"><i>Have any helpful experiences in developing clinical workflows? Or just want to share any lessons learned? Feel free to leave feedback in the comments section below!</i></span></div><div style="text-align: left;"><span style="font-family: helvetica;"><i><br /></i></span></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0Northampton, MA, USA42.3250896 -72.64120129999999214.014855763821153 -107.79745129999999 70.635323436178851 -37.484951299999992tag:blogger.com,1999:blog-8434050931789572015.post-64037624618740456512023-04-07T16:49:00.003-04:002023-07-25T14:28:25.480-04:00What are Incidental and other Actionable Findings? <p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, and other applied Clinical Informatics friends,</i></span></p><p><span style="font-family: helvetica;">I'm writing today to share some helpful insights into one of those clinical operations things <i>you don't usually learn much about during clinical education and training</i> : <b>Incidental</b> and other <b>actionable findings</b>. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx5_rGx98_UEo83vIhT-vcaU97AghIwS-quvxPetdEUx_03FEUK_ww1pJnYjWzTYQ3p5rvJsnTYs7Ohjqt96FG28a92sAYE2UAGybJdATCIja8JjdtuxljU4uX_J96xuDBk-sVh6ktF3vt8tZMHfzceYXyi-w0XA2K0xBtMuehd7WaWk5uXf7agFE1ow/s1040/Slide1.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="585" data-original-width="1040" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx5_rGx98_UEo83vIhT-vcaU97AghIwS-quvxPetdEUx_03FEUK_ww1pJnYjWzTYQ3p5rvJsnTYs7Ohjqt96FG28a92sAYE2UAGybJdATCIja8JjdtuxljU4uX_J96xuDBk-sVh6ktF3vt8tZMHfzceYXyi-w0XA2K0xBtMuehd7WaWk5uXf7agFE1ow/w640-h360/Slide1.jpeg" width="640" /></a></div><p></p><p><span style="font-family: helvetica;">First, some literature review. Before we dive into this, I'd like to share this excellent 2014 groundbreaking paper from the <b>Journal of the American College of Radiology</b> (<i><span style="color: #2b00fe;">JACR</span></i>) <b>Actionable Findings Workgroup</b>, including Larson MD, Berland MD, Griffith MD, Kahn Jr MD, and Liebscher MD:</span></p><p><span style="font-family: helvetica;"><a href="goog_316583253"></a></span></p><blockquote><span style="font-family: helvetica;"><a href="https://www.jacr.org/action/showPdf?pii=S1546-1440%2813%2900840-5" target="_blank">Actionable Findings and the Role of IT Support : Report of the ACR Actionable Reporting Workgroup</a></span></blockquote><p></p><p style="text-align: left;"><span style="font-family: helvetica;">Also note that the <b>American College of Radiology</b> (<i>ACR</i>) and <b>American College of Emergency Physicians</b> (<i>ACEP</i>) recently published a joint piece in the March 2023 <b>Journal of the American College of Radiology </b>(<i>JACR</i>), an <b>excellent</b> white paper (<i><a href="https://www.jacr.org/article/S1546-1440(23)00123-0/fulltext?_gl=1*mx3ova*_ga*NTY1MDI3ODMuMTY4MDg0MzAxOA..*_ga_K9XZBF7MXP*MTY4MDg0MzAxOC4xLjEuMTY4MDg0MzAxOC4wLjAuMA..&_ga=2.256951299.946441897.1680843018-56502783.1680843018" target="_blank">click here</a> to open it</i>) about "<a href="https://www.jacr.org/action/showPdf?pii=S1546-1440%2823%2900123-0" target="_blank">Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging</a>" (</span><span style="color: #38761d; font-family: helvetica;"><i>Christopher L. Moore, MD , Andrew Baskin, MD , Anna Marie Chang, MD, MSCE ,
Dickson Cheung, MD, MBA, MPH , Melissa A. Davis, MD, MBA , Baruch S. Fertel, MD, MPA,
Kristen Hans, RN, MS, Stella K. Kang, MD, MSc, David M. Larson, MD,
Ryan K. Lee, MD, MBA, Kristin B. McCabe-Kline, MD, Angela M. Mills, MD,
Gregory N. Nicola, MD, Lauren P. Nicola, MD,</i></span><span style="font-family: helvetica;"><i><span style="color: #38761d;"> JACR Mar 13, 2023</span></i>). However, since this is an important discussion, I thought I'd share some broader insights into these important workflows from an <b>Applied Clinical Informatics</b> perspective. </span></p><p><span style="font-family: helvetica;"><b>It all starts here</b><span> : In healthcare, there are the </span><b>routine</b><span> clinical scenarios, and then there are the </span><b>unusual, unexpected</b><span> clinical scenarios. </span><b>Most of the time</b><span>, laboratory studies are generally within </span><i>normal or anticipated ranges</i><span>, and radiologic studies (</span><i><span style="color: #2b00fe;">X-rays, ultrasounds, CT scans, and MRIs</span></i><span>) produce </span><i>expected or anticipated results</i><span>. </span></span></p><p><span style="font-family: helvetica;">So when labs or radiology are <i>unanticipated</i>, <i>unusual, or abnormal</i> - they can come in <b>different levels of abnormal</b> : </span></p><p></p><ul style="text-align: left;"><li><span style="color: #bf9000; font-family: helvetica;"><b>Mildly abnormal</b> - <i>Something is unusual that requires <b>special</b> but <b>not-urgent</b> clinical attention (within <b>days</b>)</i></span></li><li><span style="color: #e69138; font-family: helvetica;"><b>Moderately abnormal</b> - <i>Something is unusual that requires <b>urgent</b> clinical attention (within <b>hours</b>)</i></span></li><li><span style="color: red; font-family: helvetica;"><b>Severely abnormal</b> - <i>Something is unusual that requires <b>immediate</b> clinical attention (within <b>minutes</b>)</i></span></li></ul><p></p><p><span style="font-family: helvetica;">In all three cases, it's not enough to just deliver the routine results of the lab or radiology to the ordering provider. <i>For patient care and safety reasons</i>, <b>some type of</b> <b><u>extra communication</u> is warranted</b>.</span></p><p><span style="font-family: helvetica;">The three most common reasons for these extra communications all fall under a general category known as '<b>Actionable Findings' - </b>Note these categories align with the findings from the 2014 JACR Actionable Results Workgroup above : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF6mhKeAgKJa5HqYNys33C6O8ttbUFos4bGhm7HWm5X8gJTwmR0JLzq1tjoXheoZSF43CBa1t95FX3nBpklHEmJhXrNLq7dhp_7tzYMQg6yOE0mb0y8BIYx8ZjtO3xwjQ2o1mQ9WfunzEa8HC5I1cLmnRuh-GcLDXfFFxnjVJPxrVciof-cOKhKzd6uA/s1040/Slide3.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="585" data-original-width="1040" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhF6mhKeAgKJa5HqYNys33C6O8ttbUFos4bGhm7HWm5X8gJTwmR0JLzq1tjoXheoZSF43CBa1t95FX3nBpklHEmJhXrNLq7dhp_7tzYMQg6yOE0mb0y8BIYx8ZjtO3xwjQ2o1mQ9WfunzEa8HC5I1cLmnRuh-GcLDXfFFxnjVJPxrVciof-cOKhKzd6uA/w640-h360/Slide3.jpeg" width="640" /></a></div><p></p><p><span style="font-family: helvetica;">Now the interesting challenge of these additional communications is the </span><b style="font-family: helvetica;">urgency</b><span style="font-family: helvetica;"> of these additional messages and how they can sometimes conflict with </span><i style="font-family: helvetica;">real-world scenarios : </i></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">What if the <b>ordering provider</b> was a <b>resident</b> who has gone home at the end of their shift?</span></li><li><span style="font-family: helvetica;">What if the <b>attending</b> has also gone home at the end of their shift?</span></li><li><span style="font-family: helvetica;">What if both the resident and attending have <b>turned off their phones/pagers</b> or are <i>asleep</i>?</span></li><li><span style="font-family: helvetica;">Who is the <b>covering provider</b>? </span></li><li><span style="font-family: helvetica;">What if the covering provider is busy with <b>urgently caring</b> for another patient? </span></li></ul><div><span style="font-family: helvetica;">Given these scenarios, the communication workflow can be a bit difficult to dissect - but I'm happy to share a basic breakdown of what to consider. <b>Hint</b> : It stratifies along the lines of <b>acuity</b> (<i><span style="color: #bf9000;">low</span>, <span style="color: #ffa400;">medium</span>, and <span style="color: red;">high</span></i>), <b>patient location, </b>and<b> ordering provider.</b></span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><i>Let's take a closer look at these important scenarios</i>.</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><u><span style="font-family: helvetica;">1. <span style="color: #bf9000;"><b>LOW ACUITY</b> - </span>THE<span style="color: #bf9000;"> <b>INCIDENTAL</b> </span>FINDING</span></u></div><div><span style="font-family: helvetica;">In this scenario, there is something important that needs to be communicated to the ordering provider but also usually the Primary Care Provider (PCP), usually because there was something unexpected that <b>requires additional follow-up</b>, e.g. an unexpected nodule. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">While it's tempting to think that <span style="color: #bf9000;"><b>low-acuity</b> (<i>incidental</i>) <b>findings</b></span> are somehow less important than <span style="color: #e69138;"><b>moderate-acuity (</b><i>urgent</i><b>) findings</b></span> or <span style="color: red;"><b>high-acuity</b> (<i>critical</i>) <b>findings</b></span> - the truth is that they are <i><b>every bit as important</b></i>, only the <i>time needed to address the issue</i> is a little longer. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Stratifying this first <span style="color: #bf9000;"><b>low-acuity</b> (<i>incidental</i>) <b>finding</b></span> scenario by <b>patient location</b> then looks like this : </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO2SveoLJz2_bJ3_iVADUfXVU34c5bCErayda5uzXSH5XugPidT1lN98h-AMNk88WoVt0kuUxx9jV8AGwbyw1oGCEvBpGjVW5yng_IqZXWLL_z54ApmVpfDDiwtDcvQcy-59BD09mh356fiUCWT-7-Wxg7SR3_Czzbr-T-JfvN-Iic325Dxtyay8J61g/s1040/Slide1.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="585" data-original-width="1040" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhO2SveoLJz2_bJ3_iVADUfXVU34c5bCErayda5uzXSH5XugPidT1lN98h-AMNk88WoVt0kuUxx9jV8AGwbyw1oGCEvBpGjVW5yng_IqZXWLL_z54ApmVpfDDiwtDcvQcy-59BD09mh356fiUCWT-7-Wxg7SR3_Czzbr-T-JfvN-Iic325Dxtyay8J61g/w640-h360/Slide1.jpeg" width="640" /></span></a></div><i><div style="text-align: center;"><i><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;">(Sample workflow for delivering </span><span style="color: #bf9000; font-family: helvetica; font-size: x-small;"><b>low-acuity, incidental</b></span><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"> findings)</span></i></div></i><div style="text-align: center;"><span style="font-family: helvetica;"><br /></span></div></div><div><span style="font-family: helvetica;">Since <b>incidental findings require follow-up</b>, it's very important to <b>close the loop</b> with the PCP to ensure the proper follow-up studies have been ordered and the <b>patient/caregiver are aware</b> <b>of the need</b> for follow-up. (<i><a href="https://www.healthit.gov/topic/information-blocking" target="_blank">New rules from the 21st Century CURES Act</a> and open sharing via the patient portal make this <b>much more transparent</b> for patients today</i>.) To help, some EMR software will record <b>exactly when</b> the PCP has acknowledged receipt of this important message, with important instructions.</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><u><span style="font-family: helvetica;">2. <span style="color: #e69138;"><b>MODERATE</b></span> OR <span style="color: red;"><b>HIGH</b></span> ACUITY - THE <span style="color: #e69138;"><b>URGENT</b></span> AND <span style="color: red;"><b>CRITICAL</b></span> FINDINGS</span></u></div><div><span style="font-family: helvetica;">In these scenarios, there is something <span style="color: #e69138;">urgent</span> or <span style="color: red;">critical</span> that needs to be communicated to the ordering or covering provider, usually within an <span style="color: #ffa400;">hour</span> or <span style="color: red;">less</span>. Typically, <span style="background-color: #fcff01;">direct <b>provider-to-provider communication</b> is best</span> to help ensure the message has been transmitted and received properly, and an <span style="color: #e69138;">urgent</span>/<span style="color: red;">emergent</span> plan has been put in place. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Communication in these scenarios can sometimes be stymied by <i>schedule</i>/<i>change-of-shift</i>, so an <b>escalation process</b> is <i>especially important</i> for these <span style="color: #e69138;">urgent</span>/<span style="color: red;">critical</span> scenarios : </span></div><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2mSX5xjQrp5WVXP5-9mQMGqTpyYpM99NsoDMfG7L1FgFjVqqMbpvrFcKcFRyEfiDADY9C6lkLdLhC_-BsTPk3Pb-ECKz-AIpUgvk9thm4WlJOBDz_QXr1ZtQ88RfYE_16V0sbsaoYpDKlARnYdKsT_rOiVFNceWkh_ZFpjE-T25tiM0GvChBet4ltGg/s1040/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="585" data-original-width="1040" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2mSX5xjQrp5WVXP5-9mQMGqTpyYpM99NsoDMfG7L1FgFjVqqMbpvrFcKcFRyEfiDADY9C6lkLdLhC_-BsTPk3Pb-ECKz-AIpUgvk9thm4WlJOBDz_QXr1ZtQ88RfYE_16V0sbsaoYpDKlARnYdKsT_rOiVFNceWkh_ZFpjE-T25tiM0GvChBet4ltGg/w640-h360/Slide2.jpeg" width="640" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica; font-size: x-small;"><i><span style="color: #2b00fe;">(Sample workflow for delivering </span><span style="color: #e69138;"><b>medium-acuity (urgent) </b></span><span style="color: #2b00fe;">and </span><span style="color: red;"><b>high-acuity(critical)</b> </span><span style="color: #2b00fe;">findings)</span></i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">The exact <b>escalation process</b> you build for your own organization will probably depend on a number of factors, including whether you are a community hospital, teaching hospital, or critical-access hospital. For a <b>great example</b> of a well-developed escalation process, see<b> pages 7-11</b> of <a href="https://www.utmb.edu/policies_and_procedures/IHOP/Clinical/General_Clinical_Procedures_and_Care/IHOP%20-%2009.13.36%20-%20Reporting%20of%20Critical%20Results%20to%20Providers.pdf" target="_blank">this helpful policy, "<i>Reporting of Critical Results to Providers</i>"</a> from the <a href="https://www.utmb.edu/" target="_blank">University of Texas Medical Branch</a>. (<i>Thank you to UTMB for sharing your process for teaching purposes and the betterment of healthcare!</i>)</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">What's interesting about this escalation process is that it will often depend on a provider schedule; So having access to a centralized, up-to-date <b>provider on-call (</b><i>coverage</i><b>) schedule</b> is often helpful in identifying <b>covering providers</b> for various services and clinics, especially when trying to communicate actionable findings after change of shift : </span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo_LyT0gIJ89yMR1HVoX9Ikrof8FkHLDYWQWCPjsuu3ysmxYtIXBTuVFEPqlga9YwO6fPNhr0AFegR4uYG6bKY2M79ZCWtl2Wtp74tdxXKtuDSLoWKxHXQAbzRAF0_vs4jJBNxTyUzi4r_BsqGOa0drd4rteMcVdEx0BsnK4wl6lmlo1-UzuKAfd4SkA/s1040/Slide6.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="585" data-original-width="1040" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjo_LyT0gIJ89yMR1HVoX9Ikrof8FkHLDYWQWCPjsuu3ysmxYtIXBTuVFEPqlga9YwO6fPNhr0AFegR4uYG6bKY2M79ZCWtl2Wtp74tdxXKtuDSLoWKxHXQAbzRAF0_vs4jJBNxTyUzi4r_BsqGOa0drd4rteMcVdEx0BsnK4wl6lmlo1-UzuKAfd4SkA/w640-h360/Slide6.jpeg" width="640" /></a></div><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Also, depending on the scenario, having a complete and accurate <b>provider directory</b> is very important, one that properly considers both a providers' clinical <b>specialty/subspecialty (</b><i>training</i><b>)</b> and clinical <b>service</b>(s) : </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmH-HfRkoPUR0q89ZQSVPvll3B73gFaVu0FIlC-bUE_zqT6DfoXvCSpjxAzsl3rRzRVK2QgAHStUKjA6-rOgumLBpu1N0JCQmvdL8bpVJZgF_cMMoI4pek-KDYdtW1SsaYVR7M2AdiMngHPwjzlRleil65tshzyuKAoddCMCQn_RMG1o6l5l1DKWjU1w/s1040/Slide3.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="585" data-original-width="1040" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmH-HfRkoPUR0q89ZQSVPvll3B73gFaVu0FIlC-bUE_zqT6DfoXvCSpjxAzsl3rRzRVK2QgAHStUKjA6-rOgumLBpu1N0JCQmvdL8bpVJZgF_cMMoI4pek-KDYdtW1SsaYVR7M2AdiMngHPwjzlRleil65tshzyuKAoddCMCQn_RMG1o6l5l1DKWjU1w/w640-h360/Slide3.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;"><br /><span>Since most providers will arrive through your <b>Credentialing/Medical Staff office</b>, and most residents/fellows will go through your <b>Graduate Medical Education</b> (<i>GME</i>) <b>office, </b>you will want to <b>collect</b> this information at onboarding, and help <b>maintain</b> it at regular intervals (<i>e.g. recredentialing or yearly assessments</i>.)</span></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><span><br /></span></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">And after an </span><b style="font-family: helvetica;"><span style="color: #e69138;">urgent</span>/<span style="color: red;">critical</span> provider-to-provider communication</b><span style="font-family: helvetica;"> has been </span><b style="font-family: helvetica;">completed, </b><span style="font-family: helvetica;">b</span><span style="font-family: helvetica;">oth providers should </span><b style="font-family: helvetica;">document the discussion</b><span style="font-family: helvetica;"> in their clinical documentation to help ensure the </span><i style="font-family: helvetica;">loop has been closed</i><span style="font-family: helvetica;"> and a </span><i style="font-family: helvetica;">plan is in place</i><span style="font-family: helvetica;">. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Finally, for <b>providers <u>external</u> to your institution</b> - When designing your forms for ordering labs or radiology, you might consider adding the following language : </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy_jhzZ5fAlVBSRuTyCumbX9Y3ZOPT5wKr7O6s9qOcKHeQY9YCCKgh0CxziIFtk5NhM7SbfZsscwUz0mrmIyPeN1T6gqgAQe4Kx_J6_QzWwBYxskMf0KbxkXyE0AiEQ_8LurV3nnXcj9brdxpWa-QMK26nPDGMtLVaEYq99j86qQJgP8_xmRaE-FuF_w/s1040/Slide4.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="585" data-original-width="1040" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy_jhzZ5fAlVBSRuTyCumbX9Y3ZOPT5wKr7O6s9qOcKHeQY9YCCKgh0CxziIFtk5NhM7SbfZsscwUz0mrmIyPeN1T6gqgAQe4Kx_J6_QzWwBYxskMf0KbxkXyE0AiEQ_8LurV3nnXcj9brdxpWa-QMK26nPDGMtLVaEYq99j86qQJgP8_xmRaE-FuF_w/w640-h360/Slide4.jpeg" width="640" /></span></a></div><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><div style="text-align: center;">(<i>Sample language for external ordering forms, to plan for all actionable finding scenarios</i>)</div></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Having this information somewhere handy (<i>e.g., on the ordering form</i>) will help you prepare for these scenarios when they occur with external providers. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Yes, these are a lot of scenarios to think about - but with the right planning and tools, you can help your staff reach ordering or covering providers to <b>communicate these important messages</b> and <b>close the loop</b> on important patient care. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="color: #2b00fe; font-family: helvetica;"><i>Remember, this blog is for educational purposes only - Your mileage may vary. Have any experience with these workflows, or experience building them? Or have a perfect escalation process? Feel free to leave comments, feedback, and suggestions below!</i></span></div><p></p>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-9232004880393836162023-03-26T13:16:00.000-04:002023-03-26T13:16:31.185-04:00Using AI to write a Scrubs Parody about Clinical Informatics<p><span style="font-family: helvetica;"><i> Hi fellow CMIOs, CNIOs, and other Applied Clinical #Informatics friends,</i></span></p><p><span style="font-family: helvetica;">If you follow the #HealthIT industry, you're probably already aware that many people are writing about <a href="https://en.wikipedia.org/wiki/ChatGPT" target="_blank"><b>ChatGPT</b></a>, the <a href="https://en.wikipedia.org/wiki/Artificial_intelligence" target="_blank">Artificial Intelligence</a> (<i>AI</i>) tool (<i>only released in November 2022</i>) that has already spawned a number of other AI tools.</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPnFOolkzetSKG5ifOScaYbZyniia63LcsMM7D8QHFdXaLl5H90LZVAsxzSyZMrESFSMcZRQ_Mr4UmmGPpnconBoyph9ebOeFaOLg3I4nLYHn13XFwQrSU4B4yzObSCX0u2C5cZd5g0hGfh1s-mXZVqg_mFmhzncFjM35E395F4fr0Di_Uw2W7poOoMw/s1324/Writing%20Scrubs%20Parody%20about%20Clinical%20Informatics.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1024" data-original-width="1324" height="309" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPnFOolkzetSKG5ifOScaYbZyniia63LcsMM7D8QHFdXaLl5H90LZVAsxzSyZMrESFSMcZRQ_Mr4UmmGPpnconBoyph9ebOeFaOLg3I4nLYHn13XFwQrSU4B4yzObSCX0u2C5cZd5g0hGfh1s-mXZVqg_mFmhzncFjM35E395F4fr0Di_Uw2W7poOoMw/w400-h309/Writing%20Scrubs%20Parody%20about%20Clinical%20Informatics.png" width="400" /></a></div><p></p><p><span style="font-family: helvetica;">Curious about this new technology, I created an account. And when I was finally offered the opportunity to try ChatGPT on my own, I of course asked it something <b>really important</b>, something I thought might provide insight and be <b>really helpful</b> in helping to reform healthcare : </span></p><p></p><blockquote><span style="font-family: helvetica;"><b><span style="color: #2b00fe;"><i>"Write a <a href="https://en.wikipedia.org/wiki/Scrubs_(TV_series)">Scrubs</a> episode with a new Clinical Informatics character.</i></span></b>"</span></blockquote><p></p><p><span style="font-family: helvetica;">I asked it this because I'm always looking for ways to make Clinical Informatics <i>more tangible</i>, <i>practical</i>, and <i>friendly</i> - and to help explain the many benefits of having a Clinical Informatics team in successfully implementing and maintaining electronic health records (<i>EHRs</i>). So with sincerest apologies (<i>and flattery!</i>) to Bill Lawrence and the cast of Scrubs, I'd like to share these educational, AI-created parodies below.</span></p><p><span style="font-family: helvetica;">Interestingly, the </span><b style="font-family: helvetica;">first time</b><span style="font-family: helvetica;"> I asked it this, ChatGPT wrote the following - I'll call it "</span><b style="font-family: helvetica;"><span style="color: #38761d;">Episode A</span></b><span style="font-family: helvetica;">" : </span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><span style="color: #38761d; font-family: helvetica;">Title: "<b>The Informatics Consultant</b>"</span></p><p><span style="color: #38761d; font-family: helvetica;"><b>Act 1</b>:</span></p><p><span style="color: #38761d; font-family: helvetica;">The episode opens with JD and Turk in the hospital cafeteria discussing their recent struggles with the hospital's outdated electronic health record system. Suddenly, a new character walks in, a Clinical Informatics consultant named Rachel. She overhears their conversation and offers to help them with their issues.</span></p><p><span style="color: #38761d; font-family: helvetica;"><b>Act 2</b>:</span></p><p><span style="color: #38761d; font-family: helvetica;">Rachel begins to work with JD and Turk, showing them how to optimize their workflows and use the EHR system more effectively. JD becomes infatuated with her intelligence and wit, but is too nervous to express his feelings.</span></p><p><span style="color: #38761d; font-family: helvetica;"><b>Act 3</b>:</span></p><p><span style="color: #38761d; font-family: helvetica;">Meanwhile, Dr. Cox becomes increasingly frustrated with the hospital's EHR system and demands that it be fixed. Rachel agrees to help him, but clashes with him over his reluctance to change his ways. Eventually, they find a compromise and Dr. Cox begins to appreciate Rachel's insights.</span></p><p><span style="color: #38761d; font-family: helvetica;"><b>Act 4</b>:</span></p><p><span style="color: #38761d; font-family: helvetica;">As Rachel continues to work with the staff, she discovers that the hospital's EHR system has several security vulnerabilities. She works with the IT department to develop a new security protocol, but her efforts are met with resistance from a group of doctors who don't want to change their habits.</span></p><p><span style="color: #38761d; font-family: helvetica;"><b>Act 5</b>:</span></p><p><span style="color: #38761d; font-family: helvetica;">In the final scene, a hacker gains access to the hospital's EHR system and threatens to release private patient information unless they pay a ransom. Rachel, JD, Turk, and Dr. Cox work together to stop the hacker and protect their patients' privacy. In the end, they succeed in preventing the data breach, and Rachel is hailed as a hero by the staff. JD finally works up the courage to ask her out on a date, and she accepts. The episode ends with them walking out of the hospital together, hand in hand.</span></p></blockquote><p><span style="font-family: helvetica;">And the <b>second time</b> I asked it this, it wrote the following - I'll call this one "<b><span style="color: #2b00fe;">Episode B</span></b>" :</span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;">Title: "<b>Data Doctors</b>"</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;"><b>Act 1</b>:</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;">The episode opens with J.D. and Turk at the hospital cafeteria, discussing the latest technology trends in healthcare. As they talk, a new character walks up to them and introduces herself as Dr. Rachel Lee, the new Clinical Informatics specialist at Sacred Heart Hospital. She explains that her job is to use data and technology to improve patient care and safety.</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;"><b>Act 2</b>:</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;">Dr. Lee shows J.D. and Turk how to use the hospital's new electronic health record system. J.D. is initially skeptical and finds the system cumbersome, but Dr. Lee patiently guides him through the process and shows him how the system can help him make more informed clinical decisions.</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;"><b>Act 3</b>:</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;">Meanwhile, Elliot is struggling to keep up with the demands of her patient load. Dr. Lee offers to help by analyzing the hospital's data on patient flow and identifying ways to improve efficiency. With Dr. Lee's help, Elliot is able to streamline her workflow and spend more time with her patients.</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;"><b>Act 4</b>:</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;">Dr. Cox is initially dismissive of Dr. Lee's role at the hospital, but when he sees the improvements in patient care and safety that result from her work, he begins to appreciate her contributions. He even agrees to help her analyze some of the hospital's more complex data sets.</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;"><b>Act 5</b>:</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;">At the end of the episode, Dr. Lee presents her findings to the hospital's board of directors. She shows them how her work has led to significant improvements in patient outcomes and reduced costs. The board is impressed and agrees to provide more resources for Clinical Informatics at the hospital. J.D. and Turk, impressed with Dr. Lee's work, ask her to join them for drinks after work.</span></p><p style="text-align: left;"><span style="color: #2b00fe; font-family: helvetica;">As the episode closes, the three of them walk off, discussing the future of healthcare technology and the important role that Clinical Informatics will play in it.</span></p></blockquote><p><span style="font-family: helvetica;"><b>As far as fan fiction goes,<i> which episode is better</i></b>? It's fascinating to me that ChatGPT somehow offered <b>two different responses</b> to the same question - perhaps considering that my asking <i>again</i> meant its <i>initial response was not exactly what I was looking for</i>?</span></p><p><span style="font-family: helvetica;">Anyway, if you're both a Clinical Informatics leader and a <a href="https://en.wikipedia.org/wiki/Scrubs_(TV_series)" target="_blank">Scrubs</a> fan, I thought I'd share this experiment with you for your own insights and feedback. Which episode do you like better? And could medical dramas include Clinical Informatics characters, to help better introduce their role in modern healthcare?</span></p><p><span style="font-family: helvetica;"><i>Remember, this blog is for educational and discussion purposes only - Your mileage may vary. Sincerest apologies and heartfelt appreciation to <a href="https://en.wikipedia.org/wiki/Bill_Lawrence_(TV_producer)" target="_blank">Bill Lawrence</a> and the entire cast of Scrubs for making a show that clinical people could relate to</i>. </span></p><p><span style="font-family: helvetica;"><i>Have an opinion about using AI in healthcare? Or want to comment on which episode you would want to see? Feel free to leave it in the comments section below!</i></span></p>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-33054065953102118462023-02-27T23:46:00.004-05:002023-03-12T23:19:49.109-04:00Ten Ways to Help Reduce Frustration and Burnout<span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><i>Hi fellow CMIOs, CNIOs, and other Clinical Informatics and HealthIT friends,</i></span><br />
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span></span><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">With all of the recent discussions about <a href="https://en.wikipedia.org/wiki/Occupational_burnout" target="_blank">'burnout' (<i>moral injury</i>)</a> among clinicians and other <a href="https://www.forbes.com/sites/judystone/2019/11/12/electronic-medical-records-burnout-and-mans-4th-best-hospital" target="_blank">struggles with healthcare technology</a>, I thought I'd take a moment to share some lessons about what you can do to <b>help reduce frustration and burnout</b>, based on my own experiences and lessons I've learned (<i><span style="color: #2b00fe;">sometimes the hard way!</span></i>) over the last sixteen years I've worked in Applied Clinical Informatics. </span></span><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_aAirmXr-GN_WK_5xcBwHjA-lKAkx0Du51cMwP-hAcawqPnA94UShGFiyhmfb4TD96SUqhb84xFHV_JSmYPB0u6283J0EGxPR3qOmyB2NKWjmg36Jtoh_RlvU-BsSnvT_bROATKUAQR7Ct6eOQb92JjcBaeTDuUyFFcwzyrx3COgVhRFJjU5K9ngVIw/s1070/10%20Ways%20to%20Help%20Reduce%20Frustration%20and%20Burnout.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="582" data-original-width="1070" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_aAirmXr-GN_WK_5xcBwHjA-lKAkx0Du51cMwP-hAcawqPnA94UShGFiyhmfb4TD96SUqhb84xFHV_JSmYPB0u6283J0EGxPR3qOmyB2NKWjmg36Jtoh_RlvU-BsSnvT_bROATKUAQR7Ct6eOQb92JjcBaeTDuUyFFcwzyrx3COgVhRFJjU5K9ngVIw/w400-h217/10%20Ways%20to%20Help%20Reduce%20Frustration%20and%20Burnout.png" width="400" /></a></div><div><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div><div><div><div><span style="font-family: helvetica;">
<b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="color: #cc0000;">10. <i>Worry about the details</i>.</span></b><br />
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">Most providers are acutely aware of the <i>effect</i> of the problem, but not the <i>cause</i>. So when you are looking at <b>workflow problems</b>, try hard to resist the temptation to get overwhelmed with the details - <b>they are very important</b>. You can sometimes tell when people get overwhelmed, because they sometimes say things at meetings like : </span></span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><span>"</span><i>You can't boil the ocean!</i><span>"</span></span></li><li><span style="font-family: helvetica;">"<i>We can't get too into the weeds here</i>."</span></li><li><span style="font-family: helvetica;">"<i>Let's just look for some quick wins / low-hanging fruit!</i>"</span></li><li><span style="font-family: helvetica;">"<i>Don't fall victim to analysis paralysis!</i>"</span></li><li><span style="font-family: helvetica;">"<i>Perfection is the enemy of good!"</i></span></li><li><span style="font-family: helvetica;"><i>"We don't have time to plan!"</i></span></li></ul><div><span style="font-family: helvetica;">Unfortunately, anything that prevents important details from being reviewed and discussed can lead to workflow problems, so it helps to <b>set expectations early</b> and accept that <b>details are important</b> - and so you should always look for ways to discuss them <i>easily</i>, <i>openly</i>, and <i>honestly</i>.</span></div></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><span style="color: #cc0000;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><b>9. Have </b><i style="font-weight: bold;">organized, well-developed </i><b>project intake and project management processes. </b></span><br /></span></span><div><b><span style="font-family: helvetica;"><br /></span></b></div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><i>Healthcare is complicated. </i>The <b>need for change</b> could come from <i>any one</i> of a number of <b>different directions</b>: </span><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheHISDA9H9Q5jvFDuY-FcqZcZ4xxOd2sBBr9Dr8XFJNbP7QBsl0KGqUA5XFSGVlhYkjL25lpEP5PQb-MMS3ix3eKi8axA3X_PqqHDkNLGROd45u-7U90HQmHLRZHQz6Ez2l4IB9m9Ja6Q8/s1600/Workflow+Slide.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="765" data-original-width="1020" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheHISDA9H9Q5jvFDuY-FcqZcZ4xxOd2sBBr9Dr8XFJNbP7QBsl0KGqUA5XFSGVlhYkjL25lpEP5PQb-MMS3ix3eKi8axA3X_PqqHDkNLGROd45u-7U90HQmHLRZHQz6Ez2l4IB9m9Ja6Q8/w400-h300/Workflow+Slide.png" width="400" /></span></a></div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">... so you will need to plan for how to manage <b><i>all</i></b> of these stakeholders above. Developing an organized project intake, prioritization, and management process for <b><i>all</i> of your stakeholders to participate in </b>will help them to see the big picture, better negotiate conflicts when they arise, and provide transparency to end-users.</span></span></div><div><br /></div><div><span style="font-family: helvetica;"><b><span style="color: #cc0000;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">8. Have an <i>organized, well-developed</i> change management process. </span><br /></span></b>
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><i>People like predictable outcomes</i>. While it might take some <b>time and resources</b> to do :</span></span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><b>formal evaluations</b> of change/project requests, along with...</span></span></li><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">the necessary <b>policy/regulatory searches</b>, </span></span></li><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">identification of <b>best practices</b> (<i><span style="color: #2b00fe;">e.g. through literature search, site visits, and interviews</span></i>), </span></span></li><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><b>current-state/future-state</b> ('<i><span style="color: #2b00fe;">gap'</span></i>) <b>analysis</b>, </span></span></li><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">design of <span style="color: #2b00fe;">organized <b>blueprints</b></span>, and ...</span></span></li><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">proper <b>identification of stakeholders and deliverables,</b> </span></span></li></ul><span style="font-family: helvetica;">... but it always pays off in <i>smooth workflows</i>, <i>smooth implementations</i>, <i>predictable outcomes</i>, and <i>happy users/patients</i>. So the answer is <b>not to skip</b> these necessary analysis and planning steps - The answer is to have a clear, consistent, well-developed, and well-supported <b>change management</b> <b>process</b> that - <i>not unlike a factory assembly line</i> - lets you accomplish <b>all</b> of these important steps in a <i>smooth, well-oiled process </i><b>throughout</b> the <i>intake</i>, <i>analysis</i>, <i>design</i>, <i>build</i>, <i>approval</i>, <i>training</i>, <i>implementation</i>, and support phases of your projects<b>.</b></span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="color: #cc0000;"><b>7. Have standardized definitions and templates for common tools (</b><i>both inside and outside the EMR</i><b>).</b></span><br />
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span>
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">Creating an <b>organizational glossary</b> (<i><span style="color: #2b00fe;">with policy-grade definitions!</span></i>) and developing <b>standardized templates for common tools</b> will decrease training and development times, increase standardization and functionality, increase predictable outcomes, and improve user satisfaction. A common source of <b>workflow inconsistency</b> happens when development teams focus on developing <b>only</b> the <span style="color: #cc0000;"><b>tools </b><u style="font-weight: bold;">inside</u><b> the EMR (</b><i>on the right below</i><b>)</b></span>, while letting <b>someone else</b> worry about the <span style="color: #999999;"><b>tools </b><u style="font-weight: bold;">outside</u><b> of your EMR (</b><i>on the left below</i><b>)</b></span><b> : </b></span></span></div><div><span style="font-family: helvetica;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja-io4AXaUCggPymzW4iIn7hom2hO3F-98HIO79hnJdOlYkz6gv2VuDSWSXc2ksPXtw3ilRKcXn2BjqG0cCEyUbRk1LYJyk3-bbU49GOEkUTsIwEJ8tTm3ZQiuA4NTzDTHEDrZlq5r1KfK58n-cKwYln9YeZk-ioB6iNzIRHooQReH6OL3sukcTjZdKg/s720/Workflow%20Development.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="720" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja-io4AXaUCggPymzW4iIn7hom2hO3F-98HIO79hnJdOlYkz6gv2VuDSWSXc2ksPXtw3ilRKcXn2BjqG0cCEyUbRk1LYJyk3-bbU49GOEkUTsIwEJ8tTm3ZQiuA4NTzDTHEDrZlq5r1KfK58n-cKwYln9YeZk-ioB6iNzIRHooQReH6OL3sukcTjZdKg/w400-h300/Workflow%20Development.jpeg" width="400" /></span></a></div></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">You can help avoid those unnecessary workflow inconsistencies by using <b>both </b>the <b><span style="color: red;">red</span></b> and <span style="color: #999999;"><b>grey </b></span>lists above (<i><span style="color: #2b00fe;">as a checklist!</span></i>) when <b>identifying the deliverables</b> necessary for your requested clinical workflow implementations/updates. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><span style="color: #cc0000;"><b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">6. Worry about document control and standardized document management. </span></b><br /></span><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span></span></div><div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">At first, it might seem like a trivial detail. Most people don't give it much thought, but having a <b>single, centralized catalog</b> (<i><span style="color: #2b00fe;">source-of-truth</span></i>) for all of your <b>important operational documents</b> (<span style="color: #2b00fe;"><i>policies, procedures, guidelines, protocols, forms, etc.</i></span>) can help create a <b>great deal</b> of <i>clarity</i>, <i>understanding</i>, and <i>collaboration</i>. As the saying goes, "<i>Control your documents, before they control you.</i>" - Without good document control and management, it's easy for <i>project implementations to be <b>delayed</b></i> and/or result in <i><b>unexpected outcomes</b></i>. </span></span></div><div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span></span></div><div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="color: #cc0000;"><b>5. For those who write Federal/State regulations - You can help save time and frustration by fully understanding the subject matter, working from clear policy-grade definitions, and writing clearly and succinctly.</b></span></span></div><div><span style="font-family: helvetica;"><b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span></b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">Some of the administrative complexities of modern healthcare can result from Federal / State agencies sometimes writing vague regulations, using vague definitions, sometimes with a vague understanding of the clinical workflows and subject matter. So if you write regulations, you can help organizations to save time and reduce administrative costs by using standardized, federal <b>policy-grade definitions</b> and writing regulations that are <b>clear, short, </b>and<b> succinct</b>. You could even help organizations to succeed by writing <b>more than just regulations</b> - Consider other tools necessary for success, such as sample workflows, best practices, educational curriculum, and sample policies : </span></span></div><div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span></span></div><div><span style="font-family: helvetica;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisZXlgWtPlFf6e42iFTdZMim4QVtW8tsx6WLAYPjxGMVFcMP9yroN2QQOsf8hZJM-cfYQvQXfGUWl3cjowJU9c93TxBPlYoipZjv5eUERqTZXZDjeCYIf4Li0dJryhqG8oLzFbC03RsFEdR-8h4TgjarTVRJMkoUZG9DS_16aPwlaIvGjBytc04igorQ/s1168/Regulations.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="919" data-original-width="1168" height="252" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisZXlgWtPlFf6e42iFTdZMim4QVtW8tsx6WLAYPjxGMVFcMP9yroN2QQOsf8hZJM-cfYQvQXfGUWl3cjowJU9c93TxBPlYoipZjv5eUERqTZXZDjeCYIf4Li0dJryhqG8oLzFbC03RsFEdR-8h4TgjarTVRJMkoUZG9DS_16aPwlaIvGjBytc04igorQ/s320/Regulations.jpeg" width="320" /></a></div><br /></span></div><div><span style="font-family: helvetica;">Finally, always have a plan for expiring/retiring or updating your regulations - Regulations with <b>no planned expiration date</b> may not get the necessary attention and updates they deserve.</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="color: #cc0000;">4. Always have clearly written operational policies and procedures. </span></b><br />
<b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span></b>
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">Your operational <b>policies</b> are the <b>standards</b> of your organization, and your associated <b>procedures</b> describe <i><b>how</b> </i>you will <i>achieve those standards</i>. Not only do good policies and procedures create <i>clarity</i>, <i>harmony</i>, and <i>understanding</i> - but they can be used to educate staff, answer questions, and even help plan/design workflows. While some believe the mantra '<i>don't paint yourself into a corner'</i> , always remember <i>-</i> <b>Good policies</b> help to <i>create clarity</i>, <i>improve understanding</i>, <i>improve accountability</i>, <i>encourage teamwork</i>, and <i>reduce risk of harm or unexpected outcomes.</i></span></span></div><div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span></span></div><div><span style="font-family: helvetica;"><span style="color: #cc0000;"><b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">3. Have an Applied Clinical Informatics team. </span></b><br /></span>
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">When budgeting for technology, <i>details are important</i>. <b>Total Cost of Ownership</b> (<i><span style="color: #2b00fe;">TCO</span></i>) and <b>Return-on-Investment</b> (<span style="color: #2b00fe;">ROI</span>) are crucial to make smart business decisions. <b>Applied Clinical Informatics</b> <b>professionals</b> specialize in the analysis, planning, budgeting, design, development, implementation, and monitoring/support of technology implementations. So it's <b>very helpful</b> - <i>if not <b><u>essential</u></b></i> - to have a multidisciplinary team of them available to help you with your most common clinical and business needs : </span></span></div><div><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span></span></div><div><span style="font-family: helvetica;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidv7mH6fwj2Y5hLidb0jYvusOXzJ4SV-Ly_kbxALkgnG-cHjrnRQq48XjKUYdmYBEL1lrXSDnymdfDOi8-vR7VAIOCQhiLNKxxNZtn7vgXarCP5L9K75l1khCpcqDoMOTT4V6OgWoBtUzbgPyA4hB_KkmDNs5gvE1JoR8Pp4wi64lVeBNmy5-It92MTw/s960/Applied%20Clinical%20Informatics%20Team.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidv7mH6fwj2Y5hLidb0jYvusOXzJ4SV-Ly_kbxALkgnG-cHjrnRQq48XjKUYdmYBEL1lrXSDnymdfDOi8-vR7VAIOCQhiLNKxxNZtn7vgXarCP5L9K75l1khCpcqDoMOTT4V6OgWoBtUzbgPyA4hB_KkmDNs5gvE1JoR8Pp4wi64lVeBNmy5-It92MTw/w640-h360/Applied%20Clinical%20Informatics%20Team.jpeg" width="640" /></a></div><br /><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">... through not just your <b>purchasing decisions</b>, but also for your clinical workflow analysis/designs (<a href="https://www.twitter.com/hashtag/BlueprintsBeforeBuild" target="_blank"><i>#BlueprintsBeforeBuild</i></a>), complex tickets/projects, special event planning, compliance, maintenance, and other strategic clinical and business needs.</span></span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="color: #cc0000;">2. Build clear, complete, and consistent order sets.</span></b><br />
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><i>Physicians spend a lot of time ordering</i>. <b>Order sets</b> connect <b>all of the orders they need</b> for all of their <b>common clinical scenarios. </b>Having <i>inconsistent, incomplete, or unclear order sets</i> only creates frustration, clicks, and unnecessary pages for your physicians. So to help <b>reduce clicks</b>, <b>reduce frustration</b>, and <b>reduce unnecessary pages - </b>you can help ensure your order sets are always <i>clear</i>, <i>complete</i>, and <i>consistent</i> by : </span></span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">Making sure you have a <i>standardized</i> <b>order set template </b>for developing your ordering tools (<i>in a consistent manner</i>).</span></span></li><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">Making sure you have the <b>terminology</b> necessary to clearly distinguish your <b>order sets </b>from your <b>other common clinical tools</b> like <i>protocols</i>, <i>guidelines</i>, <i>templates</i>, and <i>clinical pathways</i>.</span></span></li><li><span style="font-family: helvetica;"><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">Making sure your organizational order set development, approval, implementation, monitoring/support, and update processes are <i>clear, well-defined,</i> and <i>well-supported</i>.</span></span></li><li><span style="font-family: helvetica;">Making sure you have <b>organized naming conventions</b> for all of your order set types.</span></li></ul><div><span style="font-family: helvetica;"><br /></span></div></div><div><span style="font-family: helvetica;">
<b><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif" style="color: #cc0000;">1. Empower your clinical leaders. </span></b><br />
<span face=""helvetica neue" , "arial" , "helvetica" , sans-serif"><br /></span><span face=""helvetica neue" , "arial" , "helvetica" , sans-serif">Supporting your Physician, Advanced Practice Providers (<i>APPs</i>), Nursing, and Pharmacy leaders might take time, planning, and resources - but <b>expanding their skill set</b> with helpful information about governance, committee chairing, policy writing, operations, finance, and/or project and change management will : </span></span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;">give your clinical leaders </span><b style="font-family: helvetica;">more satisfaction, understanding</b><span style="font-family: helvetica;">, and </span><b style="font-family: helvetica;">control of their workflows</b><span style="font-family: helvetica;">, while also ...</span></li><li><span style="font-family: helvetica;">empowering them them to </span><b style="font-family: helvetica;">play a more active role </b><span style="font-family: helvetica;">in</span><b style="font-family: helvetica;"> problem solving, project development, </b><span style="font-family: helvetica;">and</span><b style="font-family: helvetica;"> project implementation.</b></li></ul><span style="font-family: helvetica;">Remember - With the necessary <b>Clinical Informatics</b> support, support for/from your <b>clinical leaders</b>, and<b> change and project infrastructure - </b>you too can help create the <b>clarity</b>, <b>harmony</b>, <b>efficiency</b>, and <b>predictable outcomes</b> needed to help <b>fully see the return </b>on your<b> technology investments</b>. </span></div><div><i style="font-family: helvetica;"><br /></i></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUA1WdN9stMgcRaLAAU3zr6qW5S-vbHus0n9kGM2fxrfJl88EgfMNKq2f0kygCwMTzdqVicIdsGBHTJekfl1rDSO3r1VlMLhWyPWOOf6lx9hJaQ1Ctl5Fo8_dwPO92PJKhD505xAw0Jgrqt9ufxT8U9qJLUrXcDAid5_B0SvDI3cMdARIp2D5Cwzz_sw/s968/Soil%20Infrastructure%202.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="747" data-original-width="968" height="309" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUA1WdN9stMgcRaLAAU3zr6qW5S-vbHus0n9kGM2fxrfJl88EgfMNKq2f0kygCwMTzdqVicIdsGBHTJekfl1rDSO3r1VlMLhWyPWOOf6lx9hJaQ1Ctl5Fo8_dwPO92PJKhD505xAw0Jgrqt9ufxT8U9qJLUrXcDAid5_B0SvDI3cMdARIp2D5Cwzz_sw/w400-h309/Soil%20Infrastructure%202.jpeg" width="400" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmhH0TUvbxuayMV1hGF5DJc_EoFiBrrvvmot0_jIe_Kb_LgDMcbca2G83Lww_qhpgmpMvGCkO4EPR0LK8tcPQDOX4Vdeu-v4miDgKXFddNYAflOWmT0cr8DZBYRYso59SLj36HBmrV7B0hNSo6GRjDGWrxGj8WuIarMFGWpfnizXHlFdGKB7PkOOEnbw/s1600/Soil%20Infrastructure%201.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1199" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmhH0TUvbxuayMV1hGF5DJc_EoFiBrrvvmot0_jIe_Kb_LgDMcbca2G83Lww_qhpgmpMvGCkO4EPR0LK8tcPQDOX4Vdeu-v4miDgKXFddNYAflOWmT0cr8DZBYRYso59SLj36HBmrV7B0hNSo6GRjDGWrxGj8WuIarMFGWpfnizXHlFdGKB7PkOOEnbw/w300-h400/Soil%20Infrastructure%201.jpeg" width="300" /></a></div><br /></div><div><i style="font-family: helvetica;">I hope this blog post helps spur some discussions with your own teams on how to help reduce frustration, reduce burnout, improve planning, improve analysis/design, improve usability, improve participation, and perhaps most importantly - improve <b>patient satisfaction </b>and<b> patient care</b>. </i></div><div><span style="font-family: helvetica;">
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</span></div></div><div><span style="font-family: helvetica;"><i><b>Remember</b> : This blog is for educational and discussion purposes only - <b>Your mileage may vary</b>! Have any other helpful suggestions for reducing frustration and burnout? Please feel free to leave them in the feedback section below!</i></span></div></div></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0Northampton, MA, USA42.3250896 -72.64120129999999214.014855763821153 -107.79745129999999 70.635323436178851 -37.484951299999992tag:blogger.com,1999:blog-8434050931789572015.post-31954275864753433852022-12-18T23:26:00.003-05:002022-12-18T23:51:35.051-05:00Running a meeting, for Clinical Leaders<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, Informatics friends, and other clinical leaders,</i></span></p><p><span style="font-family: helvetica;">For this last post of 2022, I'm sharing some helpful slides I've used when presenting to new clinical leaders about the importance of knowing <b>how to plan and run a good meeting</b> : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJJ80EVEzAvuSFFfXTeTaU61sd5JHAKJrnu0rOwMctf78rSaXePSqdu8uDWO52ipHj49F4VT0uBCDjUA3hIn3S1pk0PPRcp2e8yKVSZu2DxgM49kPQzpxzQT3qiFLV5YBe2akVWLfgPxuTNPrWbUacDlc7lel-JUvfNm2HykGPslyWtNK2vcnMIMhykg/s1040/Slide1.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJJ80EVEzAvuSFFfXTeTaU61sd5JHAKJrnu0rOwMctf78rSaXePSqdu8uDWO52ipHj49F4VT0uBCDjUA3hIn3S1pk0PPRcp2e8yKVSZu2DxgM49kPQzpxzQT3qiFLV5YBe2akVWLfgPxuTNPrWbUacDlc7lel-JUvfNm2HykGPslyWtNK2vcnMIMhykg/w400-h300/Slide1.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><span style="font-family: helvetica;">To keep things short, let's focus on five basic things : The <b>importance of running a good meeting</b>, the most common <b>types</b> of meetings, common meeting <b>problems</b>, common meeting <b>solutions</b>, and some <b>final tips</b> : </span><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7dTEvzEvBn2Oi0aKUtXCr9O-R5rdg9UkJaZX1l9jSoVgzCfRjXQpr9Lk26uDq4GuAUtuevH_zj3eDY1e0JN6QmRkwTJSv44B-49ogAgQ20ddKc58aUrN1vM18OvkbMTLSm60MDdUo3QH6LuNDiHG807w61FY2RZl6HULvmYm76KzGcynwvIDwp8wjkQ/s1040/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7dTEvzEvBn2Oi0aKUtXCr9O-R5rdg9UkJaZX1l9jSoVgzCfRjXQpr9Lk26uDq4GuAUtuevH_zj3eDY1e0JN6QmRkwTJSv44B-49ogAgQ20ddKc58aUrN1vM18OvkbMTLSm60MDdUo3QH6LuNDiHG807w61FY2RZl6HULvmYm76KzGcynwvIDwp8wjkQ/w400-h300/Slide2.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica; font-size: large;"><b><u>HELPFUL BACKGROUND</u></b></span></div>As a clinical leader, running a meeting can sometimes feel a bit like <b>herding cats</b> - At your meeting, you will no doubt have <b>different types of people</b>, with <b>different roles</b>, <b>different experiences</b>, <b>different needs</b>, and <b>different ideas</b> of what needs to be done : <br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5QIay7xvTT05NutCpSnkHNvBjntQVzFjIM1jigsoaD1jTOI_kvaptPXLIgjMw778ZZRtlk2tOA48yDsgOowkXWijrtDiu_nfxB8pcw_ktmDDhe4k-Kusn66v4EYSKe4ftRX_sxbBFH9sGZ_MQUw8j7vjNA94A01q5M6hGs5kjdESsp-_53sw2J4iIDA/s1040/Slide3.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5QIay7xvTT05NutCpSnkHNvBjntQVzFjIM1jigsoaD1jTOI_kvaptPXLIgjMw778ZZRtlk2tOA48yDsgOowkXWijrtDiu_nfxB8pcw_ktmDDhe4k-Kusn66v4EYSKe4ftRX_sxbBFH9sGZ_MQUw8j7vjNA94A01q5M6hGs5kjdESsp-_53sw2J4iIDA/s320/Slide3.jpeg" width="320" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><span style="font-family: helvetica;">So if you're planning and running the meeting, it's your responsibility to anticipate these different experiences and different needs, and create a <b>productive discussion</b> that helps solve a defined problem, or create a desired outcome. Especially in healthcare - failure to do this well can be very <b>expensive</b>, and potentially even <b>create confusion</b> : <br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMxgEgXg76KfgwYTSMrks665lSwZLWTPYKnyWyB1q6dlH-DX3rSX3Z4gE885asynbrVOt-8SLgq657xJvqtRx7he4i2gRWkk85RF_DQQPLaxOIxi5Jcgqlj8UDR2Dvy_2MgmBUNNHZbw_TpgvCANu9rl7kAk0QNKFmkk_IIp1wGr2pnSpviMtJE94Ieg/s1040/Slide4.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMxgEgXg76KfgwYTSMrks665lSwZLWTPYKnyWyB1q6dlH-DX3rSX3Z4gE885asynbrVOt-8SLgq657xJvqtRx7he4i2gRWkk85RF_DQQPLaxOIxi5Jcgqlj8UDR2Dvy_2MgmBUNNHZbw_TpgvCANu9rl7kAk0QNKFmkk_IIp1wGr2pnSpviMtJE94Ieg/w400-h300/Slide4.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>So it's helpful to keep in mind, a list of things that meetings <b>should</b> be, and a list of things that meetings <b>should not</b> be (<i><span style="color: #2b00fe;">click to enlarge</span></i>) : <br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH6WhHCxJzyYPANjJCHIZ4D028HvoZha6OMfxqGHVwi83MlzV8BVLUnWndbulAo6NK2EyWrPZeS5_WG9FLvAdW4sP_c-D9G2dh4g5424V9cctZ030auwIlrTxbXtPXhVswJzcldlFIDBRR42hFaHVmWMsxmV5HRzF63G4ptupeB4wVL6MePpc_duUAFw/s1040/Slide5.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH6WhHCxJzyYPANjJCHIZ4D028HvoZha6OMfxqGHVwi83MlzV8BVLUnWndbulAo6NK2EyWrPZeS5_WG9FLvAdW4sP_c-D9G2dh4g5424V9cctZ030auwIlrTxbXtPXhVswJzcldlFIDBRR42hFaHVmWMsxmV5HRzF63G4ptupeB4wVL6MePpc_duUAFw/w400-h300/Slide5.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>Since the COVID pandemic, this has also created <b>new challenges</b> to running effective meetings, especially when on a <i>video conferencing service</i>. <b>In-person</b> meetings, <b>online</b> meetings, and <b>hybrid</b> meetings all have their own unique challenges and benefits, so it's helpful to <b>plan carefully</b> and maybe even more importantly, <b>practice</b> running a meeting in each arrangement : <br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtDPrUUGN0d6tpf1wolL_no28ob5JRXIVPalimyvAXMsnSpfqQqsE9BRS3ExcdGh75vsyRp-mdouM6eULdGTnjZgHDcZUeXp-VB23P6dot1t4jM01IlgbXqcnUvBfgdv5KiBqF7CweEhZZPc-gH5e69Hsz-VZpYRfCMQaLeeyMGtnd-p1df1KjhNC-yQ/s1040/Slide6.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtDPrUUGN0d6tpf1wolL_no28ob5JRXIVPalimyvAXMsnSpfqQqsE9BRS3ExcdGh75vsyRp-mdouM6eULdGTnjZgHDcZUeXp-VB23P6dot1t4jM01IlgbXqcnUvBfgdv5KiBqF7CweEhZZPc-gH5e69Hsz-VZpYRfCMQaLeeyMGtnd-p1df1KjhNC-yQ/w400-h300/Slide6.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>So what are the <b>most</b> <b>common reasons</b> to have meetings in Healthcare? They include: <b>Education and information</b> transfer, group <b>decision-making</b>, and <b>collaborative development</b> : </span><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRuafGdLIhmUBi2wt_e7wYuJl52KPYrz4gZGwNBFqZ6uZoXxR3ncZ6PrJuVpVFBcX3wrvoIXsw0e9lDUfYaMmINN-qskB0BDVKPnf7AhEFqMi7KdsvzMxmNsrPDILgD8ZxBTPfo-bG4NJlvdBVlzRpZLIfAwJqYiejKEesEurnogmNl9mId2H8KUyA6w/s1040/Slide7.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRuafGdLIhmUBi2wt_e7wYuJl52KPYrz4gZGwNBFqZ6uZoXxR3ncZ6PrJuVpVFBcX3wrvoIXsw0e9lDUfYaMmINN-qskB0BDVKPnf7AhEFqMi7KdsvzMxmNsrPDILgD8ZxBTPfo-bG4NJlvdBVlzRpZLIfAwJqYiejKEesEurnogmNl9mId2H8KUyA6w/w400-h300/Slide7.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>And this leads us to the <b>most common types </b>of meetings in Healthcare, which include <b>regular department meetings</b>, <b>emergent/urgent department/team meetings</b>, <b>committee meetings</b>, planned <b>project team</b> meetings, and <b>other common meetings</b> (<i><span style="color: #2b00fe;">e.g. Morbidity and Mortality conferences, planning/strategy meetings, meetings to review clinical literature and needs, etc.</span></i>)</span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhj29_qOZEk_0FPU7AwVwD8rzD-ra9GKiCUyPuvtxwZwLoDDUgIu9ATnrVAZVExQZLvdUxNMDeWZFGoslIyHodCPBgo4WEXy8EyXr6UuP4xp6pMz5SUwFB0M9KBPM_5O_6AROfETCH-KnmHp0X6Exjo6EQIZ6pdFk-B_-kD187RTEfaj0aAZ_AodMOsMw/s1040/Slide8.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhj29_qOZEk_0FPU7AwVwD8rzD-ra9GKiCUyPuvtxwZwLoDDUgIu9ATnrVAZVExQZLvdUxNMDeWZFGoslIyHodCPBgo4WEXy8EyXr6UuP4xp6pMz5SUwFB0M9KBPM_5O_6AROfETCH-KnmHp0X6Exjo6EQIZ6pdFk-B_-kD187RTEfaj0aAZ_AodMOsMw/w400-h300/Slide8.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>Without good planning and support - there are some <b>common problems</b> which can occur, including <b>poorly-defined <u>charters</u></b>, <b>poorly-defined <u>agendas</u></b>, <b>poorly-documented <u>minutes</u></b>, <b>incorrect stakeholders</b>, or <b>inadequate attendance</b> : <br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6xbEHsxStZpVL8TY_oP7Ral629Jwbl-0yHYQFBci2_LRNAUh77ByAk7ytnXMEw2vK4aH-NsbD6cOiLzCfWrdwdAy1m4NtuKQZAAsqSNyCdU0GSAa4JrOXGYPnJotN4iCGFpz6q1lplDcMPONdfHA0W40khPMHypSX2I0dx-5KrCuBOzHYGIXWbxWmbA/s1040/Slide9.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6xbEHsxStZpVL8TY_oP7Ral629Jwbl-0yHYQFBci2_LRNAUh77ByAk7ytnXMEw2vK4aH-NsbD6cOiLzCfWrdwdAy1m4NtuKQZAAsqSNyCdU0GSAa4JrOXGYPnJotN4iCGFpz6q1lplDcMPONdfHA0W40khPMHypSX2I0dx-5KrCuBOzHYGIXWbxWmbA/w400-h300/Slide9.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>Fortunately, the solution to these problems is usually to have well-defined <b>charters</b>, <b>agendas</b>, and <b>minutes</b>. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica; font-size: large;"><b><u>THE CHARTER </u></b></span></div><div><span style="font-family: helvetica;">Below, I've attached some data elements for a good <b>committee or team <u>charter</u></b> : <br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyyZW9z6_2srnpFI7Vz9e24xUTnAm13INVf-JuMD9aTykJD_ZBWWhiVOOX_UwswwLzQzcnyfqIwju0ag1dj79_S0O4xE6c0u1zmLiwC8l1QtSRU3uWG1b7SgsGE6f2m2hDc5wTnbUfDY0FkUOIM2zjIGY2tvRy_DDrrbFPtmRs4jHUMnNa7lrgkHZihg/s1040/Slide10.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjyyZW9z6_2srnpFI7Vz9e24xUTnAm13INVf-JuMD9aTykJD_ZBWWhiVOOX_UwswwLzQzcnyfqIwju0ag1dj79_S0O4xE6c0u1zmLiwC8l1QtSRU3uWG1b7SgsGE6f2m2hDc5wTnbUfDY0FkUOIM2zjIGY2tvRy_DDrrbFPtmRs4jHUMnNa7lrgkHZihg/w400-h300/Slide10.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>Another way of looking at those <b>same data elements</b>, contained in a good <b>committee / team charter</b>, is here (<i><span style="color: #2b00fe;">click to enlarge</span></i>) : </span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkNX1-5a3bMv-auU0-56qo_xMLwu4rESOnctWf86Mflq7g__JQOyQDfFzCqRcc1KT6-jspptV22uj2y9YYfgH4vm2kI867b8qp-dkzGpZgN74t3gY2iwzKCiejIaQuqxFsrpSNrvtnTGa3g0z4v5q3MULU5rs949tdUmZqK8ezwiT9Qca5D899pqPXSA/s2216/Charter%20Graphic.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="2216" data-original-width="1676" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkNX1-5a3bMv-auU0-56qo_xMLwu4rESOnctWf86Mflq7g__JQOyQDfFzCqRcc1KT6-jspptV22uj2y9YYfgH4vm2kI867b8qp-dkzGpZgN74t3gY2iwzKCiejIaQuqxFsrpSNrvtnTGa3g0z4v5q3MULU5rs949tdUmZqK8ezwiT9Qca5D899pqPXSA/w303-h400/Charter%20Graphic.png" width="303" /></span></a></div><span style="font-family: helvetica;">Assuming you have a good committee <b>charter</b> to set your team in the right direction, with clear responsibility, authority, and metrics of success - The next steps is to make sure you have a good <b>agenda</b>. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica; font-size: large;"><b><u>THE AGENDA</u></b></span></div><div><span style="font-family: helvetica;">Some of the data elements contained in a good <b>agenda</b> are here below :<br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwRxAE_vjmOGJdv_5WbCNr4it_tDUpNi2VB9GkhYAD0cx5067CjRJ_htRnvpScNONzIavON290NBNZkK0YoGLWl_oNOVXOmTFKeGvn6Rhr2VcwemFhpx8h-5uDSRYHLQ6Q44kwrr6gPGd-3-_9_EB5bfuOHbQ4ihIg3D_S7jJp2kQwqXtlutlFHIC8Kw/s1040/Slide11.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwRxAE_vjmOGJdv_5WbCNr4it_tDUpNi2VB9GkhYAD0cx5067CjRJ_htRnvpScNONzIavON290NBNZkK0YoGLWl_oNOVXOmTFKeGvn6Rhr2VcwemFhpx8h-5uDSRYHLQ6Q44kwrr6gPGd-3-_9_EB5bfuOHbQ4ihIg3D_S7jJp2kQwqXtlutlFHIC8Kw/w400-h300/Slide11.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>Note that the agenda items typically divide into "<i><b>old business</b></i>" and "<i><b>new business</b></i>", as recommended by <b>Robert's Rules of Order</b> ( <a href="http://www.robertsrules.com">www.robertsrules.com</a> ), to allow you to revisit previous topics and add new ones in an organized, predictable way. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">For a more complete set of potentially </span><span style="font-family: helvetica;">relevant data elements that might be used in an agenda, you can also see the sample <b>agenda </b></span><span style="font-family: helvetica;"><b>template</b> below (</span><i style="font-family: helvetica;"><span style="color: #2b00fe;">click to enlarge</span></i><span style="font-family: helvetica;">) : </span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb8rMxVTSgtvK91kKOo5u346fw6002MHXlHWSPB7_ZdHJzQbWAbIaOL8PZFEpbCdfhlWxw7rE14BJKAXPyQqZ8GNxtO69CtGkWRI6x9MSrzFd4UzpDW98Yqdpsx9vLdNPq9eaZU8UXqIsxMU1AHv9-Ac7wCcq3ytqXO9sRAAYtOpenM69Bd2oMa0hsWA/s1826/Agenda%20Graphic.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1826" data-original-width="1638" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgb8rMxVTSgtvK91kKOo5u346fw6002MHXlHWSPB7_ZdHJzQbWAbIaOL8PZFEpbCdfhlWxw7rE14BJKAXPyQqZ8GNxtO69CtGkWRI6x9MSrzFd4UzpDW98Yqdpsx9vLdNPq9eaZU8UXqIsxMU1AHv9-Ac7wCcq3ytqXO9sRAAYtOpenM69Bd2oMa0hsWA/w359-h400/Agenda%20Graphic.png" width="359" /></a></div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><b><u><span style="font-size: large;">THE MINUTES </span></u></b></span></div><div><span style="font-family: helvetica;">Recording the activities, discussions, and actions of the committee will require careful documentation of </span><b style="font-family: helvetica;">minutes - </b><span style="font-family: helvetica;">typically recorded by your secretary or <i>someone who has the training, experience, and ability to take minutes</i></span><b style="font-family: helvetica;">. </b><span style="font-family: helvetica;">Minutes are your official legal document, acknowledging who participated in the meeting, and what actions the committee took. They are so important that you will want to <b>send them out</b> to committee/team members, ask them to <b>review</b> them, ask for <b>any edits/corrections</b>, and bring back the <b>final minutes</b> for review and final approval at your next meeting. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Some of the data elements contained in a good set of </span><b style="font-family: helvetica;">minutes</b><span style="font-family: helvetica;"> include the below (</span><i style="font-family: helvetica;"><span style="color: #2b00fe;">click to enlarge</span></i><span style="font-family: helvetica;">) :</span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_hq0oLo4EkwU82HVCJQezMh3Noz7KHZJak7YGPG76tQz_7xSGx4sItUu2mpnuZNDharF8olqY02aimXqXxL7A8EfwW_5T26qoyxhoYSGwQIhV47YshVjSXr0-jFjhALYBmN5bWoTEfwe0-aJ2SGp1BgKMFTj3YZZ0VGn6irWQPH1qu6hkI3P9YNEnkw/s1040/Slide12.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_hq0oLo4EkwU82HVCJQezMh3Noz7KHZJak7YGPG76tQz_7xSGx4sItUu2mpnuZNDharF8olqY02aimXqXxL7A8EfwW_5T26qoyxhoYSGwQIhV47YshVjSXr0-jFjhALYBmN5bWoTEfwe0-aJ2SGp1BgKMFTj3YZZ0VGn6irWQPH1qu6hkI3P9YNEnkw/w400-h300/Slide12.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>For a more complete set of data elements that might be used in a set of minutes, you can also see this sample <b>minutes template</b> below (<span style="color: #2b00fe;"><i>click to enlarge</i></span>) : </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3zKq8KOv2i8NKy8pjS5_9zRoAveAIDfcruMke8ZN_XnU-xYz4inFDu8JnZPQYr2g1S4tpcaauDOjMbGOeJJL5I6Ksgcg__4uujMa8UN98ogrAwA5RKGa3Oe1CLTI6WIkNv6BxoKE3jn6UoKyy5_nVahqYJ3sb_FnGfttBqZMaMVh69jrkRStsPGDGAA/s2004/Minutes%20Graphic.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2004" data-original-width="1624" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3zKq8KOv2i8NKy8pjS5_9zRoAveAIDfcruMke8ZN_XnU-xYz4inFDu8JnZPQYr2g1S4tpcaauDOjMbGOeJJL5I6Ksgcg__4uujMa8UN98ogrAwA5RKGa3Oe1CLTI6WIkNv6BxoKE3jn6UoKyy5_nVahqYJ3sb_FnGfttBqZMaMVh69jrkRStsPGDGAA/w324-h400/Minutes%20Graphic.png" width="324" /></a></div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><b><u><span style="font-size: large;">HELPFUL CLOSING TIPS</span></u></b></span></div><div><span style="font-family: helvetica;">This brings us to some of my <b>closing tips</b> for running a good meeting :</span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;">It's very helpful for every clinical leader to familiarize yourself with <b>Robert's Rules of Order</b> ( <a href="http://www.robertsrules.com">www.robertsrules.com</a> ), a well-known and helpful book on running all sorts of meetings - from <i>small informal ones</i> to <i>large formal ones</i>. In addition to meeting planning, you'll learn about chairperson responsibilities, and the different types of motions and actions that help make meetings <i>run smoother</i>.</span></li><li><span style="font-family: helvetica;">Using the sample <b>charter</b>, <b>agenda</b>, and <b>minutes</b> <b>templates</b> that I've shared above can help you run your meetings in an organized and productive way.</span></li></ul></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHyz48YREhLSW0aGyer4I152cF9Qxmmkl_rAWHt3dNGNYMjG4vp_Artx78caIQq2L2Kky1w8chi-yQ1vueaPF2VczudeKk-dt9pifKLlWaYBoG5nnj8jys8YojbYRZvjqOQwFEIocZCNc_pZZb0bCr-wfBsQMaHMezTIxxoFpHMVyHv7AofAbyORHQxg/s1040/Slide13.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="780" data-original-width="1040" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHyz48YREhLSW0aGyer4I152cF9Qxmmkl_rAWHt3dNGNYMjG4vp_Artx78caIQq2L2Kky1w8chi-yQ1vueaPF2VczudeKk-dt9pifKLlWaYBoG5nnj8jys8YojbYRZvjqOQwFEIocZCNc_pZZb0bCr-wfBsQMaHMezTIxxoFpHMVyHv7AofAbyORHQxg/w400-h300/Slide13.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;">And for my <b>final tips</b> : </span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b><span style="color: #2b00fe;">Practice, practice, practice</span></b> - Running a meeting or chairing a committee takes work and practice. (<i>Don't worry - Everyone eventually learns this skill!</i>)</span></li><li><span style="font-family: helvetica;"><b><span style="color: #2b00fe;">Learn from other Clinical Leaders</span></b> - <i>What worked? What didn't?</i></span></li><li><span style="font-family: helvetica;"><b><span style="color: #2b00fe;">Remember the future of healthcare is shared governance</span></b> - Healthcare is a <b>team sport</b> - <i>You can learn a lot from your fellow nursing, physician, pharmacy, or other clinical leaders!</i></span></li><li><span style="font-family: helvetica;"><span style="color: #2b00fe;"><b>Keep reading and keep learning</b></span>!</span></li></ul><div><span style="font-family: helvetica;">Always keep in mind that <b>good, well-planned, productive meetings</b> that <b>give everyone confidence and clarity </b>might take some<i> </i>work and planning - but they<b> </b>are <i><b>completely achievable</b></i>!</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><i>Remember this blog is for education and discussion purposes - Your mileage may vary!</i></span></div><div><span style="font-family: helvetica;"><i>Have any good tips or tricks to share with clinical leaders, for creating good committees or running good meetings? Feel free to share them in the comments section below!</i></span></div><div><span style="font-family: helvetica;"><i><br /></i></span></div><p></p></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-84525435215298052582022-10-08T11:06:00.009-04:002022-10-09T11:44:46.833-04:00What can Cardiac Myocytes teach us about Teamwork and Workflow?<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, and other #HealthIT and Applied Clinical #Informatics friends,</i></span></p><p><span style="font-family: helvetica;">Today's post is short, but one that I think most <b>clinical friends</b> will understand and appreciate. For conceptual teaching purposes only, I'm going to ask the question : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0JA4TirEIPs8Qm0xuLS4zwbNv38dy1rmmzakW073nM41NJvRe8ptcYjyW8fSu4AuR8tDn9HGa5w2Y41HZ0jgB3OEi4MGT2DBqTkR7WbtsDXByxJbb_2kq9syVx6JVLQ8vhxcabFC-muQdQ_E61iXhwE3Gt2FS9kDd-L0qP5DGLYLOANxWpfoSIH4CLw/s960/Cardiac%20Myocyte%20Workflow%20Slide.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0JA4TirEIPs8Qm0xuLS4zwbNv38dy1rmmzakW073nM41NJvRe8ptcYjyW8fSu4AuR8tDn9HGa5w2Y41HZ0jgB3OEi4MGT2DBqTkR7WbtsDXByxJbb_2kq9syVx6JVLQ8vhxcabFC-muQdQ_E61iXhwE3Gt2FS9kDd-L0qP5DGLYLOANxWpfoSIH4CLw/w499-h281/Cardiac%20Myocyte%20Workflow%20Slide.jpeg" width="499" /></span></a></div><div style="text-align: center;"><span style="font-family: helvetica;"><span style="font-size: medium;"><b>"<span style="color: #2b00fe;">Q</span></b> : What can <b><span style="color: #2b00fe;">Cardiac Myocytes</span></b> teach us </span></span></div><div style="text-align: center;"><span style="font-family: helvetica;"><span style="font-size: medium;">about <b><span style="color: #2b00fe;">Teamwork</span></b> and <b><span style="color: #2b00fe;">Workflow Design</span></b>?"</span></span></div><p></p><p><span style="font-family: helvetica;"><span style="font-family: helvetica;"><b>Here's my theory</b> : Clinicians may <i>actually</i> <i>have an advantage here</i>. If you've ever studied the <b>human heart</b> - it's anatomy, it's functions, its biology, and its electrophysiology - You already know a lot about </span><b>teamwork, workflow design,</b><span style="font-family: helvetica;"> </span><b>clinical operations, </b><span style="font-family: helvetica;">and essentially</span><b> <i>how to get things done</i>. </b></span></p><p><span style="font-family: helvetica;">After all, <b>cardiac myocytes</b> and <b>humans</b> (<i><span style="color: #2b00fe;">clinical leaders and team members</span></i>) both work towards a <b><i>common goal</i></b>. We both can function as <b>individual units</b>, but we <b>function <u>even better</u> together</b> as a <i>well-organized, well-synchronized <b>team</b> : </i></span></p><p></p><p><span style="font-family: helvetica;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><span style="color: #2b00fe; font-size: x-small;">[ <b>DRAFT</b> ] <b>TABLE</b> - <i>A tongue-in-cheek but honest comparison of Myocytes with Humans (Clinicians)</i></span></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt_T5x14iAGSUCpOY9h9FIf-MxmzU1Tm_sYa-MK4aUn5NXm9DAZF6db-q-ZoPogkChRSxSOr0-S4S9_MbYiRUeWmyiLNORP82U6NqTB_JUckyF1B1xFCiJVnR1UBJg2_7Yk-ZFlJ0fo5dhnnGHwHG91aB4dLNVsy_n4JwQWMBv5mn_did0F-rQ8foOUA/s932/Cardiac%20Myocytes%20vs%20Humans.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="466" data-original-width="932" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjt_T5x14iAGSUCpOY9h9FIf-MxmzU1Tm_sYa-MK4aUn5NXm9DAZF6db-q-ZoPogkChRSxSOr0-S4S9_MbYiRUeWmyiLNORP82U6NqTB_JUckyF1B1xFCiJVnR1UBJg2_7Yk-ZFlJ0fo5dhnnGHwHG91aB4dLNVsy_n4JwQWMBv5mn_did0F-rQ8foOUA/w584-h292/Cardiac%20Myocytes%20vs%20Humans.jpeg" width="584" /></a></span></div><div style="text-align: center;"><span style="font-family: helvetica;"><br /></span></div><span style="font-family: helvetica;">Let's face it, <b>healthcare is a team sport</b>. So when I'm working with <b>other clinical leaders</b>, especially <b><i>new ones</i></b> - For support, I often remind them of the importance of the <b>infrastructure and tools</b> that, <i>especially as clinicians</i>, we sometimes take for granted - Good : </span><p></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">Regulations (<i>both Federal and State</i>)</span></li><li><span style="font-family: helvetica;">Governance (<i>e.g. Committee structures</i>)</span></li><li><span style="font-family: helvetica;">Leadership</span></li><li><span style="font-family: helvetica;">Direction</span></li><li><span style="font-family: helvetica;">Management</span></li><li><span style="font-family: helvetica;">Communication</span></li><li><span style="font-family: helvetica;">Bylaws</span></li><li><span style="font-family: helvetica;">Policies/Procedures</span></li><li><span style="font-family: helvetica;">Training / Onboarding</span></li><li><span style="font-family: helvetica;">Continuing Education</span></li><li><span style="font-family: helvetica;">Offboarding</span></li><li><span style="font-family: helvetica;">Teamwork</span></li></ul><div><span style="font-family: helvetica;">After all, when growing a plant - it's not just the <i><b>seeds </b></i>you need to worry about, it's also the <b><i>soil</i></b>. So without enough of this '<i>supporting <b>soil</b>'</i> (<i><span style="color: #2b00fe;">the tools above</span></i>) in place, it becomes very easy to run into problems growing the <b>seeds</b> - And so for end-users, managers, directors, leaders, and executives alike, this can sometimes result in loss of efficiency, frustration, disorganized workflows, problems not getting solved in a timely basis, etc.</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Typically, these tools don't get enough attention from <b>new</b> clinical leaders, because <b>until they are in a leadership position</b> - their focus has largely been on '<i>clinical things</i>' like working with patients, diagnosing and treating diseases, performing operations and procedures, etc. While those are all the <b>reasons</b> we are in healthcare, it's still important to understand the many '<i>non-clinical</i>' tools that <i>make those things happen</i>. (<i>In truth, those tools are just as clinical as penicillin - But due to time constraints, they usually don't teach much about them in medical schools</i>.)</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">What I find especially interesting is that, as a physician who during my career has treated cardiac tachyarrhythmias <b>at the bedside</b> (<i>using beta-blockers, calcium-channel blockers, adenosine, cardioversion, etc.</i>) - There are often similar analogous ways to treat these same '<b><i>human tachyarrhythmia</i></b>' problems on project teams : </span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKJalvu4QK-HkI6x6TsULlkwPL7k7Ry-ug504FTGBBXi7xCQxBRlAsAzBP55fgkDBXNTlizZIGeZkL-it81yXhPFaMhfLOeuj1bSRNAt8oUVLyciSN43eFfSrBOC9Y6Xx-QBAPFXDD45IWCUUNM2ompIFbpG7x2fFpPVPucQZ0SN5lFvuclYSf717s9Q/s960/Other%20Myocyte%20and%20Human%20Analogies.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="326" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKJalvu4QK-HkI6x6TsULlkwPL7k7Ry-ug504FTGBBXi7xCQxBRlAsAzBP55fgkDBXNTlizZIGeZkL-it81yXhPFaMhfLOeuj1bSRNAt8oUVLyciSN43eFfSrBOC9Y6Xx-QBAPFXDD45IWCUUNM2ompIFbpG7x2fFpPVPucQZ0SN5lFvuclYSf717s9Q/w581-h326/Other%20Myocyte%20and%20Human%20Analogies.jpeg" width="581" /></span></a></div><span style="font-family: helvetica;">So when I have the opportunity to teach a new clinical leader about how to solve problems and function in teams, I simply remind them that <b>modern human biology has evolved over <u>thousands of years</u> to solve these <u>same sorts of problems</u></b> that we experience in healthcare today - And so sometimes, <b>looking inward with a <u>microscope</u></b> is <i>just as helpful</i> as <b>looking outward with a <u>telescope</u></b>. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Finally, one of my clinical informatics colleagues and good friend Stefanie Shimko-Lin, BSN RN CD-L CD-PIC FHIMSS<i style="color: #2b00fe;"> </i>once shared this cardiac analogy with me : "<i><b>Collateral circulation</b> is a workaround, that happens when the <b>desired workflow doesn't work</b>. If you make it <b>easy to do the right thing</b>, people will do it.</i>"</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">These analogies may all seem <i>a bit peculiar and tongue-and-cheek</i>, but <b>if you're a clinical leader</b> - </span><span style="font-family: helvetica;">I hope this blog post helps to <b>spark helpful discussion and learning</b> with your own clinical leadership and project teams, so that you can better solve the workflow and operational issues you might encounter in your daily clinical routines.</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="color: #2b00fe; font-family: helvetica;"><i>Remember, this blog is for educational and discussion purposes only - <b>Your mileage may vary</b>! Have any other helpful analogies or advice for new clinical leaders? Feel free to share them in the comments section below!</i></span></div><p></p>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-10865309894882797352022-10-02T23:29:00.013-04:002022-10-03T14:47:21.533-04:00Advice from a Wise Business Leader<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, and other #Informatics and #HealthIT friends,</i></span></p><p><span style="font-family: helvetica;">A brief pause from Applied Clinical Informatics, just for a moment. </span></p><p><span style="font-family: helvetica;">Today's post is related to some helpful <a href="https://en.wikipedia.org/wiki/Business_ethics" target="_blank">business ethics</a> advice I once received from a wise and successful businessman my mother used to work for. His name was <a href="https://prabook.com/web/james_everett.robison/405075"><b>James</b> (<i>'<span style="color: #2b00fe;">Jim'</span></i>) <b>Everett</b> </a><b><a href="https://prabook.com/web/james_everett.robison/405075">Robison</a> (</b><span style="color: #2b00fe; font-style: italic;">11/22/1915 - 2/21/1998</span><b>)</b><i>, </i>and he was a very successful businessman and Harvard Business School graduate who, in addition to having a wonderful and loving family, also counted <a href="https://www.csmonitor.com/1980/1010/101002.html">Roy Little</a> and <a href="https://www.csmonitor.com/1980/1010/101002.html">Thomas J. Watson, Jr.</a> as some of his business associates and friends.</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ2pe7JT3RC4nu2pFbDSIwjOhWw8fVAZdqqnjm5XDqXA8XR4_U7YkB0o9leUhTO-YwcGfQIpdZZkRhQ_TnLuEuG8EPGZ6EjJqblBXzxPwQ-5R0qjV3X56TuIsr78HAxCiQliNYnfrcn2MR2WNXn14T3anjJjRvYIgPwxC7MFiFbTQOoT9NSVPk8ZylPQ/s1316/James%20E%20Robison.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="918" data-original-width="1316" height="279" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ2pe7JT3RC4nu2pFbDSIwjOhWw8fVAZdqqnjm5XDqXA8XR4_U7YkB0o9leUhTO-YwcGfQIpdZZkRhQ_TnLuEuG8EPGZ6EjJqblBXzxPwQ-5R0qjV3X56TuIsr78HAxCiQliNYnfrcn2MR2WNXn14T3anjJjRvYIgPwxC7MFiFbTQOoT9NSVPk8ZylPQ/w400-h279/James%20E%20Robison.png" width="400" /></a></div><span style="font-family: helvetica; font-size: x-small;"><div style="text-align: center;"><span style="font-family: helvetica; font-size: x-small;"><i>(L) James E. Robison as an Air Force pilot circa 1940s, and </i></span><span style="font-family: helvetica; font-size: x-small;"><i>(</i></span><i>R) as a successful business leader circa 1990s.</i></div></span><p><span style="font-family: helvetica;">A retired and decorated WWII Air Force Major (<i><span style="color: #2b00fe;">who flew 63 completed missions, 402 combat hours, 26 squadron leads, 7 group leads, and 1 wing lead!</span></i>), Jim Robison lived and breathed<b> </b><i><b>integrity</b></i>.</span></p><p><span style="font-family: helvetica;">Growing up, I would run into Mr. Robison occasionally, while my mother was working for him in Armonk, NY back in the 1980s and 1990s. During one of my visits to my mother's workplace, he shared a message with me - one that he apparently also shared with many other people - about the importance of <b><i>honesty</i></b>, <b><i>integrity</i></b>, and <b><i>ethics</i></b> in business.</span></p><p><span style="font-family: helvetica;">His message was once captured beautifully by his good friend <a href="https://en.wikipedia.org/wiki/Charles_Osgood">Charles Osgood</a>, who shared it in his November 24th, 1992 Osgood File message. </span></p><p><span style="font-family: helvetica;">The message is still so important and relevant, that I think it bears repeating today. Transcribed from an old cassette tape I found in my attic, here it is : </span></p><p><span style="background-color: white; color: #0b5394; font-family: helvetica; white-space: pre-wrap;">TRANSCRIPT : </span></p><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">Charles Osgood</span></span></div><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">CBS 880 AM Radio 11-24-1992</span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">[ <a style="cursor: pointer;" tabindex="-1"></a><i>Start of Transcript</i> ] </span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">The Osgood File, sponsored in part by ______ Heating and Cooling. I'm Charles Osgood. </span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">Last night at the University Club in New York, I attended a reunion dinner of sixty (60) people who used to work for the same company my late father did. There were books of pictures, and in some of them I could hardly recognize dad because he was so much younger then, than I am now. It made me feel like Michael J. Fox in "Back to the Future". </span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">And amongst the memorabilia I found something that impressed me so much, I wanted to share it with you, which I will do, in a moment. Stand by.</span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">My father was in the textile business. His boss, at a company called <a href="https://info.fabrics.net/indian-head-remembered-revisiting-an-american-institution/">Indianhead Mills</a>, was a dynamic young man by the name of Jim Robison. Dad thought the world of Jim, not only because he was so smart and so successful, but also because he was such a straight shooter. Robison never wanted to outdo or get the better of anybody in a business deal. If both parties didn't benefit from the deal, he didn't want to do it.</span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">My dad died several years ago, but last night I was invited to a reunion of Indianhead people, some of them I hadn't seen since I was a kid. Jim Robison was there, retired now and no longer a young man, but still sharp as ever. And looking through some materials they had there, I came on a company policy statement that he had issued 40 years ago. And I took a copy of it because I wanted to share it with you this morning. Here's what it said : </span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">"<b>There is one basic policy, to which there will never be an exception made by anyone, anywhere, in any activity owned and operated by Indianhead. That policy is as follows," </b>Jim Robinson wrote<b>. "Play it straight, whether in contact with the public, stockholders, customers, suppliers, employees, or any other individuals or groups. The only right way to deal with people is forthrightly and honestly. If any mistakes are made, admit them and correct them. Our commitments will be honored, and we have a right to expect the same performance from those people with whom we do business. </b></span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;"><b>This is fundamental. We will not welch, weasel, chisel, or cheat. We will not be a party to any untruths, half-truths, or unfair distortions. Life is too short. </b></span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;"><b>It is perfectly possible to make a decent living without any compromise with integrity.</b>"</span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">I think I'm going to frame that and put it on the wall.</span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">The Osgood File, Charles Osgood on the CBS Radio Network.</span></span></div></div><div class="l7ghb35v kjdc1dyq kmwttqpk gh25dzvf jikcssrz n3t5jt4f" style="margin: 0.5em 0px 0px; overflow-wrap: break-word; white-space: pre-wrap;"><div dir="auto"><span style="background-color: white;"><span style="color: #0b5394; font-family: helvetica;">[ <i>End of Transcript</i> ]</span></span></div><div dir="auto"><span style="background-color: white;"><span style="font-family: helvetica;"><br /></span></span></div><div dir="auto"><span style="background-color: white;"><span style="font-family: helvetica;">I agree with Charles Osgood - <i>I think I'm going to frame that and put it on the wall</i>.</span></span></div><div dir="auto"><span style="background-color: white;"><span style="font-family: helvetica;">I hope this timeless message inspires you too!</span></span></div><div dir="auto"><span style="background-color: white;"><span style="font-family: helvetica;"><i><br /></i></span></span></div><div dir="auto"><span style="background-color: white;"><span style="font-family: helvetica;"><i>Remember, this blog is for informational and educational purposes only - Your mileage may vary! </i></span></span><i style="font-family: helvetica;">Have any experience with studying business ethics? Please feel free to share in the comments below!</i></div><div dir="auto"><span style="font-family: helvetica;"><span style="background-color: white;"><i><br /></i></span></span></div></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-88809463390583101762022-06-11T13:56:00.016-04:002022-06-14T14:23:24.445-04:00How I Became a 'Document Whisperer'<p><i style="font-family: helvetica;">Hi fellow CMIOs, CNIOs, and other Applied Clinical #Informatics and #HealthIT friends,</i></p><p><span style="font-family: helvetica;">I'm writing today to share some stories from my career path in Applied Clinical Informatics, and how I became a '</span><span style="font-family: helvetica;"><b><i>document whisperer</i></b>' with regard to clinical workflow design. This post stems from a common question I get asked: </span></p><p><span style="font-family: helvetica;"></span></p><blockquote><p><span style="font-family: helvetica;"><span style="color: #2b00fe;">'<i>If you care so much about <b>clinical workflows - </b>Then why do you seem to care so much about <b>bylaws, policies, procedures, guidelines, protocols, bylaws, charters, order sets, and other documents</b>? Why don't you just worry about the things <b><u>inside</u></b> <b>the</b> <b>EMR</b>?</i>' </span></span></p><p></p></blockquote><p><span style="font-family: helvetica;">The reason is because <b><u>all</u></b> of these documents (<i><span style="color: #2b00fe;">whether they are <b>inside</b> or <b>outside</b> an EMR</span></i>) work together </span><span style="font-family: helvetica;">to </span><b style="font-family: helvetica;"><i>shape clinical workflow</i></b><span style="font-family: helvetica;">. </span></p><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVZVUjshMCGADUhoPpwW8FAiDzkmsBuoo5s36I4XMNOuq-XeWSCgC02FZBZSzYG2vTiDPsdRKfFBqycQVV3o9c9CdXXULMyQJUklqbxfaiZwJf9_I93P7tGL2uP4fLVRH29jH-Njs2djIoMeuCCFxH3D2iBfCacn-yTPEcbwtyYRqYHe6pPJxuqkvyag/s1896/Clinical%20Workflow%20Design.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="686" data-original-width="1896" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVZVUjshMCGADUhoPpwW8FAiDzkmsBuoo5s36I4XMNOuq-XeWSCgC02FZBZSzYG2vTiDPsdRKfFBqycQVV3o9c9CdXXULMyQJUklqbxfaiZwJf9_I93P7tGL2uP4fLVRH29jH-Njs2djIoMeuCCFxH3D2iBfCacn-yTPEcbwtyYRqYHe6pPJxuqkvyag/w400-h145/Clinical%20Workflow%20Design.png" width="400" /></a></div><p><span style="font-family: helvetica;">To explain, I need to first <i>offer some context</i>. </span></p><p><span style="font-family: helvetica;">Back in 2007 when I first started my formal clinical informatics career, <b>like most newcomers</b>, I didn't yet have enough experience to <i>fully understand my role</i>. I figured my job was to '<i>help with the electronic medical record</i>', so naturally, I focused mainly on the things that doctors interacted with </span><b style="font-family: helvetica;"><i>inside the EMR</i></b><span style="font-family: helvetica;">. </span></p><p><span style="font-family: helvetica;">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, <i>didn't get used</i>. There were order sets that created <i>turbulence with other workflows</i> when we rolled them out. I received complaints from doctors who felt the computer was '<i>too clunky</i>' and that '<i>it takes too long to get things done</i>'. </span></p><p><span style="font-family: helvetica;">Initially, I wondered if this was simply a matter of an EMR just being <b>more difficult to use</b>. There were some people who told me, '<i>Oh, some doctors are just resistant to change</i>' (<i>which is partly true</i>), and others who told me, '<i>Computers are just complicated and finicky</i>' (<i>which can also sometimes be true</i>).</span></p><p><span style="font-family: helvetica;">But I kept looking for a better answer - <i>There must be <b>some sort of symmetry</b> <b>here</b> that I was missing</i>. </span></p><p><span style="font-family: helvetica;">And then, over the next 2-3 years, I experienced two important things : </span></p><p></p><ol style="text-align: left;"><li><span style="font-family: helvetica;">I once worked on a complex titration <b>protocol</b>, which required an extensive analysis to fully build out the protocol, and...</span></li><li><span style="font-family: helvetica;">One day, a Registered Nurse complained to me about a <b>policy</b> that would need to be <b>updated</b>, in conjunction with a project we were actively working on.</span></li></ol><div><span style="font-family: helvetica;">So it was while confronting the question of '<b><i>How exactly do you <u>write</u> a protocol?</i></b>' that I started to really confront the question : "<b><i>What exactly </i><u>is</u><i> a protocol?</i></b>" This led to even more questions, like : </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXXHYDh-CQlO_Gv2xlWqg3OjMOkIpvVx0JyCbTJHK1kG2LRTut6OE0n3i0wXqHxKE23Xxyc2D4dNs1aUia_dO6nqw0qD8E0De9YLqKwuSBmgW5bUzopWltgxMua5BPMUAYJwTfVSqaaXgdiPtyld_uuh5lm9Lz4xMR1EZF7ZTdkFvVsWnRn4gChIw6VQ/s1006/WhatIsAProtocol.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1006" data-original-width="648" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXXHYDh-CQlO_Gv2xlWqg3OjMOkIpvVx0JyCbTJHK1kG2LRTut6OE0n3i0wXqHxKE23Xxyc2D4dNs1aUia_dO6nqw0qD8E0De9YLqKwuSBmgW5bUzopWltgxMua5BPMUAYJwTfVSqaaXgdiPtyld_uuh5lm9Lz4xMR1EZF7ZTdkFvVsWnRn4gChIw6VQ/w258-h400/WhatIsAProtocol.png" width="258" /></a></div><br /><span style="font-family: helvetica;">Trying to find more concrete answers, I looked to various potential sources, including <a href="https://www.dirkstanley.com/2019/01/">various regulations</a>, the <a href="https://www.iso.org/home.html">International Standards Organization (ISO)</a>, the <a href="https://www.nist.gov/">National Institute of Standards and Technology (NIST)</a>, the <a href="https://www.cms.gov/">CMS web site</a>, various HealthIT/Informatics societies, <a href="https://en.wikipedia.org/wiki/ITIL">ITIL</a>, and even <a href="https://thelawdictionary.org/">Black's Law Dictionary</a>, <i>without much help</i>. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">So around 2010, I decided to look at this from a <i>more analytical</i>, <b>design-thinking</b> standpoint : </span></div><div><span style="font-family: helvetica;"></span></div><blockquote><div><span style="color: #2b00fe; font-family: helvetica; font-size: medium;"><i>"If we gathered <b><u>every document</u> in healthcare</b>, both those <b>sitting on desks</b> and on <b>hard-drives - </b>what would they <b>be</b>, and what would they <b>look like</b>?"</i></span></div><div></div></blockquote><div><span style="font-family: helvetica;">This led me to scribbling down some </span><b style="font-family: helvetica;">commonly-used words</b><span style="font-family: helvetica;"> people use in healthcare, putting them into a spreadsheet, and in 2010 I came up with my first </span><a href="https://www.dirkstanley.com/2010/08/cmios-checklist.html" style="font-family: helvetica;">CMIO's Checklist</a><span style="font-family: helvetica;"> : </span></div><div style="text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div style="text-align: center;"><span style="font-family: helvetica; font-size: x-small;">[ <span style="color: red;">FIRST DRAFT</span> ] <span style="color: #2b00fe;"><i><b>Note</b> : My <a href="https://www.dirkstanley.com/2019/12/my-clinical-workflow-design-glossary.html">workflow definitions</a> have evolved since this 2010 version</i></span>.</span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF5BOuDk6ALzLsWdSti76BpTkFmf8VTeV0SWveKNKCESoIcttMkELRyXpW410I1Z4CtZoVvx6KnVUbUhfjLYoFVW8vt30AUdMFC-axKkh1vyRGCyYtYTE3meI0yWxwXmRHrJW2MYQoTyNvuRZ9rsac-uWAajYIcV-4XmBM5m5UPjqophqAgVoECXtvJQ/s1205/CMIOChecklist.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="619" data-original-width="1205" height="328" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF5BOuDk6ALzLsWdSti76BpTkFmf8VTeV0SWveKNKCESoIcttMkELRyXpW410I1Z4CtZoVvx6KnVUbUhfjLYoFVW8vt30AUdMFC-axKkh1vyRGCyYtYTE3meI0yWxwXmRHrJW2MYQoTyNvuRZ9rsac-uWAajYIcV-4XmBM5m5UPjqophqAgVoECXtvJQ/w640-h328/CMIOChecklist.jpeg" width="640" /></a></div><span style="font-family: helvetica; text-align: center;"><div style="text-align: center;"><span style="font-size: x-small;">[ <span style="color: red;">FIRST DRAFT</span> ] <span style="color: #2b00fe;"><i><b>Note</b> : My <a href="https://www.dirkstanley.com/2019/12/my-clinical-workflow-design-glossary.html">workflow definitions</a> have evolved since this 2010 version</i></span>.</span></div></span><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">... which turned out to be my first real foray into <b>clearly-defined <u>terms</u>, <u>tools</u>, and <u>functions</u></b>. Yes, a <b>sample size of <u>one</u></b> - based only on my own clinical and administrative experiences - but a fairly comprehensive <i><b><u>function-based</u></b></i> analysis, nonetheless, that helps to <b>clarify concepts</b> and <b>increase shared understanding</b>.</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dw0mvXxwGN-YmEkTdRS4jJFPqwfF2Sr-4Xu86A9s7k0uzZbf_zFjaGtXgUFmFnn9TKQM6GnEkfjye-wdydLhA' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div><div style="text-align: center;"><span style="font-family: helvetica; font-size: x-small;">(<span style="color: #2b00fe;"><i>What good, functional, policy-grade definitions do to <b>clarify</b> concepts</i></span></span></div><div style="text-align: center;"><span style="color: #2b00fe; font-size: x-small;"><i><span style="font-family: helvetica;">and <b>increase shared understanding</b> - </span><span style="font-family: helvetica;">Hit </span><b style="font-family: helvetica;">PLAY</b></i></span><span style="font-family: helvetica;"><span style="color: #2b00fe; font-size: x-small;"><i> to see animation</i></span>)</span></div></div><div><span style="font-family: helvetica;"><div style="text-align: center;"><br /></div></span></div><div><span style="font-family: helvetica;">Now with this new </span><i style="font-family: helvetica;"><b>function-based</b></i><span style="font-family: helvetica;"> analysis in hand, I stumbled into two interesting [</span><span style="color: red; font-family: helvetica;">DRAFT</span><span style="font-family: helvetica;">] </span><i style="font-family: helvetica;"><b>functional</b> definitions</i><span style="font-family: helvetica;"> : </span></div><div><b></b></div><blockquote><div><span style="font-family: times;"><span style="color: #38761d; font-size: medium;"><b>Template</b> (<i>n.</i>) - A tool used to standardize and expedite the creation of a</span><span style="color: #2b00fe; font-size: medium;"> <i><b>document</b></i>. </span></span></div><div></div></blockquote><div><span style="font-family: helvetica;">... and ...</span></div><div><span style="color: #2b00fe; font-family: helvetica; font-size: medium;"></span></div><blockquote><div><span style="color: #2b00fe; font-family: times; font-size: medium;"><b>Document</b> (<i>n.</i>) - A tool used to record and transmit <b>information</b>.</span></div><div></div></blockquote><div><span style="font-family: helvetica;">... both of which shed light on an important concept - For many of you, this may be common-sense or trivial, but for me it was a <b>'<i><a href="https://en.wikipedia.org/wiki/Eureka_(word)">eureka</a></i>' moment</b> : </span></div><div><span style="font-family: helvetica;"></span></div><div style="text-align: left;"><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b><span style="color: #bf9000;"><i>Definitions</i></span></b><b style="color: #2b00fe;"> </b>can be used to create<b><span style="color: #2b00fe;"> </span><span style="color: #38761d;"><i>templates</i></span><span style="color: #2b00fe;">.</span></b></span></li><li><span style="font-family: helvetica;"><b><span style="color: #38761d;"><i>Templates</i></span></b><span style="color: #2b00fe;"> </span>can be used to create<span style="color: #2b00fe;"> </span><b style="color: #2b00fe;"><i>documents</i></b><span style="color: #2b00fe;">.</span></span></li><li><span style="font-family: helvetica;"><span style="color: #2b00fe;"><b><i>Documents</i></b> </span>can be used to store and transmit the information needed to support<span style="color: #2b00fe; font-weight: bold;"> </span><span style="color: #800180; font-weight: bold;"><i>workflows</i></span><span style="color: #2b00fe; font-weight: bold;">.</span></span></li></ul></div><div></div><div><span style="font-family: helvetica;">So around 2015, this led me to the realization that <i><b>these concepts all <u>depend on each other</u></b></i>. </span><span style="font-family: helvetica;">And so, realizing that <i>workflow </i></span><i style="font-family: helvetica;">inconsistencies sometimes arise from misalignment of these concepts</i><span style="font-family: helvetica;">, I wrote this blog post about </span><a href="https://www.dirkstanley.com/2015/11/the-informatics-domain-and-workflow.html?m=1" style="font-family: helvetica;">workflow management and the Clinical Informatics domain</a><span style="font-family: helvetica;"> : </span></div><div><span style="font-family: helvetica;"><br /></span></div><div style="text-align: center;"><span style="font-family: helvetica; font-size: x-small;">[ <b>SCREENSHOT</b> ] From <a href="https://www.dirkstanley.com/2015/11/the-informatics-domain-and-workflow.html?m=1">Informatics Domain and Workflow Management</a>, 2015</span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXafWfwrBFcIFLhcULoiw3ZYdCSDAz9xKp_y7i6iNPskabFETHjrMTcZIxWPgrfXV8fAjTrl6N-p6WBT_hKkRPdXPt2cIUYWLT1Szk3ekMWX9qIGBpvhSckIPcdk1d1FazpTbPk0telu4oUuloxFkvpYmX8_q1HgBA5Wh5lokzEJ4LocKQqE03xuPLkw/s720/Operations%20Pyramid.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="720" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXafWfwrBFcIFLhcULoiw3ZYdCSDAz9xKp_y7i6iNPskabFETHjrMTcZIxWPgrfXV8fAjTrl6N-p6WBT_hKkRPdXPt2cIUYWLT1Szk3ekMWX9qIGBpvhSckIPcdk1d1FazpTbPk0telu4oUuloxFkvpYmX8_q1HgBA5Wh5lokzEJ4LocKQqE03xuPLkw/w400-h300/Operations%20Pyramid.jpeg" width="400" /></a><span style="font-family: helvetica; font-size: small;"> </span></div></div><p></p><div><span style="font-family: helvetica;">This also led me to the realization that all of the documents and tools contained in <span style="color: #2b00fe;">drawer #4 above</span> :</span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;">needed to be <b>aligned</b> with the <span style="color: #800180;">workflows</span>, <span style="color: #ff00fe;">goals</span>, and <span style="color: red;">mission</span> <i><u>above</u> it, </i>and... </span></li><li><span style="font-family: helvetica;">were <b>shaped by the concepts</b> contained in <span style="color: #38761d;">#5</span>, <span style="color: #f1c232;">#6</span>, <span style="color: #b45f06;">#7</span>, and <span style="color: red;">#8</span> <i><u>below</u> it</i>. </span></li></ul></div><div><span style="font-family: helvetica;">It also revealed to me that </span><span style="font-family: helvetica;">some of the <span style="color: #2b00fe;"><b>documents and tools</b></span> that support workflows are typically contained <b><span style="color: #cc0000;"><u>inside</u></span></b> the EMR, and others were contained <b><span style="color: #666666;"><u>outside</u></span></b> the EMR : </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX6N4n-XA_oNJWbXqSFt3W5STPuAZVfz96Zqu6KJd7uBo2PeiutnV5uSB_sUR6gPYc2xdxP9Sc0IkMU25HZVkt7ETDe_hsvj6hXu4BbQfXJ64U2pHsQ-aOEBI0flfQYXQ9CfY57VeGVf3GKyIUuk7AhNFxpad6cDg7jzjHJRQXfhbMWoDWdMPepZbJLg/s720/Workflow%20Development.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="720" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhX6N4n-XA_oNJWbXqSFt3W5STPuAZVfz96Zqu6KJd7uBo2PeiutnV5uSB_sUR6gPYc2xdxP9Sc0IkMU25HZVkt7ETDe_hsvj6hXu4BbQfXJ64U2pHsQ-aOEBI0flfQYXQ9CfY57VeGVf3GKyIUuk7AhNFxpad6cDg7jzjHJRQXfhbMWoDWdMPepZbJLg/w400-h300/Workflow%20Development.jpeg" width="400" /></a></div><br /><span style="font-family: helvetica;">So now being able to <b>mentally</b> <b>visualize</b> this conceptual structure (<i>above</i>), I also realized that : </span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><span style="color: #800180;"><b>Workflow</b></span> depends on <b><span style="color: #666666;"><u>all</u> of </span><span style="color: #990000;">these tools</span></b> (<i>above</i>) for support. </span></li><li><span style="font-family: helvetica;">Changing <span style="color: #800180;"><b>workflow</b></span> means changing <span style="color: #666666;"><b><u>all</u> of </b></span><span style="color: #990000;"><b>the tools</b></span> (<i>both <b><span style="color: #990000;">inside</span></b> and <span style="color: #666666;"><b>outside</b></span> the EMR</i>) that are used to support the <span style="color: #800180;"><b>workflow</b></span>.</span></li></ul></div><div><span style="font-family: helvetica;">... and so effective <span style="color: #800180;"><b>workflow change management</b></span> means : </span></div><div><ol style="text-align: left;"><li><span style="font-family: helvetica;"><b>Clearly understanding</b> each deliverable (<i>tool</i>) above.</span></li><li><span style="font-family: helvetica;"><b>Identifying the deliverables</b> (<i>both <span style="color: #990000;"><b>inside</b></span> and <span style="color: #666666;"><b>outside</b></span> the EMR</i>) that are needed (<i><span style="color: #2b00fe;">or need to change</span></i>) to support the <b>desired</b> <span style="color: #800180;"><b>workflow</b></span>. </span></li><li><span style="font-family: helvetica;"><b>Quickly drafting</b> those deliverables, to demonstrate to users and HealthIT professionals how the deliverables need to fit together,</span></li><li><span style="font-family: helvetica;">Reviewing those <b>draft</b> deliverables with clinical stakeholders, to confirm their needs/expectations <b>before</b> committing them to a formal build, and to help <b>get their input</b> and <b>align expectations</b>.</span></li></ol></div><div><span style="font-family: helvetica;">So to help quickly <b>draft the deliverables</b> in step #3 above, I had to quickly make <b><span style="color: #38761d;">templates</span></b> for these <b>roughly 24 documents</b> that we <i>commonly use in healthcare. </i>And this brought me back to my pursuit for <b><i>high-quality, high-grade</i> definitions</b> so that my workflow templates were <i>quick</i>, <i>easy-to-use</i>, and maybe most important - <b>functionally sound</b>. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">And this is essentially how I became a <b>document whisperer</b> for good clinical workflow design and EMR support. Using this deeper understanding of how these common concepts are related has helped me to <b>quickly draft</b> the '<i><b><span style="color: #2b00fe;">workflow blueprints</span></b></i>' that help to <b>outline workflows, identify deliverables, identify stakeholders, create clarity, develop understanding</b>, and <b>align expectations</b> <i><u>before</u></i> beginning a project. (<i>This understanding has proven especially useful when scoping/analyzing clinical project requests <b>prior to</b> approval</i>.)</span></div><div><span style="font-family: helvetica;"> </span></div><div><span style="font-family: helvetica;">I hope sharing this journey helps give you a roadmap for your own journey, and helps you develop your own definitions, templates, and tools for rapid workflow analysis and scoping before undertaking any significant projects. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><i>Remember this blog is for <b>educational purposes only</b> - <b>Your mileage may vary</b>. Have any anecdotes or stories to share about workflow analysis or development? Feel free to leave them in the comments section below!</i></span></div><div><span style="font-family: helvetica;"><i><br /></i></span></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com1tag:blogger.com,1999:blog-8434050931789572015.post-54257137557846460592022-05-31T01:04:00.006-04:002022-06-18T21:18:08.255-04:00A Tale of Applied Clinical #Informatics, in Four Parts<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, #HealthIT, and other Applied Clinical #Informatics friends,</i></span></p><p><span style="font-family: helvetica;">Today I'm writing today to share a <b>tale of Applied Clinical #Informatics</b>, <i>in <b>four parts</b></i>. </span><span style="font-family: helvetica;">(</span><span style="color: #2b00fe; font-family: helvetica;"><i>Or,</i> "<i>Why <b>workflow analysis, naming conventions</b>, <b>indexing</b>, and <b>usability</b> all <b><u>really do matter</u></b></i>."</span><span style="font-family: helvetica;">)</span></p><p><span style="font-family: helvetica;">Feel free to leave comments at the end - <i>Hope you enjoy it!</i></span></p><div style="text-align: left;"><span style="font-family: helvetica; font-size: large;"><u><b>1. PART ONE - </b></u></span></div><p><span style="font-family: helvetica;">"I'm sorry, I <span style="color: #cc0000;"><b style="background-color: #fcff01;">don't have time to talk</b></span> about <b>workflow analysis</b>, <b>naming conventions</b>, <b>indexing</b>, or <b>usability</b> - just give me <span style="color: #2b00fe;"><b><u>everything I need</u></b> in <b><u>one place</u></b>, <i>and</i> <b><i><u>quick</u></i></b></span>!!"</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4C0gIS8Na9E9mucKd2LLbjqXGb_WA4MHbDT7M4Q4kCGD5b9IxGSXrJmAomI9NQiLqmCRfMSf92w7h-BXbxrt6__q_9Z2ZdFFnpw3KLIXEiEm3FlLk7Tfu_ABus5olvtce1LUv6PyIKIPYgBBe9mvKzT7bQh6Yn3ujX5EPx9ZoI6Npphty5kmWAYba4w/s2048/IMG_1338.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1536" data-original-width="2048" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4C0gIS8Na9E9mucKd2LLbjqXGb_WA4MHbDT7M4Q4kCGD5b9IxGSXrJmAomI9NQiLqmCRfMSf92w7h-BXbxrt6__q_9Z2ZdFFnpw3KLIXEiEm3FlLk7Tfu_ABus5olvtce1LUv6PyIKIPYgBBe9mvKzT7bQh6Yn3ujX5EPx9ZoI6Npphty5kmWAYba4w/w640-h480/IMG_1338.JPG" width="640" /></a></div><br /><p></p><div style="text-align: left;"><span style="font-family: helvetica; font-size: large;"><u><b>2. PART TWO - </b></u></span></div><p><span style="font-family: helvetica;">"Wait, that's <b>not right,</b> <b><i>I can't use that</i></b>. I <span style="color: #cc0000;"><b>still don't have time to talk</b></span> about any of that workflow or usability stuff, but can you <span style="color: #2b00fe;">just <b>put <u>everything I need in one place</u></b> so I can <b><u>see it all</u></b></span> and <b>easily </b><span style="color: #2b00fe;"><b><u>access everything I need</u></b> with just <b><u>one click</u></b></span>?"</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOLNYP09OfVjeM6M_oZpYxtFyVBXE6UU2iq4M09a_rGLMEyL2DCocQN3_vMarrafOEagYhqeIkCkVIoSySqa46UlzhLS719Nurp_4iVwVU_mSnOOy152f-kAocMsviZgSp38XMp9q1XtjdgQ4QERpWq-QkveD2K2hWren2DmBCyxFevmPUxcSfBlOiug/s2048/IMG_1336.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="510" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOLNYP09OfVjeM6M_oZpYxtFyVBXE6UU2iq4M09a_rGLMEyL2DCocQN3_vMarrafOEagYhqeIkCkVIoSySqa46UlzhLS719Nurp_4iVwVU_mSnOOy152f-kAocMsviZgSp38XMp9q1XtjdgQ4QERpWq-QkveD2K2hWren2DmBCyxFevmPUxcSfBlOiug/s16000/IMG_1336.JPG" /></a></div><br /><p></p><div style="text-align: left;"><span style="font-family: helvetica; font-size: large;"><u><b>3. PART THREE - </b></u></span></div><p><span style="font-family: helvetica;">"Wait, that <b>still doesn't look right</b>, and I'm afraid I'm going to be <b><i>scrolling forever</i></b>. I <span style="color: #cc0000;"><b><span style="background-color: #fcff01;">still don't have the time to meet</span>,</b></span> but I heard there's <span style="color: #2b00fe;"><b><u>some tool</u> they use at <u>another organization</u> </b></span>- Can you just <b><span style="color: #2b00fe;">find out what tool <u>they use</u> to do this</span></b>, and then just <span style="color: #2b00fe;"><b>put <u>my stuff</u> into whatever <u>tool</u> <u>they use</u></b></span>?"</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiibMxXQjh48hRNextrTfomjj343XyjqWCxzehTAXljoTnFnJDSDpfg6nYqxQD4QFPDxVyDM81dbIbfHGw2zAA6QAesOX8Tfxzgb3HZn6ZIKC4a8wAHhzb1OqexAEoNFQ1rXh7Ji8n5XyzbEQGBkz8WCzDXedniMsQ4BxvHd2VrVr_lXLUbKY-IDNoMOQ/s2048/IMG_1335.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1536" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiibMxXQjh48hRNextrTfomjj343XyjqWCxzehTAXljoTnFnJDSDpfg6nYqxQD4QFPDxVyDM81dbIbfHGw2zAA6QAesOX8Tfxzgb3HZn6ZIKC4a8wAHhzb1OqexAEoNFQ1rXh7Ji8n5XyzbEQGBkz8WCzDXedniMsQ4BxvHd2VrVr_lXLUbKY-IDNoMOQ/w480-h640/IMG_1335.JPG" width="480" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div style="text-align: left;"><span style="font-family: helvetica; font-size: large;"><u><b>4. PART FOUR - </b></u></span></div><p><span style="font-family: helvetica;">"<b>OK, <i>wait... </i>I<i> think I see the problem</i></b>. Let's <b><span style="color: #38761d;"><span style="background-color: #fcff01;">make some time to talk</span> about </span><span style="color: #2b00fe;">workflow</span></b>, including <b><span style="color: #2b00fe;">exactly what these tools do - Both</span></b> <b><span style="color: #2b00fe;"><u>what</u> I use them for</span></b>, and <span style="color: #2b00fe;"><b><u>when</u> I use them</b></span>. Then let's talk about the <b><span style="color: #2b00fe;"><u>naming conventions and indexing</u></span></b> for each tool, so they all have a <b>standard look and feel</b>. Then let's talk about <b><span style="color: #2b00fe;"><u>usability</u></span></b>, so that I keep the <b>most commonly-needed tools in one place</b>, and the <b>less common tools in a <i><u>separate but nearby</u> </i></b><b><i>place</i></b>. And then finally <b><i><u>after you build it </u></i></b>- I'll help <b><span style="color: #2b00fe;"><u>test it</u></span></b> to make sure it's both <b>functional (</b><i><span style="color: #2b00fe;">what-we-need</span></i><b>)</b> and also <b><i>easy-to-use</i></b>."</span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDIKFy0Kj_H1rgooFDLd2AMSRuwdJEJBSAq_lbwpCWctdZk0y5kX8wn-oqRJ52AAX2UtpwA-iNm-hzDVXHFFaag06isYFv4L2ZhMO40hyUf59D2wxFafRtHumBlQlWuycTaWhkZqlI4EcCqdqciI_e4eqfXCIOi5iD9dpHzrV9RnvxYJ0iBVGG8dc72w/s2048/IMG_1337.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1536" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDIKFy0Kj_H1rgooFDLd2AMSRuwdJEJBSAq_lbwpCWctdZk0y5kX8wn-oqRJ52AAX2UtpwA-iNm-hzDVXHFFaag06isYFv4L2ZhMO40hyUf59D2wxFafRtHumBlQlWuycTaWhkZqlI4EcCqdqciI_e4eqfXCIOi5iD9dpHzrV9RnvxYJ0iBVGG8dc72w/w480-h640/IMG_1337.JPG" width="480" /></a></div><br /><span style="color: #2b00fe; font-family: helvetica;"><b><i>"<a href="https://en.wikipedia.org/wiki/Eureka_(word)">Eureka</a> - That's it!" </i></b></span><div><p></p><p><span style="font-family: helvetica;">[ <i>THE END</i> ] </span></p><p><span style="font-family: helvetica;"><i>Remember, this blog is for educational/discussion purposes only - <b>Your mileage may vary</b></i><b>.</b> <i>Have a good teaching example you'd like to share? Feel free to leave in the comments section below!</i></span></p></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com2tag:blogger.com,1999:blog-8434050931789572015.post-20346630553473361112022-05-01T18:37:00.002-04:002022-05-01T18:37:18.342-04:00Applied Clinical Informatics Progress Bar Video<div style="text-align: left;"><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, and other Applied Clinical #Informatics friends,</i></span></div><div style="text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div style="text-align: left;"><span style="font-family: helvetica;">I recently put together a quick animation, help tell the story of <b>Applied Clinical Informatics</b> in a short (<i>2 minute 38 second</i>) YouTube video.</span></div><div style="text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div style="text-align: left;"><span style="font-family: helvetica;">There's not much to say, other than it frames <b>one potential journey</b> - <i>from beginning to end</i> - and the progress that eventually leads to improved engagement, improved usability, improved return-on-investment, and <i>most importantly</i> - improved <b>patient care.</b> </span></div><div style="text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div style="text-align: left;"><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/mFL6WkPaog4" width="320" youtube-src-id="mFL6WkPaog4"></iframe></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><b>YouTube Link</b> : </span><span style="text-align: left;"><span style="font-family: helvetica;"><a href="https://youtu.be/mFL6WkPaog4">https://youtu.be/mFL6WkPaog4</a></span></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">At the end, the bar suddenly returns to the very beginning - Letting the viewer consider their own journey. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Feel free to share with anyone who's looking to better understand the Applied Clinical Informatics journey, and the many benefits it (<i>and <a href="https://twitter.com/hashtag/blueprintsbeforebuild" target="_blank">#BlueprintsBeforeBuild</a></i>) can bring. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>Remember - This blog is for academic and discussion purposes only - Your mileage may vary!</i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>Have any experience from your own journey that you would like to share? Feel free to leave in the comments section below!</i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i><br /></i></span></div></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com1tag:blogger.com,1999:blog-8434050931789572015.post-69348843674465644012022-03-27T22:51:00.003-04:002022-03-27T23:20:06.675-04:00Difference between Specialty, Service, Level-of-Care, and Location?<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, and other Applied Clinical Informatics and #HealthIT friends,</i></span></p><p><span style="font-family: helvetica;">In today's post, I thought I'd help answer a <b>common clinical terminology</b> question I sometimes get asked, about information management during inpatient hospitalizations : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqqGZUgRJnJMJl4rC4J64D5zwzxPq7hCwBFCWzkSeIRrBAA6ckmfgsm52v757S8S303B31E1rpcb6C9W_Sm23MJ0lSVBTtPJIRvtTeAvftfL5JAtwLbB2hCg33swkt8Rnun4UxhAowH-udXD-YonVZgOm3i-oAH8XX_e8t-DK5BNu2rDoUfHq1-suG1g/s1364/ClinicalTerminologyQuestion.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="550" data-original-width="1364" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqqGZUgRJnJMJl4rC4J64D5zwzxPq7hCwBFCWzkSeIRrBAA6ckmfgsm52v757S8S303B31E1rpcb6C9W_Sm23MJ0lSVBTtPJIRvtTeAvftfL5JAtwLbB2hCg33swkt8Rnun4UxhAowH-udXD-YonVZgOm3i-oAH8XX_e8t-DK5BNu2rDoUfHq1-suG1g/w640-h258/ClinicalTerminologyQuestion.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><span style="text-align: left;">I thought I'd write this post, largely because these </span><b style="text-align: left;">very impor</b><b style="text-align: left;">tant terms</b><span style="text-align: left;"> : </span></span></div><p></p><p></p><ol style="text-align: left;"><li><span style="font-family: helvetica;"><b><span style="color: #38761d;">Specialty</span> / <span style="color: #cc0000;">Subspecialty</span></b></span></li><li><span style="color: #800180; font-family: helvetica;"><b>Service</b></span></li><li><span style="font-family: helvetica; font-weight: bold;">(</span><span style="font-family: helvetica;"><i>Nursing</i></span><span style="font-family: helvetica; font-weight: bold;">)<span style="color: #e69138;"> Level-of-Care</span></span></li><li><span style="color: #2b00fe; font-family: helvetica;"><b>Geographic Location</b></span></li></ol><span style="font-family: helvetica;"><span>... can often </span><b>look alike </b><span>and </span><b>sound alike</b><span>, and so they are sometimes easily confused (</span><i>or used interchangeably</i><span>) by both clinical and administrative staff.</span></span><p></p><p><span style="font-family: helvetica;">Unfortunately, getting this terminology right is <b>essential to good communication, good patient flow</b>, <b>good bed management</b>, and <b>good data reporting</b> - So for clinical educational purposes, I figured I'd write this helpful primer on these terms, what they do, and how to use them. </span></p><p><span style="font-family: helvetica;"><span style="font-size: large;"><b>A. WHAT IS <span style="color: #38761d;">SPECIALTY</span> (</b><i>and <span style="color: #cc0000;">SUBSPECIALTY</span></i><b>)</b></span></span></p><p><span style="font-family: helvetica;">Specialty (and subspecialty) is what a Provider is <b>trained to do</b>. While the <b><a href="https://www.aamc.org/" target="_blank"><span style="color: #38761d;">Association of American Medical Colleges</span></a></b> (<i>AAMC</i>) recognized the need to <a href="https://www.aamc.org/who-we-are/aamc-history" target="_blank"><span style="color: #38761d;">stratify medical training back in 1876</span></a>, this <span style="color: #38761d;">specialty</span> (and <span style="color: #cc0000;"><i>subspecialty</i></span>) training has since <i>continued to <b>evolve</b></i>. </span></p><p><span style="font-family: helvetica;"><b>Today</b>, we recognize a number of :</span></p><p></p><ul style="text-align: left;"><li><span style="color: #38761d; font-family: helvetica;"><b>RESIDENCIES</b> (<i>SPECIALTY TRAINING</i>)</span></li><li><span style="color: #cc0000; font-family: helvetica;"><b>FELLOWSHIPS</b> (<i>SUBSPECIALTY TRAINING</i>)</span></li></ul><div><span style="font-family: helvetica;">...which together, gives us some of the physician <span style="color: #38761d;"><b>specialties</b></span> (<i>and <span style="color: #cc0000;"><b>subspecialties</b></span></i>) that most people will recognize today : </span></div><div><ul style="text-align: left;"><li><span style="color: #2b00fe; font-family: helvetica;"><i>Select ONE :</i></span></li><li><span style="font-family: helvetica;"><b><span style="color: #38761d;">( ) INTERNAL</span> <span style="color: #38761d;">MEDICINE</span></b> (<i><span style="color: #38761d;">General Internal Medicine</span></i>)</span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>INTERNAL MEDICINE</span> > <b><span style="color: #cc0000;">CARDIOLOGY</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>INTERNAL MEDICINE</span> > <b><span style="color: #cc0000;">ENDOCRINOLOGY</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>INTERNAL MEDICINE</span> > <b><span style="color: #cc0000;">GASTROENTEROLOGY</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>INTERNAL MEDICINE</span><b> </b>><b> <span style="color: #cc0000;">RHEUMATOLOGY</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>INTERNAL MEDICINE</span><b> </b>><b> </b><span style="color: #cc0000;"><b>GERONTOLOGY (</b><i>Geriatrics</i><b>)</b></span></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>INTERNAL MEDICINE</span><b> </b>><b> </b><span style="color: #cc0000; font-weight: bold;">PULMONARY/CRITICAL CARE</span></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>INTERNAL MEDICINE</span><b> </b>><b> </b><span style="color: #cc0000; font-weight: bold;">HEMATOLOGY / ONCOLOGY</span></span></li><li><span style="font-family: helvetica;"><b><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>PEDIATRICS</span> (</b><i><span style="color: #38761d;">General Pediatrics</span></i><b>)</b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>PEDIATRICS</span><b> > <span style="color: #cc0000;">EMERGENCY MEDICINE</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>PEDIATRICS</span><b> > <span style="color: #cc0000;">NEONATOLOGY</span></b></span></li><li><span style="font-family: helvetica;"><b><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>EMERGENCY MEDICINE</span></b> (<span style="color: #38761d;"><i>General emergency medicine</i></span>)</span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>EMERGENCY MEDICINE</span> > <b><span style="color: #cc0000;">TRAUMATOLOGY</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>EMERGENCY MEDICINE</span> > <b><span style="color: #cc0000;">TOXICOLOGY</span></b></span></li><li><span style="font-family: helvetica;"><b><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>RADIOLOGY</span></b> (<span style="color: #38761d;"><i>General Radiology</i></span>)</span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>RADIOLOGY</span> > <b><span style="color: #cc0000;">INTERVENTIONAL</span></b></span></li><li><span style="font-family: helvetica;"><b><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>SURGERY</span></b> (<i><span style="color: #38761d;">General Surgery</span></i>)</span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>SURGERY</span> > <b><span style="color: #cc0000;">ORTHOPEDICS</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>SURGERY</span> > <b><span style="color: #cc0000;">PLASTIC SURGERY</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>SURGERY</span> > <b><span style="color: #cc0000;">NEUROSURGERY</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>SURGERY<b> > </b></span><span style="color: #cc0000; font-weight: bold;">TRANSPLANT</span></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>SURGERY<b> > </b></span><span style="color: #cc0000; font-weight: bold;">GYNECOLOGIC</span></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>SURGERY<b> > </b></span><span style="color: #cc0000; font-weight: bold;">VASCULAR</span></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d; font-weight: bold;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>NEUROLOGY (</span><span style="color: #38761d;"><i>General Neurology</i></span><span style="color: #38761d; font-weight: bold;">)</span></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>NEUROLOGY<b> > </b></span><span style="color: #cc0000; font-weight: bold;">MOVEMENT DISORDERS</span></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>NEUROLOGY</span><b><span style="color: #38761d;"> > </span><span style="color: #cc0000;">MULTIPLE SCLEROSIS</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d; font-weight: bold;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>OBGYN (</span><span style="color: #38761d;"><i>General OBGYN</i></span><span style="color: #38761d; font-weight: bold;">)</span></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>OBGYN</span><b><span style="color: #38761d;"> > </span><span style="color: #cc0000;">MATERNAL FETAL MEDICINE</span></b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>OBGYN</span><b style="color: #38761d;"> > </b><b><span style="color: #cc0000;">FERTILITY MEDICINE</span></b></span></li><li><span style="font-family: helvetica;"><b style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>PSYCHIATRY (</b><i><span style="color: #38761d;">General Psychiatry</span></i><b style="color: #38761d;">)</b></span></li><li><span style="font-family: helvetica;"><span style="color: #38761d;"><b style="color: black;"><span style="color: #38761d;">( ) </span></b>PSYCHIATRY</span><b><span style="color: #38761d;"> > </span><span style="color: #cc0000;">CHILD AND ADOLESCENT</span></b></span></li></ul><div><span style="font-family: helvetica;">... and<span style="color: #38761d;"> <a href="https://www.aamc.org/cim/explore-options/specialty-profiles" target="_blank"><span style="color: #38761d;">over 135 other specialties/subspecialties currently recognized by the AAMC</span></a></span>.</span></div><div><blockquote><span style="font-family: helvetica;"><b>Note</b> : While there may be some <b>occasional variation</b> about how one ended up in a particular <span style="color: #cc0000;">subspecialty</span> (<i>e.g. <b><span style="color: #38761d;">Pediatrics</span>><span style="color: #cc0000;">Emergency Medicine</span></b>, or <b><span style="color: #38761d;">Emergency Medicine</span>><span style="color: #cc0000;">Pediatrics</span></b></i>), <i>historically - </i>this system of categorization has generally worked <b>fairly well</b>, and gives people a good sense of <span style="color: #38761d;"><b>what training</b> the provider has had</span>. </span></blockquote></div><div><span style="font-family: helvetica;">The key take-home point : <i><span style="color: #38761d; font-weight: bold;">Specialty</span><b>/</b><span style="color: #cc0000; font-weight: bold;">Subspecialty</span><b> training </b>is <b>what the provider has been </b><u style="font-weight: bold;">clinically <span style="color: #38761d;">trained</span> and licensed to do</u></i>.</span></div></div><div><span style="font-family: helvetica;"><br /></span></div><p></p><p><span style="font-family: helvetica;"><b><u><span style="font-size: large;">B. WHAT IS A <span style="color: #741b47;">SERVICE</span>?</span></u></b></span></p><p><span style="font-family: helvetica;"><span style="color: #741b47;"><b>Service</b> is what the provider <b><i><u>actually does</u></i></b></span>. It'stypically <b>one-or-more <span style="color: #741b47;">clinical function(s)</span></b><span style="color: #741b47;"> </span>that they have been assigned to <b><i><span style="color: #800180;">deliver</span></i></b>.</span></p><p><span style="font-family: helvetica;"><b><span style="color: #741b47;">Services</span></b> are commonly categorized as either <span style="color: #741b47;">INPATIENT, ED, or OUTPATIENT services</span>, and again, a <span style="color: #741b47;">provider may function in <b>one or more</b> <b>services</b></span> : </span></p><p></p><ul style="text-align: left;"><li><span style="color: #2b00fe; font-family: helvetica;"><i>Select ALL THAT APPLY : </i></span></li><li><span style="font-family: helvetica;"><span style="color: #741b47;">[ ] <b>OUTPATIENT Internal Medicine</b> (</span><i><span style="color: #741b47;">Ambulatory Internal Medicine Clinic</span></i><span style="color: #741b47;">)</span></span></li><li><span style="font-family: helvetica;"><span style="color: #741b47;">[ ] <b>INPATIENT Hospitalist</b></span></span></li><li><span style="font-family: helvetica;"><span style="color: #741b47;">[ ] <b>INPATIENT Intensivist</b></span></span></li><li><span style="font-family: helvetica;"><span style="color: #741b47;">[ ] <b>INPATIENT Labor and Delivery</b></span></span></li><li><span style="font-family: helvetica;"><span style="color: #741b47;">[ ] <b>OUTPATIENT Psychiatry</b></span></span></li><li><span style="font-family: helvetica;"><span style="color: #741b47;">[ ] <b>INPATIENT Psychiatry</b></span></span></li><li><span style="font-family: helvetica;"><span style="color: #741b47;">[ ] <b>EMERGENCY MEDICINE</b> (</span><span style="color: #741b47;"><i>Emergency Services</i></span><span style="color: #741b47;">)</span></span></li><li><span style="color: #741b47; font-family: helvetica;">[ ] <b>INPATIENT Neurology</b></span></li><li><span style="color: #741b47; font-family: helvetica;">[ ] <b>OUTPATIENT Neurology</b> (</span><span style="color: #741b47; font-family: helvetica;"><i>Ambulatory Neurology Clinic</i></span><span style="color: #741b47; font-family: helvetica;">)</span></li><li><span style="color: #741b47; font-family: helvetica;">[ ] <b>INPATIENT Surgery </b></span></li><li><span style="color: #741b47; font-family: helvetica;">[ ] <b>OUTPATIENT Surgery</b> (</span><span style="color: #741b47; font-family: helvetica;"><i>Ambulatory Surgery Clinic</i></span><span style="color: #741b47; font-family: helvetica;">)</span></li></ul><p></p><p><span style="font-family: helvetica;">... and <b>many other <span style="color: #741b47;">clinical services</span> (</b><i><span style="color: #741b47;">functions</span></i><b>)</b> that have been designed to <b>provide patient care services</b> in <i>various settings</i>. </span></p><p><span style="font-family: helvetica;">This is where <b>confusion</b> can sometimes arise, especially for scenarios where a <b>provider</b> might have <b><span style="color: #38761d;">one specialty</span></b> but <b><span style="color: #800180;">two services</span></b>, e.g. : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b><span style="color: #38761d;">SPECIALTY</span>/<span style="color: #cc0000;">SUBSPECIALTY</span></b> = <span style="color: #38761d;">INTERNAL MEDICINE (<i>General Internal Medicine</i>)</span></span></li><li><span style="color: #741b47; font-family: helvetica;"><b>SERVICE1 (</b><i>Primary Service</i><b>) </b>= OUTPATIENT INTERNAL MEDICINE (General Internal Medicine)</span></li><li><span style="color: #741b47; font-family: helvetica;"><b>SERVICE2 (</b><i>Secondary Service</i><b>) </b>= INPATIENT HOSPITALIST</span></li></ul><p></p><p><span style="font-family: helvetica;">Confusing <b><span style="color: #38761d;">specialty</span></b> and <b><span style="color: #741b47;">service</span></b> can lead to <b>incorrect scheduling of meetings</b> - E.g. Let's say you want to introduce a <b>new outpatient televideo service</b> to your <b><span style="color: #741b47;">OUTPATIENT INTERNAL MEDICINE</span></b> docs, then : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">[ <span style="background-color: #d9ead3;">WRONG WAY</span> ] Mail to <b><span style="color: #38761d;">SPECIALTY</span></b> = <span style="color: #38761d;"><b>Internal Medicine (</b><i>'Please mail this to <b><u>all Internal Medicine Docs</u>!</b>'</i><b>)</b></span></span></li><li><span style="font-family: helvetica;">[ <span style="background-color: #d9d2e9;">RIGHT WAY</span> ] Mail to <b><span style="color: #741b47;">SERVICE</span></b> = <span style="color: #741b47;"><b>Outpatient Internal Medicine (</b><i><b>'</b>Please mail this to<b> <u>all docs who work in the Outpatient Internal Medicine Clinic/Service!</u>'</b></i><b>)</b></span></span></li></ul><p></p><p><span style="font-family: helvetica;">If you accidentally <b>did</b> mail your announcement to <span style="color: #38761d;"><b>SPECIALTY = Internal Medicine</b></span>, then half of the recipients might wonder why you contacted them about this new <b>outpatient</b> tool : </span></p><p></p><ul style="text-align: left;"><li><span style="color: #38761d; font-family: helvetica;"><u><b>SPECIALTY = INTERNAL MEDICINE</b> - <i>Includes both</i> : </u></span></li><li><span style="color: #741b47; font-family: helvetica;">[ INTENDED AUDIENCE ] <b>SERVICE</b> = Outpatient Internal Medicine</span></li><li><span style="color: #741b47; font-family: helvetica;">[ UNINTENDED AUDIENCE ] <b>SERVICE</b> = Inpatient Hospitalist</span></li></ul><p></p><p><span style="font-family: helvetica;">As you can see, it's <b>very easy to get tripped up</b> on this terminology, when it <b>looks <i>so similar</i></b>. </span></p><p><span style="font-family: helvetica;">One final note about <b><span style="color: #741b47;">SERVICE</span></b> - This is often used during inpatient admissions to <span style="color: #741b47;">describe the "<b>Admitting/Covering Service</b>"</span>, as in, <b><span style="color: #741b47;">who</span></b> should Nursing call when they <span style="color: #741b47;">identify something that needs a Physician's attention</span>?</span></p><p><span style="font-family: helvetica; font-size: large;">C. WHAT IS A (<i>Nursing</i>) <b><span style="color: #b45f06;">LEVEL-OF-CARE</span></b></span></p><p><span style="font-family: helvetica;">The (<i>Nursing</i>) <b><span style="color: #b45f06;">Level-of-Care</span></b> is an important concept that basically answers the question, "<i>What are the <b><span style="color: #b45f06;"><u>nursing standards</u></span></b> that are required for a patient admitted in this hospital bed?</i>" Typically, this is based on <span style="color: #b45f06;"><b>patient type and acuity</b></span>, and is developed in conjunction with both Nursing Leadership and Physician Leadership. From a practical standpoint, this usually needs to include some agreements about : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b><span style="color: #b45f06;">Patient Acuity</span></b> - <i>How active are the patient's medical problems, and how much care will they need? (Low/Medium/High?)</i></span></li><li><span style="font-family: helvetica;"><b><span style="color: #b45f06;">Standard Frequency of Vitals</span></b> - <i>How often does a Nurse need to monitor the patient?</i></span></li><li><span style="font-family: helvetica;"><b><span style="color: #b45f06;">Standard Nursing Skill Set</span></b> - <i>What are the Nurses trained/certified to do? Is it general care, or specialty care? On what patient population? Adults? Pediatric? Neonates?</i></span></li><li><span style="font-family: helvetica;"><b><span style="color: #b45f06;">Standard Nurse Staffing Ratios</span></b> - <i>How many patients are Nurses routinely expected to manage concurrently for this <b><span style="color: #b45f06;">Level-of-Care</span></b>?</i></span></li></ul><p></p><p><span style="font-family: helvetica;">Because these are all important to establish a <span style="color: #b45f06;"><b>level-of-care</b></span>, they are commonly laid out in a table that <i>might</i> look something like this : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi309bU1sakhXfJkOxJBwGtv5a8z9rgfvoaYa4u4v6wa_7AG8c_99CBTP6doOclt1WpwIpjzOMxdBY3jzM8xTZo-_VIzuJI-JsriPR6gjoCQcHd_xRrEABg9CLvf9dmPxO_hs4OCuQMF36kF-jr7u94EjOUZZ0LY7WnOG285XhEOoQiv6u6pRvNVwRFA/s1598/Inpt%20Levels%20of%20Care.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="700" data-original-width="1598" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgi309bU1sakhXfJkOxJBwGtv5a8z9rgfvoaYa4u4v6wa_7AG8c_99CBTP6doOclt1WpwIpjzOMxdBY3jzM8xTZo-_VIzuJI-JsriPR6gjoCQcHd_xRrEABg9CLvf9dmPxO_hs4OCuQMF36kF-jr7u94EjOUZZ0LY7WnOG285XhEOoQiv6u6pRvNVwRFA/w640-h280/Inpt%20Levels%20of%20Care.png" width="640" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><span style="font-family: helvetica;">So to help standardize care along the <b>needs of the patient</b> (<i>and <b>patient acuity</b></i>), most <b>admission order sets</b> are aligned along these <b><span style="color: #e69138;">Nursing Levels-of-Care</span></b>, with vitals that default to the institutional standards - E.g. :</span><p></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;"><u>ADMIT TO <b><span style="color: #e69138;">ADULT MED/SURG</span></b> : </u></span></li><li><span style="font-family: helvetica;">[ ] Vital Signs every <b>8 hours</b></span></li><li><span style="font-family: helvetica;">[ ] Vital Signs every <b>6 hours</b></span></li></ul><div><span style="font-family: helvetica;">... and ...</span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><u>ADMIT TO <b><span style="color: #e69138;">ADULT ICU</span></b></u></span></li><li><span style="font-family: helvetica;">[ ] Vital Signs <b>every 1 hour</b></span></li><li><span style="font-family: helvetica;">[ ] Vital Signs <b>continuously</b></span></li></ul><div><span style="font-family: helvetica;">... and so on. </span></div></div><p></p><p><span style="font-family: helvetica; font-size: large;">D. WHAT IS A <span style="color: #2b00fe;"><b>GEOGRAPHIC LOCATION</b>?</span></span></p><p><span style="font-family: helvetica;"><b><span style="color: #2b00fe;">Geographic location</span></b> technically <b>should</b> be the <i>easiest concept to manage</i> - It's just the <span style="color: #2b00fe;">floor/room</span> (<span style="color: #2b00fe;"><i>and sometimes bed slot, E.g. Bed A or Bed B</i>)</span> that the patient's bed is <span style="color: #2b00fe;">geographically located in</span>. Sometimes it also includes a <span style="color: #2b00fe;">temporary location</span>, such as when a patient is being temporarily located in Radiology for an X-ray :</span></p><p></p><ul style="text-align: left;"><li><span style="color: #2b00fe; font-family: helvetica;"><b>Geographic Location</b> = <b>Room 401 </b></span></li><li><span style="color: #2b00fe; font-family: helvetica;"><i><b>Temporary Location</b> = Radiology</i></span></li><li><span style="color: #2b00fe; font-family: helvetica;">Sometimes displayed as "<b>Room 401</b> (<i>Radiology</i>)"</span></li></ul><p></p><p><span style="font-family: helvetica;">However, <span style="color: #2b00fe;">location</span> can occasionally be confused with a (<i>Nursing</i>) <b><span style="color: #bf9000;">Level of Care</span></b>, especially when <b>naming conventions </b>sometimes<b> <span style="color: #2b00fe;">combine</span> <span style="color: #b45f06;">these concepts</span></b>, usually intended for <b>convenience purposes</b>. (E.g. "<span style="color: #2b00fe;"><b>5th Floor</b></span> <span style="color: #bf9000;"><b>Telemetry</b></span>")</span></p><p><span style="font-family: helvetica;">Note that there are <b>two challenges</b> that can sometimes occur when <span style="color: #2b00fe;"><b>combining</b></span> <span style="color: #bf9000;"><b>these concepts</b></span> in the <b>naming convention</b> for your <span style="color: #2b00fe;"><b>geographic locations/floors : </b></span></span></p><p><span style="font-family: helvetica;">1. <b>FIRST CHALLENGE</b> : The first of these challenges is <b>boarding -</b> which is when a patient bed needs to be created in a <i>non-standard location</i>, usually for <b>patient flow</b> and/or <b>surge</b> purposes. For example<b> -</b> </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">If you usually have <b>ten</b> (<b>10) beds on your <span style="color: #2b00fe;">FOURTH floor</span></b>, where you commonly care for up to <b>ten (10) </b><span style="color: #b45f06; font-weight: bold;">Med/Surg patients</span>...</span></li><li><span style="font-family: helvetica;">One day, you have a patient <b>surge</b>, and need to be able to care for <b>twelve (12) </b><b><span style="color: #b45f06;">Med/Surg patients...</span></b></span></li><li><span style="font-family: helvetica;">... then you will need to create <b>two (2)</b> extra <b><span style="color: #b45f06;">Med/Surg beds</span></b>, maybe on the <span style="color: #2b00fe;"><b>FIFTH floor</b></span>. </span></li></ul><p></p><p><span style="font-family: helvetica;">Assuming you are approved to '<i>surge</i>' your bed capacity like this, and have the <span style="color: #b45f06;"><b>Med/Surg nurses</b></span> available to support those two (2) extra <b><span style="color: #b45f06;">Med/Surg beds</span></b> on the <b><span style="color: #2b00fe;">FIFTH floor</span></b>, then you can hypothetically create a bed with a <span style="color: #b45f06;"><b>defined (</b><i>Nursing</i><b>) level-of-care</b></span> in <b><span style="color: #2b00fe;">any geographic location</span></b> that can support the delivery of the necessary <span style="color: #b45f06;">(<i>Nursing</i>) </span><b><span style="color: #b45f06;">level-of-care</span></b>. </span></p><p><span style="font-family: helvetica;">For example, in an <b>disaster scenario</b>, you could <i>hypothetically</i> make a <b><span style="color: #b45f06;">med/surg bed</span></b> available in your <span style="color: #2b00fe;"><b>cafeteria</b></span> (<i>assuming you had the available resources</i>) : </span></p><p></p><ul style="text-align: left;"><li><span style="color: #b45f06; font-family: helvetica;"><b>ADMIT TO = Med/Surg</b> <i>Level-of-care</i></span></li><li><span style="color: #2b00fe; font-family: helvetica;"><b>GEOGRAPHIC LOCATION</b> = CAFETERIA Bed 2</span></li><li><span style="color: #741b47; font-family: helvetica;"><b>SERVICE</b> = Inpatient Hospitalist</span></li></ul><p></p><p><span style="font-family: helvetica;">Or, if you are admitting a <span style="color: #b45f06;"><b>Med/Surg Patient</b></span> from the <span style="color: #2b00fe;"><b>Emergency Room</b></span> to your <b><span style="color: #2b00fe;">FOURTH floor</span></b> (<i>where you commonly care for <span style="color: #b45f06;">Med/Surg patients</span></i>) - If there is <b>no bed available</b> on the <span style="color: #2b00fe;"><b>FOURTH floor</b></span>, you you could hypothetically <b>admit and </b>'<b>board'</b> the <span style="color: #b45f06;"><b>Med/Surg patient</b></span> (<i>temporarily</i>) in an <span style="color: #2b00fe;"><b><u>Emergency Department</u> </b></span>location : </span></p><p></p><ul style="text-align: left;"><li><span style="color: #b45f06; font-family: helvetica;"><b>ADMIT TO = Med/Surg</b> <i>Level-of-Care</i></span></li><li><span style="color: #2b00fe; font-family: helvetica;"><b>GEOGRAPHIC LOCATION</b> = ED Bed 2</span></li><li><span style="color: #800180; font-family: helvetica;"><b>SERVICE</b> = Inpatient Hospitalist</span></li></ul><div><span style="font-family: helvetica;">... and then once the bed becomes available on the <span style="color: #2b00fe;"><b>FOURTH floor</b></span>, you could <b>update</b> the status: </span></div><p></p><ul><li><span style="color: #b45f06; font-family: helvetica;"><b>ADMIT TO = Med/Surg</b> <i>Level-of-Care</i></span></li><li><span style="color: #2b00fe; font-family: helvetica;"><b>GEOGRAPHIC LOCATION</b> = Fourth Floor Bed 401</span></li><li><span style="color: #800180; font-family: helvetica;"><b>SERVICE</b> = Inpatient Hospitalist</span></li></ul><div></div><p></p><div><span style="font-family: helvetica;">As you can see, keeping this terminology <b>clear and concise</b> is important for the delivery of services. </span></div><p></p><p><span style="font-family: helvetica;">2. <b>SECOND CHALLENGE</b> : The second challenge that comes from naming conventions that <b><span style="color: #2b00fe;">combine</span></b> <b><span style="color: #b45f06;">concepts</span></b> (e.g. "<b><span style="color: #2b00fe;">FOURTH Floor</span></b> <span style="color: #b45f06;"><b>Med/Surg</b></span>") is <b>data-reporting</b>. Suppose that when beds are needed - you </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">sometimes have to board <span style="color: #b45f06;"><b>MED/SURG patients</b></span> on your <span style="color: #2b00fe;"><b>FIFTH floor</b></span>, or </span></li><li><span style="font-family: helvetica;">sometimes you have to board <span style="color: #b45f06;"><b>TELEMETRY patients</b></span> on your <span style="color: #2b00fe;"><b>FOURTH floor.</b></span></span></li></ul><p></p><p><span style="font-family: helvetica;">And then one day, you need to know, "<i>How many <span style="color: #b45f06;"><b>Med/Surg patients</b></span> did we see last month?</i>"</span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">If you generate a report of '<b>How many patients were <span style="color: #2b00fe;">geographically</span> admitted to the <span style="color: #2b00fe;">FOURTH floor</span></b>', you may <b>miss</b> any <span style="color: #b45f06;"><b>Med/Surg patients</b></span> who were boarded in <span style="color: #2b00fe;"><b>other locations</b></span>, or <b>over-count</b> other <span style="color: #b45f06;"><b>telemetry patients</b></span> who might have been temporarily boarded on the <b><span style="color: #2b00fe;">FOURTH floor</span></b>.</span></li><li><span style="font-family: helvetica;">If, instead, you generate a report of '<b>How many patients were admitted with a <span style="color: #b45f06;">Level-of-Care=Med/Surg</span></b>", your report will be accurate and will account for any patients who were <b>temporarily boarded</b> in <i>non-standard locations</i>.</span></li></ul><div><span style="font-family: helvetica;">If this all <i>seems</i> <b>confusing</b>, <i>you're not alone</i>. Even seasoned professionals can sometimes confuse/interchange these terms. It's helpful to have an experienced <b>Clinical Leader</b>, <b>Bed Manager</b>, <b>HIM/Billing/Coding</b> person, or <b>Applied Clinical Informatics</b> person to help <b>translate/validate, </b>help<b> </b>design your bed management and patient flow strategy, and then help turn that into build/configuration that meets the needs of your <b>patients</b>, <b>Nurses</b>, <b>Physicians</b>, <b>Bed Managers</b>, <b>Billers/Coders</b>, and <b>Data Reporting teams</b>. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><b>In conclusion</b> - These terms are all very important, and are the reason <b>most hospital admissions</b> contain the following information : </span></div><div><ul style="text-align: left;"><li><span style="color: #b45f06; font-family: helvetica;">[ <b>REQUIRED</b> ] <b>ADMIT TO</b> = ________ (<i>Nursing</i>) <i>Level-of-care</i></span></li><li><span style="color: #741b47; font-family: helvetica;">[ <b>REQUIRED</b> ] <b>SERVICE</b> = ___________</span></li><li><span style="font-family: helvetica;">[<span style="color: #2b00fe;"> <b>OPTIONAL</b> ] <b>GEOGRAPHIC LOCATION</b>=(<i>Use <b>only</b> if a particular location is necessary, otherwise Nursing may <b>not have any flexibility</b> about <b>where</b> to geographically locate the patient in a <b>surge/boarding</b> scenario.</i>)</span></span></li></ul></div><p></p><p><span style="font-family: helvetica;">... and why it's also helpful to <b>track doctors</b> by both their <span style="color: #38761d;"><b>specialty</b></span>/<span style="color: red;"><b>subspecialty</b></span> and also their <span style="color: #741b47;"><b>service(s)</b></span> : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b style="color: #38761d;">SPECIALTY</b><span style="color: #38761d;">/</span><b><span style="color: red;">SUBSPECIALTY</span></b><span style="color: #38761d;"> = <b>Internal Medicine</b> (</span><i style="color: #38761d;">General Internal Medicine</i><span style="color: #38761d;">)</span></span></li><li><span style="color: #800180; font-family: helvetica;"><b>SERVICE1</b> (<i>Primary Service</i>) = Inpatient Hospitalist</span></li><li><span style="color: #800180; font-family: helvetica;"><b>SERVICE2</b> (<i>Secondary Service</i>) = Outpatient General Internal Medicine</span></li></ul><p></p><p><span style="font-family: helvetica;">While this may have been somewhat lengthy, I hope this helps you review and discuss this terminology with your own teams. </span></p><p><span style="font-family: helvetica;"><i>Remember, this blog is for <b>academic/discussion purposes</b> only - <b>Your mileage may vary</b>! Have any patient flow or bed management tips you'd like to share? Have any experiences managing this terminology with your teams, or any other feedback you'd like to share? Leave it in the comments section below!</i></span></p>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-72277437792888654772022-03-19T14:06:00.010-04:002022-03-20T13:00:42.797-04:00What Multicultural, Bilingual Clinical Informaticists Know<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, Clinical Informaticists, and other HealthIT friends,</i></span></p><p><span style="font-family: helvetica;"><span>Can growing up in a <b>multicultural, bilingual</b> (<i>or polylingual</i>) household help to prepare you for a career in Applied <b>Clinical Informatics</b>? In today's post, </span>I'll explain why I believe the answer to this is "<i>Yes</i>".</span></p><p><span style="font-family: helvetica;">Almost all of my Applied Clinical Informatics colleagues that I've met over the years have </span><b style="font-family: helvetica;">amazing educational and experiential backgrounds</b><span style="font-family: helvetica;">. However, I've noticed that a surprising number of them also come from <b>multicultural backgrounds,</b> where they grew up speaking </span><b style="font-family: helvetica;">multiple languages. </b></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/a/AVvXsEihnV3qB1v6oQeVK4AZGvj31PbpzCeJ5KN4DmdwnIz-m7utXF7iSj4VhsDhrr87f87f4VWrow8xt1Y2-mnsdexYaRRRb3-0nDhhoJtKl3Yc2roXyvSaLOXuaXfBWJL1LfkaGHy-59MS9TTOaNhwNgLWiTUTrl_Y2JNP9SCNA4wJiaaegXRUmmtl_57jWA=w640-h360" width="640" /></span></div><p></p><p><span style="font-family: helvetica;"><i>In full disclosure</i> : <b>I don't have great data to support this claim</b>. And I might be biased (<i>or more sensitive</i>) to this issue because I grew up in a polylingual household myself, the son of a <b>German immigrant mother</b> and a <b>polyglot American father</b>, who counted <b>German</b> as one of this favorite and most fluent languages. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEiy5Y0nd0Fpu3pVjREG8kBKAUYphQs9lhFFCYr1LdiBPDmC8Bq2wyMacfRcEOLpCRxdvaS1kGeUBWwQo86qNt-N7EJzljnYR9QWTUTrPVuaOacdP0qntZDdUndk_G_RDzKGfVOhyXOI228CC7Uj1rsbGmTwr6GF2iYMCgjoCn1J75IdoPmCaEzFAEKEaA=s1308" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1308" data-original-width="1039" height="200" src="https://blogger.googleusercontent.com/img/a/AVvXsEiy5Y0nd0Fpu3pVjREG8kBKAUYphQs9lhFFCYr1LdiBPDmC8Bq2wyMacfRcEOLpCRxdvaS1kGeUBWwQo86qNt-N7EJzljnYR9QWTUTrPVuaOacdP0qntZDdUndk_G_RDzKGfVOhyXOI228CC7Uj1rsbGmTwr6GF2iYMCgjoCn1J75IdoPmCaEzFAEKEaA=w159-h200" width="159" /></a><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgWwtZh9Q-M-W-JjDTgsreMX0_rFcAxsg_3ha48-ZAnhU3RZgnVFYfcT3H10Sadc-uX__rSxupyt2t1Dh6mrf0WVvmkH4UqPkjSGPYbIz8xveSG3TfUXxL6jijqAPGrFLuoKiZ-FdU2eZ9S5ozyTrJYkm4y4eqXEmYpXevIkHZW5n_MjEoo3MrC8yTjdg=s3996" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3996" data-original-width="2736" height="200" src="https://blogger.googleusercontent.com/img/a/AVvXsEgWwtZh9Q-M-W-JjDTgsreMX0_rFcAxsg_3ha48-ZAnhU3RZgnVFYfcT3H10Sadc-uX__rSxupyt2t1Dh6mrf0WVvmkH4UqPkjSGPYbIz8xveSG3TfUXxL6jijqAPGrFLuoKiZ-FdU2eZ9S5ozyTrJYkm4y4eqXEmYpXevIkHZW5n_MjEoo3MrC8yTjdg=w137-h200" width="137" /></a></span></div><div class="separator" style="clear: both; text-align: center;"><i><span style="font-family: helvetica;"><b>Left</b> : My father during his US military servjce.</span></i></div><div class="separator" style="clear: both; text-align: center;"><i><span style="font-family: helvetica;"><b>Right</b> : My American father and German immigrant mother, circa 1965. </span></i></div><p><span style="font-family: helvetica;">My father's passion for languages started as a high school student in <a href="https://en.wikipedia.org/wiki/Yonkers,_New_York" target="_blank">Yonkers, NY</a>, and would continue to develop until he became a Military Policeman (MP) for the US Army, in Germany, where he also served as a<b> court interpreter</b>. This would also eventually lead him to <b>meet my mother</b> (<i>who had immigrated from <a href="https://en.wikipedia.org/wiki/Herford" target="_blank">Herford, Germany</a> to <a href="https://en.wikipedia.org/wiki/Westchester_County%2C_New_York" target="_blank">Westchester County, NY</a></i>), and to a <b>future career as a high school language teacher </b>at <b>White Plains High School </b>in White Plains, NY.</span></p><p><span style="font-family: helvetica;">So with parents like these, I grew up in a <b>multicultural, multilingual household</b>, where we commonly spoke German at home, and then spoke English when other people came to visit our house. Vacations were often spent visiting relatives in Germany, immersed in German language and culture, before returning to America and resuming daily activities in English.</span></p><p><span style="font-family: helvetica;">Given my father's interpreter experiences, he always took languages and translation <i>very seriously</i>. Growing up outside of NYC in the 1970s and 1980s, he would occasionally take me into the city to the <a href="https://en.wikipedia.org/wiki/United_Nations">United Nations</a>, to learn about and watch the famous <a href="http://clearwordstranslations.com/language/en/7-interesting-facts-about-un-interpreters/">UN Interpreter pool</a> at work. Over our dinner table, we would often discuss the <b>inseparable bond</b> between <b>culture and language</b>, the real <b>responsibilities</b> of professional interpreters, and the occasional <b>fallibility</b> of both written and spoken words. </span></p><p><span style="font-family: helvetica;">This sort of cross-cultural upbringing led me to some frequent challenges, that <b>most multicultural people can probably relate to </b>: </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">Having to explain "<i>American things</i>" to my German family<b>.</b></span></li><li><span style="font-family: helvetica;">Having to explain "<i>German things</i>" to my American friends.</span></li><li><span style="font-family: helvetica;">Occasionally having to do <b>real-time interpretation</b> of <i>English-to-German</i>, and <i>German-to-English, </i>to facilitate discussions between my German family and American friends.</span></li></ul><p></p><p><span style="font-family: helvetica;">I didn't fully appreciate this sort of multicultural upbringing until I was older, and learned that not everyone struggled with (<i>or learned to manage</i>) these types of issues. </span></p><p><span style="font-family: helvetica;">One of the things you learn from this sort of cross-cultural upbringing is that <b>communication is actually <u>much more frail and fragile</u> than you might imagine</b>. Success often depends on a number of factors helping you achieve a desired <b>comprehension rate</b> : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgjNqDtPjOf5sm0EPsr5IqE7LrU1dHW4SZ8P8cud-yhgZeLg4YgbO2cMEh5NpCGtVW0RcE7LBNqAh0oBtX9152TGTdr4s5j1GXg6qtLKDAces_IGKCnARyTTVZJX51WWjK2GWGllcmpV7cL1Epdsm7QL2cJeQctLHZ8MNDyxRAOnbVfwEmwkYIuBgwSrA=s960" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/a/AVvXsEgjNqDtPjOf5sm0EPsr5IqE7LrU1dHW4SZ8P8cud-yhgZeLg4YgbO2cMEh5NpCGtVW0RcE7LBNqAh0oBtX9152TGTdr4s5j1GXg6qtLKDAces_IGKCnARyTTVZJX51WWjK2GWGllcmpV7cL1Epdsm7QL2cJeQctLHZ8MNDyxRAOnbVfwEmwkYIuBgwSrA=w640-h360" width="640" /></span></a></div><span style="font-family: helvetica;">For most routine, practical, day-to-day communications, about <b><span style="color: #2b00fe;">75%-80% comprehension</span></b> is <i>just fine</i>. Typically, <span style="color: #2b00fe;"><b>your brain fills in the gaps</b></span> (<i>without your awareness</i>), and you usually <i>don't even notice the small details</i> you might have missed. It still gets you to work, gets you to dinner on time, lets you order food at restaurants, and lets you manage your typical day-to-day activities. Informally, I personally refer to this as "<b><span style="color: #2b00fe;">Kitchen Language</span></b>", since it's what you'd typically hear <b>in a kitchen</b> when people are making dinner and talking about their day. <b><span style="color: #2b00fe;">Failures sometimes happen</span></b>, but when they do - they usually only result in some <b>brief confusion</b>, a <b>wrong or forgotten birthday gift</b>, or an <b><span style="color: #2b00fe;">impromptu discussion</span></b> about '<i>ineffective communication</i>' from a loved one. After a little more discussion - The error or conflict usually <b><i>gets resolved</i></b>. <b><span style="color: #2b00fe;">Failure is usually pretty <i>well-tolerated</i></span></b>.</span><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">And then there is another standard, which I informally call "<span style="color: #cc0000;"><b>High Risk Language</b></span>". This is where <span style="color: #cc0000;"><b>failure</b> is <b>NOT well-tolerated</b></span>, and so <b>additional work and terminology</b> are commonly required to help ensure a <span style="color: #cc0000;"><b>higher accuracy rate, </b>typically <b>>90-95%</b></span>. Political, industrial, and <b><u>clinical</u></b> discussions all fall into this range. Successfully navigating <span style="color: #cc0000;"><b>High-Risk Language</b></span> often requires <span style="color: #cc0000;"><b>additional analysis/planning</b></span>, <span style="color: #cc0000;"><b>work</b></span>, and often even <span style="color: #cc0000; font-weight: bold;">new terminology </span>that both sides (<i>separately</i>) agree to and understand, to help <b><span style="color: #cc0000;">align concepts</span></b> for <i>effective cross-cultural communication</i>.</span></div><div><span style="font-family: helvetica;"><b><u><br /></u></b></span></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><span style="font-family: helvetica;"><span><u><b>*Interesting historical side-note</b> :</u></span> </span></div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div style="text-align: left;"><span style="font-family: helvetica;">Ever wonder about the <a href="https://en.wikipedia.org/wiki/Cuban_Missile_Crisis">June 1961 Cuban Missile</a> summit between Kennedy and Kruschev? <a href="https://www.rbth.com/history/332670-viktor-sukhodrev-cold-war-diplomacy">Viktor Sukhodrev was the interpreter in between them</a> - Talk about <b>responsibility</b> for ensuring both <span style="color: #cc0000;"><b>accurate translation and comprehension</b></span>!</span></div></blockquote><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Don't believe me that <b>age</b> is an important factor in effective communication, even in the <b>same language</b>? Check out this <b>Saturday Night Live</b> skit, "<a href="https://youtu.be/JF2Mf6HxIi0">Gen Z Hospital</a>" - Your appreciation of this skit will largely depend on the year you were born. </span><span style="font-family: helvetica;">Similarly, different upbringings, experiences, education, and culture can also <b>quietly</b> <b>degrade comprehension rates, </b>sometimes to the point of <i>failure</i>. (<i>Applied Clinical Informaticists often see this cultural boundary when translating across <b>clinical</b> and <b>administrative</b> realms, which <b>both have their own culture and terminology</b></i>.)</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">So to overcome these differences across <b>different languages - </b>for both <b><span style="color: #2b00fe;">Kitchen Language</span></b> and <b><span style="color: #cc0000;">High-Risk Language</span></b> scenarios - good interpreters need to know <b>how different people speak and write</b>. They need to know <b>different cultures and subcultures</b>, and the specific context and nuances of the language they use <i>in each culture</i>. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">I think this may be why I notice a lot of <b>multicultural, polylingual people</b> in Applied Clinical Informatics. Even in English, this sort of <b>cross-cultural interpretation</b> requires an understanding of <b>two different cultures</b> - Both <b>Clinical</b>, and <b>Information Technology</b> (<b>IT</b>) : </span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEimpTx3habAb3VEZ0rDNZLSZqVsVeRnUDSp53Z9Vu8zUB-IrdUcJF4DNlsz4aoGttDr1MyDATMVaEYXWZWkCKAVGt2-INV0iqN_Op-zo_Ek2hH6f1QkvnK5nzsYaCeRkvO0VyDRALFQ7GwD3BmqlKa5h2urVFJzSBaG-2A_HF1HsvZyaTCWFmqBzAYvFA=s960" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/a/AVvXsEimpTx3habAb3VEZ0rDNZLSZqVsVeRnUDSp53Z9Vu8zUB-IrdUcJF4DNlsz4aoGttDr1MyDATMVaEYXWZWkCKAVGt2-INV0iqN_Op-zo_Ek2hH6f1QkvnK5nzsYaCeRkvO0VyDRALFQ7GwD3BmqlKa5h2urVFJzSBaG-2A_HF1HsvZyaTCWFmqBzAYvFA=w640-h360" width="640" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">And then once you have mastered the art of interpreting the culture and language of both sides - you can then become <b>even more helpful</b> when you add <b>clinical <span style="color: #6aa84f;">architecture</span></b> to your repertoire, developing <b>new terminology</b> and <b>documented 'blueprints'</b> that meet the needs of <b>both sides</b>: </span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgnfduujgMHOpruLvuqjrS_20f8upnfhD-VPct8R8dVFmE0CG9_Bjfgm0wxp6nb4E9c84GRRoerod08-TJhmUZ-GKjqcUcsL3xfhtryeb8geg-uaFENE6VWZG3Az2hEZyj_YMJx0hEN1xdiUyhuGGjlx-BfTpR2cnSf4r76qQwAqG3P29a_rmvroG-HgQ=s960" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="960" height="360" src="https://blogger.googleusercontent.com/img/a/AVvXsEgnfduujgMHOpruLvuqjrS_20f8upnfhD-VPct8R8dVFmE0CG9_Bjfgm0wxp6nb4E9c84GRRoerod08-TJhmUZ-GKjqcUcsL3xfhtryeb8geg-uaFENE6VWZG3Az2hEZyj_YMJx0hEN1xdiUyhuGGjlx-BfTpR2cnSf4r76qQwAqG3P29a_rmvroG-HgQ=w640-h360" width="640" /></a></div><br /><span style="font-family: helvetica;">So in closing - I'd say a <b>bilingual</b> (<i>or polylingual</i>), <b>multicultural upbringing</b> can serve as an excellent model for the same interpretation functions that <b>Applied Clinical Informaticists</b> provide in their daily work. It would be interesting to do some formal research into these concepts, to help confirm the value of this sort of <i>early training</i>.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>Remember, this blog is for education and discussion only - Your mileage may vary!</i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i><br /></i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>Have any thoughts or feedback about this post? Did you grow up in a multicultural household, and do you speak multiple languages? Do you find these experiences helped you in your career in Applied Clinical Informatics? If so, please feel free to leave a comment in the comments box below!</i></span></div></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-25358271809616510432022-01-17T12:14:00.002-05:002022-01-17T12:16:59.718-05:00A Student's Take on A.I. in Healthcare<p><span style="color: #0b5394; font-family: arial;"><i>Hi fellow Clinical Informaticists, workflow designers, and other clinical architects,</i></span></p><p><span style="color: #0b5394; font-family: arial;">Today's blog post is a slight deviation from my usual posts - It's actually a <b>guest post</b>, from a smart young college student, <b><a href="https://www.linkedin.com/in/paullestz/">Paul Lestz</a></b>, who I recently had the good fortune of working with on an educational internship.</span></p><p><span style="color: #0b5394; font-family: arial;">Paul's particular interest is related to the use of Artificial Intelligence (A.I.), so we discussed the current state of A.I. in healthcare, and ways to implement this technology to a broader audience. </span></p><p><span style="color: #0b5394; font-family: arial;">So I'm very happy to report that, after reading Paul's blog post below, that '<i>The Kids Are Alright</i>' - If this is what our future leadership looks like, then I have great confidence in our future. </span></p><p><span style="color: #0b5394; font-family: arial;">Please enjoy Paul's post below : </span></p><p><span style="font-family: arial; white-space: pre-wrap;">______________________________</span></p><div style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: left;"><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">If after an exhaustive examination of data, an </span><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">artificial intelligence (A.I.) algorithm</span><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> were to recommend termination of care for a relative - how would you react? How would you feel if this type of recommendation or decision was made solely by an A.I. algorithm, with </span><span style="background-color: white; font-family: arial; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">no clear human oversight</span><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">? Does it help to differentiate a </span><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">recommendation</span><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> from a </span><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">decision</span><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">?</span></div><div style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: left;"><span style="background-color: white; font-family: arial; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Currently, there are few industry-wide reasons to be concerned - </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">at least so far</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. While some healthcare institutions have begun the deployment of A.I. systems, we are not yet </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">dependent</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> on them for these types of </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">high-risk </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">decisions</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Human doctors</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> still have responsibility and remain in control - which means now is a good time to educate ourselves on A.I., including its </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">many compelling benefits</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">potential risks</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, and </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">ways to mitigate those risks</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">.<br /></span></span><span style="font-family: arial;"> <br /></span><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">While reading, please remember - </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">A.I. is a complicated topic</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, that warrants our attention. Turning a '</span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">blind eye</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">' to A.I. does not mean that the field will not continue to expand into every industry, </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">including healthcare</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. I hope this post provides some helpful education - as a starting point for future discussions - and helps to reduce the </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">initial intimidation</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> that A.I. discussions often induce.</span></span></div><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Why do I believe that A.I. will continue to expand into the healthcare industry? It's because of the </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">many potential benefits</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> of using A.I. to manage the high-risk scenarios that healthcare workers commonly encounter. Among others, here are some major benefits offered by A.I.:</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Adapted from: </span><a data-saferedirecturl="https://www.google.com/url?q=https://www.ibm.com/watson-health/learn/artificial-intelligence-medicine?p1%3DSearch%26p4%3D43700050370361195%26p5%3De%26gclid%3D7d99ed9eb76317dbe6ef8d0d9f0cec98%26gclsrc%3D3p.ds&source=gmail&ust=1642523150361000&usg=AOvVaw0Dxli1WcpCioGv9-qC4UM7" href="https://www.ibm.com/watson-health/learn/artificial-intelligence-medicine?p1=Search&p4=43700050370361195&p5=e&gclid=7d99ed9eb76317dbe6ef8d0d9f0cec98&gclsrc=3p.ds" style="color: #1155cc; text-decoration-line: none;" target="_blank"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; vertical-align: baseline; white-space: pre-wrap;">Artificial Intelligence in Medicine | Machine Learning | IBM</span></a></span></p><ul style="background-color: white; color: #222222; margin-bottom: 0px; margin-top: 0px;"><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 12pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Cutting through the noise</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - A.I. can help </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">make sense</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> of the overwhelming amount of clinical data, medical literature, and population and utilization data to inform decisions.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Providing contextual relevance</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - A.I. can help </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">empower</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> healthcare providers to see expansively by quickly interpreting billions of data points - <i>both text and image data</i> - to identify contextually relevant information for individual patients.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Reducing errors related to human fatigue</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - Human error is costly and human fatigue can cause errors. A.I. algorithms donโt suffer from fatigue, distractions, or moods. They can process vast amounts of data with incredible speed and accuracy, </span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">all of the time</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 12pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Identifying diseases more readily</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - A.I. systems can be used to </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">quickly spot anomalies</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> in medical images (</span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">e.g. CT scans and MRIs</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">).</span></span></p></li></ul><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">From my perspective as a student, these are all compelling examples of how A.I. could help develop healthcare into a more modern, efficient, and reliably data-driven </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">patient-care system</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">To do this, however, also requires an examination of the </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">challenges</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> that A.I. can bring with it - unsurprisingly, </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">extremely new technology</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> sometimes brings </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">unexpected issues</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. Some of the known challenges of A.I. implementation include: </span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Adapted from: </span><a data-saferedirecturl="https://www.google.com/url?q=https://www.thomasnet.com/insights/the-challenges-and-dangers-of-ai-in-the-health-care-industry-report/&source=gmail&ust=1642523150361000&usg=AOvVaw3mLRqlOW7B78FkxODB-YVI" href="https://www.thomasnet.com/insights/the-challenges-and-dangers-of-ai-in-the-health-care-industry-report/" style="color: #1155cc; text-decoration-line: none;" target="_blank"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; vertical-align: baseline; white-space: pre-wrap;">The Dangers of A.I. in the Healthcare Industry [Report] (thomasnet.com)</span></a></span></p><ul style="background-color: white; color: #222222; margin-bottom: 0px; margin-top: 0px;"><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 12pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Distributional shift</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - A mismatch in data due to a change of environment or circumstance can result in erroneous predictions. For example, over time, disease patterns can change, leading to a disparity between training and operational data.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Insensitivity to impact</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - A.I. doesnโt yet have the ability to take into account false negatives or false positives.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Black box decision-making</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - With A.I., predictions are not open to inspection or interpretation. For example, a problem with training data could produce an inaccurate X-ray analysis that the A.I. system cannot factor in, and that clinicians cannot analyze.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Unsafe failure mode</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - Unlike a human doctor, an A.I. system can diagnose patients without having </span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">confidence</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> in its prediction, especially when working with insufficient information.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; text-decoration-line: underline; vertical-align: baseline;">Automation complacency</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; text-decoration-line: underline; vertical-align: baseline;"> - Clinicians may start to trust A.I. tools implicitly, assuming all predictions are correct and failing to cross-check or consider alternatives.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Reinforcement of outmoded practice</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - A.I. canโt adapt when developments or changes in medical policy are implemented, as these systems are trained using historical data.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Self-fulfilling prediction</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - An A.I. machine trained to detect a certain illness may lean toward the outcome it is designed to detect.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Negative side effects</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - A.I. systems may suggest a treatment but fail to consider any potential unintended consequences.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Reward hacking</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - Proxies for intended goals sometimes serve as '</span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">rewards</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">' for A.I., and these clever machines are able to find hacks or loopholes in order to receive unearned rewards, without actually fulfilling the intended goal.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Unsafe exploration</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - In order to learn new strategies or get the outcome it is searching for, an A.I. system may start to </span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">test boundaries</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> in an unsafe way.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Unscalable oversight</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - Because A.I. systems are capable of carrying out countless jobs and activities, including multitasking, monitoring such a machine can be extremely challenging.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Unrepresentative training data </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">- A dataset lacking in sufficient demographic diversity may lead to unexpected, incorrect diagnoses from an A.I. system.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Lack of understanding of human values and emotions </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">-</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;"> </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">A.I. systems lack the complexity to both feel emotions (<i>e.g. empathy</i>) and understand intangible virtues (<i>e.g. honor</i>), which could lead to decisions that humans would consider immoral or inhumane.</span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: disc; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 12pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">Lack of accountability for mistakes </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">- Because A.I. systems cannot feel pain and have no ability to compensate monetarily or emotionally for their decisions, there is no way to hold them accountable for errors. Blame is therefore redirected onto the many people related to the incident, with no one person ever truly held liable. </span></span></p></li></ul><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Rather than feel discouraged when comparing the benefits of A.I. versus these risks above, I'd like to share that </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">there are solutions</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> to many, </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">if not all</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, of these known risks above - through commitment and </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">detailed policy work</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">For instance, letโs take a look at the challenge underlined above: </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">automation complacency</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. At first glance, one might think it would be too difficult to resolve this </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">extremely conceptual issue,</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> intrinsic to the mind of the clinician. However, automation complacency serves little to no problem if the <i>following workflow is implemented</i>: </span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEgpn-TG0_ff7AwjABg2FwAAmzjanRZcWt-fQH9h8q7L06lb6YFSNnonRTXgqXfFYhUHfgAjLIpFlZ89jkReqE_VTs2tLKXYR8AK5OIkuxveFTv70KQQ4wzfNLLdTEQq3SjQBX-cIGkDGgCuG_bi01ZbQLiAVGbvSbVyG4rWXTEmwPO0obreqTGo_hjOKw=s5775" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: arial;"><img border="0" data-original-height="2063" data-original-width="5775" height="228" src="https://blogger.googleusercontent.com/img/a/AVvXsEgpn-TG0_ff7AwjABg2FwAAmzjanRZcWt-fQH9h8q7L06lb6YFSNnonRTXgqXfFYhUHfgAjLIpFlZ89jkReqE_VTs2tLKXYR8AK5OIkuxveFTv70KQQ4wzfNLLdTEQq3SjQBX-cIGkDGgCuG_bi01ZbQLiAVGbvSbVyG4rWXTEmwPO0obreqTGo_hjOKw=w640-h228" width="640" /></span></a></div><p></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin: 0pt 11pt; text-align: center;"><span style="font-family: arial; font-size: x-small;"><span style="background-color: transparent; color: #2b00fe; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">(</span><span style="background-color: transparent; color: #2b00fe; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Sample policy/workflow for managing automation complacency</span><span style="background-color: transparent; color: #2b00fe; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> - </span><span style="background-color: transparent; color: #2b00fe; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Click to enlarge</span><span style="background-color: transparent; color: #2b00fe; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">)</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial; font-size: x-small;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">I designed this visual to help simplify the complex process of </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">reducing automation complacency</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> to a </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">few</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">easy-to-follow</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> steps.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Resolving the issues related to A.I. </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">does</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">not </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">mean instantly coming up with a single, lengthy procedure in the hopes that it will work. Instead, resolving challenges means </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">breaking the problem down into pieces</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> and </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">isolating different steps</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> in order to achieve the </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">desired result</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">When developing the flow chart above, I had to determine what exactly was the </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">root</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> of the unwanted issue: </span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-left: 60pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><b>Q</b>: How could a clinician be biased towards picking the </span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">A.I. algorithmโs result</span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> without considering </span><span style="color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">alternatives</span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">? </span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-left: 60pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><b>A</b>: It would most likely be because </span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">they </span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; text-decoration-line: underline; vertical-align: baseline; white-space: pre-wrap;">knew</span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> the A.I.โs prediction </span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; text-decoration-line: underline; vertical-align: baseline; white-space: pre-wrap;">before/at the time</span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> they made their </span><span style="color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">initial diagnosis</span><span style="color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. </span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">While we, as humans, might think that we are </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">not biased</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> by certain information, this assumption is </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">often an illusion</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Subconscious biases</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> tend to be the most powerful because we do not realize </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">how much they affect us</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">In order to solve this problem, my workflow above </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">mandates</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> that the </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">clinician provide and lock in their initial opinion</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">before</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> being provided the </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">A.I. algorithmโs prediction</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. By doing so, we resolve our first issue of </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">initial, subconscious biases</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">______________________________</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span></span> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">As I have just demonstrated, solving A.I.-related issues is often a matter of </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">breaking down problems </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">and coming up with </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">small solutions</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> that </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">together</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, sum up to a </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">working whole</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">So, if there are often ways to </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">mitigate the risks</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> of these A.I.-related issues - </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">are we good to go? </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">The answer: </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">itโs complicated</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Often, users (</span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">e.g. healthcare institutions</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">) are </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">not</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> actually </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">making their own algorithms</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. Instead, they </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">purchase them</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. Therefore, one must consider various factors in deciding </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">which</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> A.I. algorithms to purchase. Unfortunately, after an extensive literature search, it doesn't appear that there has been a helpful, cohesive guide as to </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">what factors to consider</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> when purchasing A.I. solutions, </span><span style="background-color: white; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">so I would like to propose the <b>following guidelines</b>:</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin: 0pt 11pt; text-align: center;"><span style="text-align: left;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: arial;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEitXKK3kbxBrMac-V3sqt4wqrFK854Bx9P6zKOJn4PNScx7dsxBByOLYfBMj_5efuvKANKN9QRtHUzsd0dr1JmHDnrhrqnNz_qri33D3qUOBCQGWONylNwCEZKf-Y9iG8dB4p9V8RadYB0NXKJprkYn-n1tp-vZu2laPlR7LIJuOmeQ3LSknVoC6An90Q=s1078" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1078" data-original-width="834" height="640" src="https://blogger.googleusercontent.com/img/a/AVvXsEitXKK3kbxBrMac-V3sqt4wqrFK854Bx9P6zKOJn4PNScx7dsxBByOLYfBMj_5efuvKANKN9QRtHUzsd0dr1JmHDnrhrqnNz_qri33D3qUOBCQGWONylNwCEZKf-Y9iG8dB4p9V8RadYB0NXKJprkYn-n1tp-vZu2laPlR7LIJuOmeQ3LSknVoC6An90Q=w496-h640" width="496" /></a><span style="text-align: left;"> </span></span></div><p></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;"><span style="font-family: arial; font-size: x-small;"><span style="background-color: transparent; color: #2b00fe; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">(Sample questions to consider in A.I. purchasing - </span><span style="background-color: transparent; color: #2b00fe; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Click to enlarge</span><span style="background-color: transparent; color: #2b00fe; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">)</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><br /></span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">I created the infographic above to help frame </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">some helpful questions</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> to ask a vendor when considering the purchase of an A.I. solution.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">______________________________</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: arial;">Generally, I hope that this piece helps to serve two primary purposes: </span></span></p><ol style="background-color: white; color: #222222; margin-bottom: 0px; margin-top: 0px;"><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 12pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">The first is to convince you that, </span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">with good understanding</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> </span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">and planning</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> - A.I. typically brings about </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">more good than harm</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;"> in the world. </span></span></p></li><li dir="ltr" style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; list-style-type: decimal; margin-left: 11pt; vertical-align: baseline; white-space: pre-wrap;"><p dir="ltr" role="presentation" style="line-height: 1.38; margin-bottom: 12pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">(</span><span style="background-color: transparent; color: #2b00fe; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">This second purpose assumes that you have already embraced the first</span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">) - </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">The second purpose is to convince you not to take A.I. for granted, but to be thoughtful in the approach so that institutions (<i>and the people who work at them</i>) </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">solve problems</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">, </span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">purchase algorithms</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">, and engage with the world of A.I. </span><span style="background-color: transparent; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline;">responsibly</span><span style="background-color: transparent; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline;">.</span></span></p></li></ol><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">It's generally important to prepare and '</span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">do your homework</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">' before engaging in A.I. discussions. This preparation is especially important if we want to </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">maximize the benefits of A.I. </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">and</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"> minimize the risks</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. This postโs goal, therefore, is to bring the focal point of A.I. not to its </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">use</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, but to its </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">purchase. </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">After all, a </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">well-considered purchase </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">combined with a</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"> thoughtful implementation</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> often leads to more responsible ownership and successful outcomes. Alternatively, </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">inadequate preparation</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> can lead to </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">unexpected outcomes</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. </span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">______________________________</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"> </span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">As a </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">student, </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">and without a </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">deeper knowledge of the exact workflow expectations for a particular circumstance, </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">I am unfortunately unable to offer any </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">more</span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">-</span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">detailed perspectives</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. However, I hope this initial post helps to 'get</span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> the ball rolling</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">' on some important discussions related to proper A.I. </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">planning</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">purchasing</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">, and </span><span style="background-color: transparent; color: black; font-style: italic; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">use</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. The </span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">right answers</span><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"> will still need to be evaluated and defined by planners, users, regulatory agencies, and society.</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><span style="font-family: arial;"><span style="background-color: transparent; color: black; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">______________________________</span></span></p><p dir="ltr" style="background-color: white; color: #222222; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><i style="background-color: transparent; font-family: arial;"><br /></i></p><p dir="ltr" style="background-color: white; line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;"><i style="background-color: transparent; font-family: arial;"><span style="color: #0b5394;">Remember this blog is for educational and discussion purposes only - Your mileage may vary. Have any thoughts or feedback to share about A.I. in Healthcare? Feel free to leave in the comments section below!</span></i></p>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-6401725223626886112021-12-02T00:29:00.011-05:002021-12-02T00:40:23.827-05:00Engineering Healthcare : Through A Historical Lens<p><span style="font-family: helvetica;"><i> Hi fellow CMIOs, CNIOs, Clinical Informatics, and other HealthIT friends,</i></span></p><p><span style="font-family: helvetica;">I'm writing today to share a presentation I recently did, on <b>engineering Healthcare</b> through a <i><b>historical lens</b></i>.</span></p><p><span style="font-family: helvetica;">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.</span></p><p><span style="font-family: helvetica;">Below is my slide deck I used - Sharing it in case any of the slides help you develop your presentations on clinical <b>Change/Project Management</b> or <b>Applied Clinical Informatics</b>.</span></p><p><span style="font-family: helvetica;">First - My intro slide : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2AE8QdvaZy_-SzMPqZZIyg9v7ay2OwtylkZ8gPlIjj_ukUxuuYBWVG7JcVdo8lx0P1oJe1c6Wg3vDggCQpXasRQG7FNBVoGUYzBGzAxOG9D_T8kY56Pv_1_kZFzsEcPg4caP7XEHN-9pg/s960/Slide1.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2AE8QdvaZy_-SzMPqZZIyg9v7ay2OwtylkZ8gPlIjj_ukUxuuYBWVG7JcVdo8lx0P1oJe1c6Wg3vDggCQpXasRQG7FNBVoGUYzBGzAxOG9D_T8kY56Pv_1_kZFzsEcPg4caP7XEHN-9pg/w400-h225/Slide1.jpeg" width="400" /></span></a></div><p><span style="font-family: helvetica;">... which brings me to a brief discussion of our <b>human history of documentation</b> : </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ7ACl73xryzqipkYzRrX6AjTa3aDcKQEh3DeVK7WVHvr8whRbydyGEEa_MBQCs0-rM3lTK6NO9DJAWgYbJvj0hY47EbP7O9XYNdjawEAGmfomN_uyHGgLOxK-T7DtT898Ch2XB77rg2Z0/s960/Slide2.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJ7ACl73xryzqipkYzRrX6AjTa3aDcKQEh3DeVK7WVHvr8whRbydyGEEa_MBQCs0-rM3lTK6NO9DJAWgYbJvj0hY47EbP7O9XYNdjawEAGmfomN_uyHGgLOxK-T7DtT898Ch2XB77rg2Z0/w400-h225/Slide2.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">It was pretty profound to me, when I first fully grasped the magnitude of this simple <b>documentation loop</b>, between both <b>reading and writing</b> information : </span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijzq0CxugMWXsfVrcGO4fIf96OZK6Jir3CO2UIlhdSXWi85nfLF56d5dxsNKW3gT3BYxBNNzFG103dADWynbECjzasRWO-fo0gZ_w97XAKSHHkO39TDMADfIPqB1yoj0KuLSP8yZhm2jaL/s960/Slide3.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijzq0CxugMWXsfVrcGO4fIf96OZK6Jir3CO2UIlhdSXWi85nfLF56d5dxsNKW3gT3BYxBNNzFG103dADWynbECjzasRWO-fo0gZ_w97XAKSHHkO39TDMADfIPqB1yoj0KuLSP8yZhm2jaL/w400-h225/Slide3.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">Unfortunately, despite being open for business for over 300+ years - Healthcare has never really had an opportunity to really '<i><b>pause</b></i>' to '<b><i>fix the plane</i></b>' - so a lot of changes have happened <i>serendipitously</i> over this long timeframe : </span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitfYyyCLg0kDq2eOr_IWpqCSbony6LcN9Iya7yqZE42k7znhbIezGyn2Vl5B36lfLXgunmxXdj-MbCDQPFm-cohFe-26miqg_H7Z7sT7XjkMjpTkEuQ7U5cQNSsVHYjl27QUSe7It7I-yh/s960/Slide4.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitfYyyCLg0kDq2eOr_IWpqCSbony6LcN9Iya7yqZE42k7znhbIezGyn2Vl5B36lfLXgunmxXdj-MbCDQPFm-cohFe-26miqg_H7Z7sT7XjkMjpTkEuQ7U5cQNSsVHYjl27QUSe7It7I-yh/w400-h225/Slide4.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p>... which tells us a few things : </p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZgjgWVxqmseged76rlT9YDbUfum-Oh383es9cKAteTLVdYZzBOQkeiLbsQTM5qd8cKE6iwS8SkrK1Jt9FHHOR0H8k-U59a0_Jf2tOzMbpG9yegzFoyUp4wo7s-78iPBp_S6eCLCSl83c6/s960/Slide5.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZgjgWVxqmseged76rlT9YDbUfum-Oh383es9cKAteTLVdYZzBOQkeiLbsQTM5qd8cKE6iwS8SkrK1Jt9FHHOR0H8k-U59a0_Jf2tOzMbpG9yegzFoyUp4wo7s-78iPBp_S6eCLCSl83c6/w400-h225/Slide5.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">So how can we do better? We need to start <b>thinking like designers and engineers</b>, and plan our workflows and changes by <b>examining those documents</b> that users interact with every day : </span></p></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm6S1EBO4Y94CXrd8IIwP4V68a9U4bVF2NI_YVz-Nj9IE8YERcH3pzpkWCmbZT5pSqH2diOf30eXV_7hmZw12Gvth3DdiI3Nmr6GEJ_gYn5d0Ico3idTWvNI0fAoli6at3OCN2SIeacHGT/s960/Slide6.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm6S1EBO4Y94CXrd8IIwP4V68a9U4bVF2NI_YVz-Nj9IE8YERcH3pzpkWCmbZT5pSqH2diOf30eXV_7hmZw12Gvth3DdiI3Nmr6GEJ_gYn5d0Ico3idTWvNI0fAoli6at3OCN2SIeacHGT/w400-h225/Slide6.jpeg" width="400" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">... and if we look at those documents more closely, we see that <span style="color: #cc0000;">roughly half of them are contained inside an electronic medical record</span> - And the <span style="color: #2b00fe;">other half are outside</span>. This gives us the <b>roughly 24 building blocks</b> of all clinical workflows : </span></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGB9KTbkpZlJIrRheSVSEDYg7lz76hkgNYLiZZDylxDCj24nRVhMwNMtmJK-fumLfldJBmsnzaNOoVUf9hEA2WsM6cmMIP4vm8MdvfNqTnwhNzjwOtx7p_UqyfD_D1nLTjP-Za-88lG2Mr/s960/Slide7.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGB9KTbkpZlJIrRheSVSEDYg7lz76hkgNYLiZZDylxDCj24nRVhMwNMtmJK-fumLfldJBmsnzaNOoVUf9hEA2WsM6cmMIP4vm8MdvfNqTnwhNzjwOtx7p_UqyfD_D1nLTjP-Za-88lG2Mr/w400-h225/Slide7.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">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 <b>functional definitions</b> - Both <b><i>what it's called</i></b>, and <b><i>what it does</i></b>.</span></div><div><br /></div></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiccauPz7AuD0_I1ausB2ooE3Lhd3AULSkRYB1C7kVTaIbeFQucPxrppgGuchy3FjQR7SMiJt1t5lRbYdWk7fY3kz-Bem94mk-I2RqMXfJSV4IqYFUEzQ9WFGf-Uvb2kc4CLzxzQXo1POLt/s960/Slide8.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiccauPz7AuD0_I1ausB2ooE3Lhd3AULSkRYB1C7kVTaIbeFQucPxrppgGuchy3FjQR7SMiJt1t5lRbYdWk7fY3kz-Bem94mk-I2RqMXfJSV4IqYFUEzQ9WFGf-Uvb2kc4CLzxzQXo1POLt/w400-h225/Slide8.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div>Once you have those <b>functional</b> <b>definitions</b>, this helps you create a working <b>glossary</b> and <b>document templates</b>, to help you quickly develop <b><i>high-quality documents</i></b> to build your workflows from : </div><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQZAqGr3BCN3tcg5F35ZGe_BCfs17hnQnEIpyC4gjoJr1HrGnqgNBdZhiI0zLLcvjvWGG_o8jfjibHZxX2If-k0IQmd_Nft3aNyGA3-7_lTV-_4eVb6g65e6YVz51VhSOM5MNG8TTxDryN/s960/Slide9.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQZAqGr3BCN3tcg5F35ZGe_BCfs17hnQnEIpyC4gjoJr1HrGnqgNBdZhiI0zLLcvjvWGG_o8jfjibHZxX2If-k0IQmd_Nft3aNyGA3-7_lTV-_4eVb6g65e6YVz51VhSOM5MNG8TTxDryN/w400-h225/Slide9.jpeg" width="400" /></span></a></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">And to help you <b>further develop</b> your documents, it helps to understand how to build them in the <b>most robust way</b> - Aligning the <i>concepts</i> > <i>terminology</i> > <i>templates</i> > <i>documents</i> > <i>workflows</i> > <i>goals/regulations</i> > <i>mission/vision</i> : </span></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo1e3aKA2M00Jbs-2EmK0tvJ0TNlHlHTtDZ9qnP1U5cT5n66aRO8SH6Ve3KJyfKeet3dIBR5ftym5WbuINFx-HT3pxCvJaNTdKbzWZa8cbImwJyV3fer4mLd4WDrJ0xrl2RgeRlPlSWhhY/s960/Slide10.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo1e3aKA2M00Jbs-2EmK0tvJ0TNlHlHTtDZ9qnP1U5cT5n66aRO8SH6Ve3KJyfKeet3dIBR5ftym5WbuINFx-HT3pxCvJaNTdKbzWZa8cbImwJyV3fer4mLd4WDrJ0xrl2RgeRlPlSWhhY/w400-h225/Slide10.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Now that you know how to <b>engineer these documents</b> for maximum benefit, it's helpful to figure out how to move (<i>change</i>) from <b>Point A </b>(<i>current</i>) to <b>Point B</b> (<i>future</i>). The <b>distance</b> between these two points gives you a <b>rough estimate</b> of <i>which tools you will need to get there</i>, and the <b>project scope</b> - How much <b>time, people, and resources</b> it will take to <i>get there</i>. </span></div><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5AvbL8WHDdplXudkm7sliGt0eqixsQLEGWq8AwGjPUbzyvlOojENrljXQ2kKDiee9P6IP4W3DXnu6Ma6_DVpsfKW26fzeZBDMlKovF6E52g29KChyphenhyphensoxVP0u_N_Pf3vOS1H1-uugDTvp2/s960/Slide11.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5AvbL8WHDdplXudkm7sliGt0eqixsQLEGWq8AwGjPUbzyvlOojENrljXQ2kKDiee9P6IP4W3DXnu6Ma6_DVpsfKW26fzeZBDMlKovF6E52g29KChyphenhyphensoxVP0u_N_Pf3vOS1H1-uugDTvp2/w400-h225/Slide11.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGckDYRppQLb3U8z1i6IlZsHFfI3BEDaYJW6wNGZ2IW9_QzytB87TnXVQAfhMS0rqF4ZAKYYc3DMqHo_735MTghe21LqmYJ5GM9jNdJBMByno4Aqueo0I7I8zlmmfimS7iD02tmYTysZ5c/s960/Slide12.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGckDYRppQLb3U8z1i6IlZsHFfI3BEDaYJW6wNGZ2IW9_QzytB87TnXVQAfhMS0rqF4ZAKYYc3DMqHo_735MTghe21LqmYJ5GM9jNdJBMByno4Aqueo0I7I8zlmmfimS7iD02tmYTysZ5c/w400-h225/Slide12.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Once you have your stakeholders and deliverables identified, it's helpful to orchestrate your change in a <i>linear</i>, <i>organized, thoughtful, and predictable</i> manner. For this, I offer up a helpful general-purpose <b>change management recipe</b> : </span></div><div><br /></div></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaiw7BC4LL8V8mZDtYXdAIToE3_kr5SHaQdMEnJNfX9vWDPOHZPurF5etlxP6MekfwiIT-BKDknkR3WTFdW8h-h7y8SUzhiSMIXjpwS_3efcMLzKoUxtAhRiYapAoQoteiNU4PgoX-jpwU/s960/Slide13.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaiw7BC4LL8V8mZDtYXdAIToE3_kr5SHaQdMEnJNfX9vWDPOHZPurF5etlxP6MekfwiIT-BKDknkR3WTFdW8h-h7y8SUzhiSMIXjpwS_3efcMLzKoUxtAhRiYapAoQoteiNU4PgoX-jpwU/w400-h225/Slide13.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">If you don't have an <b>organized process</b> for managing/engineering changes - you could fall into one of these <b>engineering pitfalls</b>, which can lead to <b>unexpected outcomes</b> : </span></div><div><br /></div></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvLhN4q5IU2x0zybQVKFGsBXtUPK7j-RkzuOojvr0hOlO277s92S6vgSLhjjn6L7hpzyKuFiXyuyHOrwx6_69HsSLQ91vNzFYzrS8excHMcTKe1ObUVO1bSk9eMcZmr3VTkiw9uTLbxaZL/s960/Slide14.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvLhN4q5IU2x0zybQVKFGsBXtUPK7j-RkzuOojvr0hOlO277s92S6vgSLhjjn6L7hpzyKuFiXyuyHOrwx6_69HsSLQ91vNzFYzrS8excHMcTKe1ObUVO1bSk9eMcZmr3VTkiw9uTLbxaZL/w400-h225/Slide14.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE5CeFTw7W1qKY9FMmD1zjtsvcPrdwgdI_wiZccvwhnO9gTxOe44fajZLoEDxjq1B3tqWsBX9k6NLsZjO1vpsPnIkP-_nuxB4i9uQwhK-x-jhZ-Ltj517cCsfADdc8dbVjtuhb4Jdt4XIT/s960/Slide15.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE5CeFTw7W1qKY9FMmD1zjtsvcPrdwgdI_wiZccvwhnO9gTxOe44fajZLoEDxjq1B3tqWsBX9k6NLsZjO1vpsPnIkP-_nuxB4i9uQwhK-x-jhZ-Ltj517cCsfADdc8dbVjtuhb4Jdt4XIT/w400-h225/Slide15.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">... all of which should be aligned to your <b>policies and procedures</b>, the <b><i>standards</i></b> of your organization : </span></div><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOqPMwa-n_I3IKDmsepsJ5ujuq4ahOkszp0C7piEpGb2341N58DliX4zjlFW8NedGlt3D_4GsN62M1maw5VF6LMQn6EFD24V2vgKW5Oox5v0EpxVk0UFw-Q9PpbHQl8KPro4TokkPDDDIX/s960/Slide16.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOqPMwa-n_I3IKDmsepsJ5ujuq4ahOkszp0C7piEpGb2341N58DliX4zjlFW8NedGlt3D_4GsN62M1maw5VF6LMQn6EFD24V2vgKW5Oox5v0EpxVk0UFw-Q9PpbHQl8KPro4TokkPDDDIX/w400-h225/Slide16.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtT6IqhPzcu4MFUDu9LHg8mzWAfDVp72iFjKAOVSkUV3VlkFkE9VmxAO7OaCfPYyLtpXVQgb64vCcds74Yeskc9fh57IbSJFYj8qh9D9QgJfuSVDsuZASkLQkvyVNmJlQ9z_UBSQUHvgR-/s960/Slide17.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtT6IqhPzcu4MFUDu9LHg8mzWAfDVp72iFjKAOVSkUV3VlkFkE9VmxAO7OaCfPYyLtpXVQgb64vCcds74Yeskc9fh57IbSJFYj8qh9D9QgJfuSVDsuZASkLQkvyVNmJlQ9z_UBSQUHvgR-/w400-h225/Slide17.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">A few <b>final tips and closing thoughts</b>, about <i>planning</i>, <i>infrastructure</i>, and <i>clinical operations</i> :</span></div><div><span style="font-family: helvetica;"> </span></div></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ_845QA6UDPPmlSS-ndw0L0nf_Bh46fjdxpL23D9H3_UM6PtW337qLnNxTlok3axECo5WQBRupWoB6Tdto7pAFMfkkl6IcoymwJW6fYlpMOaem5RS0NDmIQ1ajJ4vtviUXAul_fb3HAY3/s960/Slide18.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ_845QA6UDPPmlSS-ndw0L0nf_Bh46fjdxpL23D9H3_UM6PtW337qLnNxTlok3axECo5WQBRupWoB6Tdto7pAFMfkkl6IcoymwJW6fYlpMOaem5RS0NDmIQ1ajJ4vtviUXAul_fb3HAY3/w400-h225/Slide18.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5L4MBzY_154E7CIfkINHxVASOnbYjh6c7f5E9GzT65f0m4JPY3gA20pwnWZNONGBeZQn-KAQ4EdsKGPB83rr-c9lPlIi3RvgMa1hbiLvVHnNgUjziGbHuubhH3WSgUE6p-WBMBQlo1kGI/s960/Slide19.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5L4MBzY_154E7CIfkINHxVASOnbYjh6c7f5E9GzT65f0m4JPY3gA20pwnWZNONGBeZQn-KAQ4EdsKGPB83rr-c9lPlIi3RvgMa1hbiLvVHnNgUjziGbHuubhH3WSgUE6p-WBMBQlo1kGI/w400-h225/Slide19.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>... and my final thank you and advice : "<i>Control your documents, before they control you</i>."</span><div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7Fdy9jP2z0Z-l80k2Y2Oc_NKp2F6wceSXG7qsmAMeKttsdn5Q9KRnQzWphnkdJ9w3UE-Kf1LGWwf3sapWaTKfUUC26gvQf9H9iWnOYaUfy6QypNgWpsPkKQ5zyrzk-KKb8C0Lucb8qYzZ/s960/Slide20.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="540" data-original-width="960" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7Fdy9jP2z0Z-l80k2Y2Oc_NKp2F6wceSXG7qsmAMeKttsdn5Q9KRnQzWphnkdJ9w3UE-Kf1LGWwf3sapWaTKfUUC26gvQf9H9iWnOYaUfy6QypNgWpsPkKQ5zyrzk-KKb8C0Lucb8qYzZ/w400-h225/Slide20.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><br />I hope these slides help you develop your own presentations on <b>Applied Clinical Informatics</b>, and the importance of <b>solid clinical leadership</b> and <b>clinical change / project management</b>. </span><span style="font-family: helvetica;">Thank you!</span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><i>Remember - This blog is for educational and discussion purposes only - Your mileage may vary!</i></span></div><div><span style="font-family: helvetica;"><i><br /></i></span></div><div><span style="font-family: helvetica;"><i>Have any secrets about policy writing, workflow development, or project/change management? Feel free to share in the comments section below!!</i></span></div><div><span style="font-family: helvetica;"><i><br /></i></span></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-6615192369858952462021-10-30T20:38:00.003-04:002021-10-30T22:10:42.261-04:00Optimizing your Intranet<p><span style="font-family: helvetica;"><i>Hi fellow CMIOs, CNIOs, Applied Clinical Informaticists, and other HealthIT friends,</i></span></p><p><span style="font-family: helvetica;">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 <b>very good</b>, and facilitate <i>lots of innovative, new ways to deliver care</i>.</span></p><p><span style="font-family: helvetica;">So for this post, I thought I'd piggyback onto my last post, "<a href="https://www.dirkstanley.com/2021/06/welcome-to-healthcare.html">Welcome to Healthcare</a>", by showing how helpful it can be to use a <b>standardized index</b> <b>of healthcare</b> to optimize your <b>organizational Intranet</b>. </span></p><p><span style="font-family: helvetica;"><b>Why optimize your Intranet?</b> It's the one '<i>filing cabinet</i>' that <b>everyone</b> has access to, on their desktop, usually with <i>one click</i>. Imagine... Could your Intranet become a <b>silo-busting</b>, <b>high-value tool</b> 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 <b>internal communication tool</b> that <i>invisibly</i> <b>teaches them</b> about the structure of healthcare? I believe <b>good indexing</b> can do this, and I'll share why I believe this below.</span></p><p><span style="font-family: helvetica;"><b>But first</b> - I'd like to provide some background, using one of my heroes, the brilliant Clinical Informatics pioneer <a href="https://en.wikipedia.org/wiki/Lawrence_Weed"><b>Lawrence 'Larry' Weed, MD</b></a> (<i>1923 - 2017</i>).</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRiohwom3pVNjmDvX-oDHMDVLSkQz8qmF_PRieOx6tR2IPujzAbS7ShhPxTop4LmjfcgM6ZvKPGUI-BS4YCz17ZL2xYtRL-FSYgq6m_Rn3mtt_UsVY_XS1QPuEAU8lpoeT-GAmStGVwbfL/s1024/DrWeedAndDrStanley.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img alt="Dr. Weed and Dr. Stanley" border="0" data-original-height="764" data-original-width="1024" height="299" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRiohwom3pVNjmDvX-oDHMDVLSkQz8qmF_PRieOx6tR2IPujzAbS7ShhPxTop4LmjfcgM6ZvKPGUI-BS4YCz17ZL2xYtRL-FSYgq6m_Rn3mtt_UsVY_XS1QPuEAU8lpoeT-GAmStGVwbfL/w400-h299/DrWeedAndDrStanley.jpeg" title="Dr. Weed and Dr. Stanley" width="400" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><i>A treasured photo of me with the great Dr. Larry Weed, </i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><i>at the 2014 HIMSS Conference.</i></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><p></p><p><span style="font-family: helvetica;"><span>If you've ever written a <a href="https://en.wikipedia.org/wiki/SOAP_note">SOAP note</a>, it's because of Larry Weed's 1968 <a href="https://www.nejm.org/">New England Journal of Medicine</a> article, "<a href="https://www.nejm.org/doi/full/10.1056/NEJM196803142781105">Medical Records that Guide and Teach</a>" - This was the breakthrough article that changed the way the <i><b>whole globe</b> writes clinical documentation</i>. </span><span>A copy of his original article in .PDF format is available on the Washington University web site by </span><a href="http://faculty.washington.edu/tpayne/Upload/NEJM%20-%20Medical%20records%20that%20guide%20and%20teach%20(Weed%20-%201968).pdf">clicking here</a><span>.</span></span></p><p></p><p><span style="font-family: helvetica;"><i>It's a fantastic read</i>. What amazes me is that his <b><a href="https://journals.lww.com/academicmedicine/fulltext/2019/01000/remembering_lawrence_weed__a_pioneer_of_the_soap.9.aspx">SOAP note template</a></b> allowed us, <i>as clinicians</i>, to <b>organize our thoughts</b> and then <b>share them</b> <i>with other clinicians</i>. One could argue that the <b>whole specialization of healthcare in the 1960s and 1970s</b> was <i>made possible</i> through his contributions to clinical documentation! </span></p><p><span style="font-family: helvetica;"><span>In short - <b>Larry Weed was right</b>. <i>You can't separate <b>reading, writing</b> and <b>thinking</b></i> - They are <i>intrinsically connected</i>. How you <b>read and write</b> shapes how you <b>think</b>. (By the way, if you'd like to learn more about him, you can also see his </span><b>1971 Grand Rounds </b><span>at</span><span> </span><b>Emory University </b><span>by</span><span> </span><a href="https://youtu.be/qMsPXSMTpFI">clicking here</a><span>.)</span></span></p><p><span style="font-family: helvetica;">Now, borrowing from Dr. Weed's lessons that <b>what we read and write</b> shapes <b>how we think </b>- let's look back at the <b>sample index</b> we discussed in my last post. (<i>Remember, your mileage may vary, depending on your institution's needs...</i>)</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgc7KSqzq9XP27vStJvRnlZRdCIFtKR9Gz-1DIzJX2l9C1wRGVrDcKKYRWM55EBWwwbQThLZ46KunMUVEPogTIT4c9F8CWo43W-114loF4BSaVhZy9weBAzkPlzVpjqTz6pDLTi-U_om_-N/s2048/HealthcareIndex.jpg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img alt="Sample Healthcare Index" border="0" data-original-height="1536" data-original-width="2048" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgc7KSqzq9XP27vStJvRnlZRdCIFtKR9Gz-1DIzJX2l9C1wRGVrDcKKYRWM55EBWwwbQThLZ46KunMUVEPogTIT4c9F8CWo43W-114loF4BSaVhZy9weBAzkPlzVpjqTz6pDLTi-U_om_-N/w400-h300/HealthcareIndex.jpg" title="Sample Healthcare Index" width="400" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica; font-size: x-small;"><b>Note</b> : This [DRAFT] sample index may vary from institution to institution, depending on your needs. </span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica; font-size: x-small;">Also, for clarity and brevity, it also does not reflect the Board of Directors.</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">This <b>general-purpose index</b> can help us make seven very helpful Intranet homepages that guide and teach (<i>thank you Dr. Weed!</i>), with landing pages specific to each operational area of your institution, but yet connected to each other logically by <b>links</b> and strategically-designed <b>news/announcement links</b>. For example, using this index :</span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">1. The <b>Administrative Enterprise (</b><i>1</i><b>) Homepage</b> would look something like this : </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh5EX2twudlKFPZFS8mzWW4ycVt-34EyPzVWdj_EMhvG6ebMpbJhScyWHbhF4ZSXUroT8_MX2JmySB5AgQvvj3vC8OLa5Bv0c4xuSSXzGoXjZeZ2TsO85U9TLDknnjpHBrpjX9zkdqSa2g/s828/Intranet+-+1.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Administrative Enterprise Homepage (1)" border="0" data-original-height="653" data-original-width="828" height="504" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhh5EX2twudlKFPZFS8mzWW4ycVt-34EyPzVWdj_EMhvG6ebMpbJhScyWHbhF4ZSXUroT8_MX2JmySB5AgQvvj3vC8OLa5Bv0c4xuSSXzGoXjZeZ2TsO85U9TLDknnjpHBrpjX9zkdqSa2g/w640-h504/Intranet+-+1.png" title="Administrative Enterprise Homepage (1)" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Notice that in each of these pages, for institutional communication and awareness, there are <b>three news banners</b> for <b>Administrative</b> news local to this page, and also news from the <i>other areas of the organization.</i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">2. The </span><span style="font-family: helvetica;"><span style="color: #38761d; font-weight: bold;">Academic Enterprise</span><b> (</b><span style="color: #38761d;"><i>1.a</i></span><b>) </b><span style="color: #38761d; font-weight: bold;">Homepage</span></span><span style="font-family: helvetica;"> would look something like this : </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFT6i3xAAaymC1opLGNC2UV5wAX0M6VDaQCcIhrJO-vl2Cd2n69ZFobcbfn9nj5g365lQHu2CHXiEJxDI5IGwz-ao4u_hbpVqyueaxpxUtV-rB0D5cw3L896MCnLNVVE0uXpv9Nh7jIqCf/s789/Intranet+-+1-a.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Academic Enterprise Homepage (1.a)" border="0" data-original-height="522" data-original-width="789" height="424" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFT6i3xAAaymC1opLGNC2UV5wAX0M6VDaQCcIhrJO-vl2Cd2n69ZFobcbfn9nj5g365lQHu2CHXiEJxDI5IGwz-ao4u_hbpVqyueaxpxUtV-rB0D5cw3L896MCnLNVVE0uXpv9Nh7jIqCf/w640-h424/Intranet+-+1-a.png" title="Academic Enterprise Homepage (1.a)" width="640" /></a></div><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Here again, </span><b style="font-family: helvetica;"><i>for awareness</i></b><span style="font-family: helvetica;"> - there are </span><b style="font-family: helvetica;">three news banners</b><span style="font-family: helvetica;">, connecting </span><span style="color: #38761d; font-family: helvetica;"><b>Academic</b></span><span style="font-family: helvetica;"> users with the events happening in </span><b style="font-family: helvetica;">Administrative</b><span style="font-family: helvetica;">/</span><span style="color: #b45f06; font-family: helvetica;"><b>Research</b></span><span style="font-family: helvetica;">/</span><span style="color: #cc0000; font-family: helvetica;"><b>Clinical</b></span><span style="font-family: helvetica;"> Enterprises, and also the </span><span style="color: #cc0000; font-family: helvetica;"><b>clinical services</b></span><span style="font-family: helvetica;">. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">3. The </span><span style="font-family: helvetica;"><span style="color: #b45f06; font-weight: bold;">Research Enterprise</span><b> (</b><span style="color: #b45f06;"><i>1.b</i></span><b>) </b><span style="color: #b45f06; font-weight: bold;">Homepage</span></span><span style="font-family: helvetica;"> would look something like this : </span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPrFpc4JMtHCQEqO4WvD_y3CpZWBmmRvysbklp7OBo1oqvU9LkcgTmNu1J-3erDNP17N4Wc-LK4RW8kkiql_fp61VsBxzZzThaXOy2s_HJAFdUS6qEpTOdq1iXTh9F74OJDGYzVSitebeV/s814/Intranet+-+1-b.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Research Enterprise Homepage (1.b)" border="0" data-original-height="528" data-original-width="814" height="416" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPrFpc4JMtHCQEqO4WvD_y3CpZWBmmRvysbklp7OBo1oqvU9LkcgTmNu1J-3erDNP17N4Wc-LK4RW8kkiql_fp61VsBxzZzThaXOy2s_HJAFdUS6qEpTOdq1iXTh9F74OJDGYzVSitebeV/w640-h416/Intranet+-+1-b.png" title="Research Enterprise Homepage (1.b)" width="640" /></a></div></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">Again, with its </span><b style="font-family: helvetica;">three news banners</b><span style="font-family: helvetica;">, the </span><span style="color: #b45f06; font-family: helvetica;">Research Enterprise Homepage</span><span style="font-family: helvetica;"> connects users with </span><b style="font-family: helvetica;">Administrative</b><span style="font-family: helvetica;">, </span><span style="color: #38761d; font-family: helvetica;"><b>Academic</b></span><span style="font-family: helvetica;">, and </span><span style="color: #cc0000; font-family: helvetica;"><b>Clinical Enterprise</b></span><span style="font-family: helvetica;"> news. </span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><span>4. </span><span>The </span><b><span style="color: #cc0000;">Clinical Enterprise </span></b><span><b>(</b><span style="color: #cc0000;"><i>1.c</i></span><b>) </b></span><b><span style="color: #cc0000;">Homepage</span> </b><span>would look something like this : </span></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIgHaZHZF6XsTeAJDQU4iEAJq8-vlUUZQF0sbbk4IYjkkHkjcLzHGDTtplSspf2PwvbGlp4TiygpQUIpdCo3-wZunJwPx30sV9-63Dx-5OjzgXEGPkAsnW1Uiro4R5QosvTl2aGqXqDlGq/s745/Intranet+-+1-c.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Clinical Enterprise Homepage (1.c)" border="0" data-original-height="745" data-original-width="686" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIgHaZHZF6XsTeAJDQU4iEAJq8-vlUUZQF0sbbk4IYjkkHkjcLzHGDTtplSspf2PwvbGlp4TiygpQUIpdCo3-wZunJwPx30sV9-63Dx-5OjzgXEGPkAsnW1Uiro4R5QosvTl2aGqXqDlGq/w590-h640/Intranet+-+1-c.png" title="Clinical Enterprise Homepage (1.c)" width="590" /></a></div><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">While the first level of news banners here is focused on </span><b style="font-family: helvetica;"><span style="color: #cc0000;">Clinical Enterprise</span></b><span style="font-family: helvetica;"> news, the second level connects with </span><span style="color: #cc0000; font-family: helvetica;">Hospital-Based, Ambulatory-Based, and Off-Campus Services</span><span style="font-family: helvetica;">, followed by a third with </span><b style="font-family: helvetica;">Administrative</b><span style="font-family: helvetica;">, </span><span style="color: #38761d; font-family: helvetica;"><b>Academic</b></span><span style="font-family: helvetica;">, and </span><span style="color: #b45f06; font-family: helvetica;"><b>Research</b></span><span style="font-family: helvetica;"> News. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><span>5. </span><span>The </span><b><span style="color: #cc0000;">Clinical Enterprise > Hospital-Based Services </span></b><span><b>(</b><span style="color: #cc0000;"><i>1.c.i</i></span><b>) </b></span><b><span style="color: #cc0000;">Homepage</span> </b><span>would look something like this : </span></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjlEt8HrqiIVeI90i6cgIWKZNMyBULonZU7KQogRovi2kI7yY92ZsiepLw5L_O3JM5lDcLAu-BvQSSOKCEAft9jHgKWyUraVJ_v8Po1eKlczhGN3gnf6QyWT52HKNS5LYQcgKngZHG2dHq/s673/Intranet+-+1-c-i.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Clinical Enterprise > Hospital-Based (1.c.i)" border="0" data-original-height="540" data-original-width="673" height="514" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjlEt8HrqiIVeI90i6cgIWKZNMyBULonZU7KQogRovi2kI7yY92ZsiepLw5L_O3JM5lDcLAu-BvQSSOKCEAft9jHgKWyUraVJ_v8Po1eKlczhGN3gnf6QyWT52HKNS5LYQcgKngZHG2dHq/w640-h514/Intranet+-+1-c-i.png" title="Clinical Enterprise > Hospital-Based (1.c.i)" width="640" /></a></div><br /></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">Here, the primary news links are related to </span><span style="color: #cc0000; font-family: helvetica;"><b>Hospital-Based News</b></span><span style="font-family: helvetica;">, followed by </span><span style="color: #cc0000; font-family: helvetica;"><b>General Clinical Enterprise</b></span><span style="font-family: helvetica;"> and </span><span style="color: #cc0000; font-family: helvetica;"><b>Ambulatory Clinical Service</b></span><span style="font-family: helvetica;"> News, followed by </span><b style="font-family: helvetica;">Administrative</b><span style="font-family: helvetica;">, </span><b style="font-family: helvetica;"><span style="color: #b45f06;">Research</span></b><span style="font-family: helvetica;">, and </span><span style="color: #38761d; font-family: helvetica;"><b>Academic</b></span><span style="font-family: helvetica;"> News. </span></div><div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><span>6. </span><span>The </span><b><span style="color: #cc0000;">Clinical Enterprise > Ambulatory-Based Services </span></b><b>(</b><span><i><span style="color: #cc0000;">1.c.ii</span></i></span><b>) </b><b><span style="color: #cc0000;">Homepage</span> </b><span>would look something like this : </span></span></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqGXDOtHNXtYYXS2vyq3DDjLpQzw88EdfFgLPgw6NN9mBYEefOP2-kVHs1CdSx7veCh2h9T2UFx4cdERhxtLr_mtqjLWsU7FEchueZklZGxClTUtppr-OtHZzZHgwxzsT6om3NMxJYlOVa/s906/Intranet+-+1-c-ii.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Clinical Enterprise > Ambulatory (1.c.ii)" border="0" data-original-height="906" data-original-width="678" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqGXDOtHNXtYYXS2vyq3DDjLpQzw88EdfFgLPgw6NN9mBYEefOP2-kVHs1CdSx7veCh2h9T2UFx4cdERhxtLr_mtqjLWsU7FEchueZklZGxClTUtppr-OtHZzZHgwxzsT6om3NMxJYlOVa/w478-h640/Intranet+-+1-c-ii.png" title="Clinical Enterprise > Ambulatory (1.c.ii)" width="478" /></a></div><br /></div><div class="separator" style="clear: both;"><span style="font-family: helvetica;">Here, the news links will help connect </span><span style="color: #cc0000; font-family: helvetica;"><b>Ambulatory Users</b></span><span style="font-family: helvetica;"> to </span><b style="font-family: helvetica;"><span style="color: #cc0000;">Ambulatory News</span></b><span style="font-family: helvetica;">, followed by </span><b style="font-family: helvetica;"><span style="color: #cc0000;">General Clinical Enterprise</span></b><span style="font-family: helvetica;"> and </span><span style="color: #cc0000; font-family: helvetica;"><b>Hospital-Based</b></span><span style="font-family: helvetica;"> news, followed by </span><b style="font-family: helvetica;">Administrative</b><span style="font-family: helvetica;">, </span><b style="font-family: helvetica;"><span style="color: #b45f06;">Research</span></b><span style="font-family: helvetica;">, and </span><span style="color: #38761d; font-family: helvetica;"><b>Academic</b></span><span style="font-family: helvetica;"> news/announcements. </span></div></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><span>7. Finally, the <b><span style="color: #cc0000;">Clinical Enterprise > Off-Campus Services</span></b></span><span> </span><span>(<i><span style="color: #cc0000;">1.c.iii</span></i>)</span><span> </span><b><span style="color: #cc0000;">Homepage</span></b><span> would look something like this : </span></span></div><div><span style="font-family: helvetica;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVZdryB6Tk4APel6VD3ZQKyENM040QKFiFePC4XMnM0ZQrpc6EolAE1G7hKeOFzbA-uK9ZKu36J9mFmLMvadPjeoiZLpfa5yQNBUkFWT6ATSwa9o6S7xcRi3fQWBX6eFR3FcUYuyvqHKUf/s664/Intranet+-+1-c-iii.png" style="margin-left: 1em; margin-right: 1em;"><img alt="Clinical Enterprise > Off-Campus (1.c.iii)" border="0" data-original-height="338" data-original-width="664" height="326" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVZdryB6Tk4APel6VD3ZQKyENM040QKFiFePC4XMnM0ZQrpc6EolAE1G7hKeOFzbA-uK9ZKu36J9mFmLMvadPjeoiZLpfa5yQNBUkFWT6ATSwa9o6S7xcRi3fQWBX6eFR3FcUYuyvqHKUf/w640-h326/Intranet+-+1-c-iii.png" title="Clinical Enterprise > Off-Campus (1.c.iii)" width="640" /></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>Here, the news links help connect </span><span style="color: #cc0000; font-family: helvetica;"><b>Off-Campus Clinical Services</b></span><span style="font-family: helvetica;"> with </span><span style="color: #cc0000; font-family: helvetica;"><b>Off-Campus News</b></span><span style="font-family: helvetica;">, followed by </span><span style="color: #cc0000; font-family: helvetica;"><b>General Clinical Enterprise news</b></span><span style="font-family: helvetica;">, followed by </span><b style="font-family: helvetica;">Administrative</b><span style="font-family: helvetica;">, </span><span style="color: #b45f06; font-family: helvetica;"><b>Research</b></span><span style="font-family: helvetica;">, and </span><span style="color: #38761d; font-family: helvetica;"><b>Academic</b></span><span style="font-family: helvetica;"> News links. </span></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Creating this sort of framework is <b>not easy</b>, and would require a significant investment in time and resources to <i>implement and maintain</i> this. One of the biggest challenges would be <b>maintenance</b> - How exactly would you maintain such a framework? Would there be <b>one central 'webmaster'</b> <b>team</b>, or would there be <b>distributed 'webmasters' in different departments</b>, each trained to maintain their area, links, news/announcements, and files?</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">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.</span></div><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">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.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>Have any experience with Intranet optimization? See any areas for improvement? Feel free to leave them in the comments section below!</i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i><br /></i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>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!</i></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i><br /></i></span></div></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com2tag:blogger.com,1999:blog-8434050931789572015.post-108890389713163362021-06-08T00:24:00.010-04:002021-06-17T14:10:12.809-04:00Welcome to Healthcare!<p><i><span style="font-family: helvetica;">Hi fellow CMIOs, CNIOs, Clinical Leaders, and any healthcare newcomers,</span></i></p><p><span style="font-family: helvetica;">Today's post came after I recently had someone actually <b>thank me</b> (!) for quickly explaining the <b>fundamentals of healthcare</b> to them. </span></p><p><span style="font-family: helvetica;">After this conversation, it dawned on me that I've never really found a </span><b style="font-family: helvetica;">good welcome introduction</b><span style="font-family: helvetica;"> </span><b style="font-family: helvetica;">to healthcare</b><span style="font-family: helvetica;">, this industry that I've worked in for years. It's been open for business, 24/7, for <a href="https://www.dirkstanley.com/2019/04/highlights-from-last-250-years-of.html">roughly 250+ years</a>, but has never had a good <b>opportunity to pause</b> and ask itself : <i>What we are doing, and how we are doing it?</i> </span></p><p><span style="font-family: helvetica;">If you're a <b>newcomer</b> to healthcare, the welcome can sometimes seem a little cold and informal, something like this graphic :</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYOkof3xad_prtopxAGF4PQ7SqivUhp2rrQHiLVPzL2dNQtUuKMvbJKU7i2TW-uVGJVy68kHJyPTAiKKO_pZpN1sWr3BmV7jzzs4mcNFY7IgzO-hkdF70tQHdF4lAsDQliabcFlploiWGh/s686/Healthcare+Welcome+Mat.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="686" data-original-width="646" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYOkof3xad_prtopxAGF4PQ7SqivUhp2rrQHiLVPzL2dNQtUuKMvbJKU7i2TW-uVGJVy68kHJyPTAiKKO_pZpN1sWr3BmV7jzzs4mcNFY7IgzO-hkdF70tQHdF4lAsDQliabcFlploiWGh/s320/Healthcare+Welcome+Mat.png" /></span></a></div><span style="font-family: helvetica;"><br /><span>While there are some reasons why seasoned healthcare professionals might greet newcomers this way, it <b>doesn't actually help newcomers to <u>understand</u> healthcare. </b>Sure, it's an industry that saves lives and treats diseases - but it can also make technology companies throw in the towel, and can frustrate politicians, providers, and patients alike. <i>We could probably all benefit from newcomers having a good understanding of it's inner workings, before they get started.</i></span></span><div><span style="font-family: helvetica;"><span></span></span><p></p><p><span style="font-family: helvetica;">So as a Clinical Informaticist, clinical translator, and general <i>'tour guide'</i>, I thought I'd write a friendlier, more explanatory piece, to help newcomers succeed by better understanding the fundamentals of this industry.</span></p><p><span style="font-family: helvetica;">First, let's start with a sample diagram showing the overall structure of a <b>typical healthcare organization :</b></span></p><p><span style="font-family: helvetica;"></span></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9w5moXXt_swZPat-9tD264Y8NAd42phRP2YMif-aJ9fcSu6Qo3S2i_kl5QeF8_U_IfT7xyDsNo1Ynon_SunOsTaWZYSSw4Ef8ljcjRl48rKlayeoBFZdb-8zYdDFMw9w-uNRhK-P6HNMg/s2048/DRAFT+-+SLIDE+-+Structure+of+a+Typical+Healthcare+Org+-+Updated+06-06-2021.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1536" data-original-width="2048" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9w5moXXt_swZPat-9tD264Y8NAd42phRP2YMif-aJ9fcSu6Qo3S2i_kl5QeF8_U_IfT7xyDsNo1Ynon_SunOsTaWZYSSw4Ef8ljcjRl48rKlayeoBFZdb-8zYdDFMw9w-uNRhK-P6HNMg/w640-h480/DRAFT+-+SLIDE+-+Structure+of+a+Typical+Healthcare+Org+-+Updated+06-06-2021.jpeg" width="640" /></a></span></div><span style="color: #2b00fe; font-family: helvetica; font-size: x-small;"><div style="text-align: center;"><i>*<b>Note</b> : This is a <b>sample</b> general-purpose structure - Many healthcare organizations will <b>differ</b></i></div><div style="text-align: center;"><i> from this structure, </i><i>based on their mission and other local legal, financial, operational, or regulatory nee<b>ds.</b></i></div><div style="text-align: center;"><i><b>*Also note : </b>To help keep the chart simple, the Board of Directors is not depicted in the slide above. </i></div></span><p></p><p style="text-align: left;"><span style="font-family: helvetica;">If I actually did a <b>walking tour</b> of this 'House of Healthcare' (<b><span style="color: #2b00fe;"><i>not an org chart!</i></span></b>), it might actually sound like this :</span></p><p><span style="font-family: helvetica;"><b>1. THE ADMINISTRATIVE ROOM</b></span></p><p><span style="font-family: helvetica;">Walking into the administrative room, you can look around to see a lot of departments here, collectively tasked with <b>running the organization</b> and <b>providing services to the areas below them</b>. From here, some of the departments you can see include : Finance, Human Resources, Legal/Regulatory/Compliance, Privacy and Information Security, Contracting/Procurement, Employee Health, Facilities Management / Physical Plant, Public Safety/Security, Staff Education, the Switchboard/Operator, the Staff Directory, Public and Internal Communications, Enterprise IT/Informatics, Enterprise Project Management, Enterprise Analytics and Data Governance, and even the Library!</span></p><p><span style="font-family: helvetica;">These departments are all busy providing the <b>day-to-day support</b> necessary for the <span style="color: #38761d;"><b>Academic/Education</b></span>, <span style="color: #b45f06;"><b>Research</b></span>, and <span style="color: #cc0000;"><b>Clinical</b></span> domains below them - And that means understanding both the common and unique needs of these three areas. (<i>This is no small task!</i>)</span></p><p><span style="font-family: helvetica;"><b><span style="color: #38761d;">1.a. THE ACADEMIC / EDUCATIONAL ROOM</span></b></span></p><p><span style="font-family: helvetica;">Walking down the path from the <b>Administrative</b> area, the <span style="color: #38761d;"><b>Academic/Educational</b></span> room often has a lot of schools/departments here, including <b>Medical, Nursing, Dental, Pharmacy</b>, and <b>other Ancillary types of schooling</b>. While these students and staff may also do <b><span style="color: #b45f06;">research</span></b>, and may provide clinical support (<i>work</i>) to the <span style="color: #cc0000;"><b>clinical enterprise</b></span>, the main focus of this area is <span style="color: #38761d;"><b>academics and education</b></span>. So, for example, a Medical school might have several divisions : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">Undergraduate Medical Education (UME)</span></li><li><span style="font-family: helvetica;">Graduate Medical Education (GME)</span></li><li><span style="font-family: helvetica;">Continuing Medical Education (CME)</span> </li></ul><p></p><p><span style="font-family: helvetica;">Before you think that these academic areas have it easy, keep in mind that clinical care and technology are <b>constantly changing at an increasingly rapid pace</b>. What was once considered <b>desirable</b> in the past - <b><i>Memorizing textbooks full of science and clinical information</i></b> - Is now considered <i>passรฉ</i>, since a student who <b>rotely memorizes facts</b> is only memorizing clinical information that is <b>rapidly outdated</b>. Modern clinical educational thinking depends on not only learning a great deal of <b>foundational knowledge</b>, but also <b>incorporating</b> <b>electronic databases</b> and real-time decision-support tools into <b>daily practices</b>, with the goal of producing <b>clinicians</b> (<i>doctors, nurses, and pharmacists</i>) who <b>continuously improve their knowledge</b> while making decisions. </span></p><p><span style="font-family: helvetica;">Finally - Since the <b><span style="color: #b45f06;">Research</span></b> and <span style="color: #cc0000;"><b>Clinical</b></span> Enterprises often depend on the students and staff from these <b><span style="color: #38761d;">Academic</span></b> areas - They are a <b>cornerstone of many healthcare institutions</b>. (<i>Except <b>non-academic</b> institutions, which <b>do not have an academic/educational mission</b></i>.)</span></p><p><span style="font-family: helvetica;"><b><span style="color: #b45f06;">1.b. THE RESEARCH ROOM</span></b></span></p><p><span style="font-family: helvetica;">Walking up from the <span style="color: #38761d;"><b>Academic/Educational</b></span> room, you can walk down the hallway to the <b><span style="color: #b45f06;">Research</span></b> room, where you'll find a lot of very important departments, including : The <b>Independent Review Board</b> (IRB), Grant Management, Research Centers, Research Laboratories, Research Compliance, Research IT, Research Analytics and Translational science, and of course - <i>a lot of highly-educated Researchers and Research Assistants!</i></span></p><p><span style="font-family: helvetica;">This <b><span style="color: #b45f06;">research</span></b> is very important to us as a society, since it drives the <b>foundations of medicine</b> by creating the therapies and understanding that we all depend on. </span></p><p><span style="font-family: helvetica;"><b><span style="color: #cc0000;">1.c. THE CLINICAL ENTERPRISE ROOM</span></b></span></p><p><span style="font-family: helvetica;">Now walking from the <span style="color: #b45f06;"><b>Research Enterprise</b></span> to the <span style="color: #cc0000;"><b>Clinical Enterprise</b></span>, you'll notice some <b>sudden, palpable cultural changes</b> : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">The <span style="color: #cc0000;"><b>Clinical Enterprise</b></span> is largely <b>open-for-business 24/7</b>, so many of the staff are used to working in <b>shifts</b> and on <b>holidays</b>. </span></li><li><span style="font-family: helvetica;"><b>Patient safety</b> is a constant focus of the workers here.</span></li><li><span style="font-family: helvetica;">A lot of people in these areas are wearing <b>scrubs or white coats</b>, and the <b>air</b> often smells faintly of <b>antiseptic cleaning fluids</b>.</span></li><li><span style="font-family: helvetica;">The <b>fault tolerance is suddenly a lot less -</b> requiring <b>higher standards</b> for hiring, budgeting, training, and implementing new tools. </span></li><li><span style="font-family: helvetica;">Because it <b>never gets to shut down for maintenance</b>, and the <b>low fault-tolerance</b> - both the <b>change management</b> and <b>project management</b> are <i>higher-caliber</i> and <i>noticeably different</i>.</span></li><li><span style="font-family: helvetica;">The staff are often <b>highly-educated</b>, many with large amounts of <b>student debt</b>, so the <i>salaries are suddenly higher</i>. </span></li><li><span style="font-family: helvetica;">The <b>language and culture change</b>, and may sometimes <i>overlap</i> <b>or</b> <i>be different</i> than the culture and language of the <span style="color: #38761d;"><b>Academic/Educational</b></span> or <span style="color: #b45f06;"><b>Research</b></span> enterprises.. </span></li><li><span style="font-family: helvetica;">Navigating the '<i>quasi-military'</i> style <span style="color: #cc0000;"><b>clinical roles and responsibilities</b></span> can sometimes be very complicated.</span></li></ul><div><span style="font-family: helvetica;">In this first <b><span style="color: #cc0000;">top 1.c Clinical Enterprise</span></b> box, we can see the many <b><span style="color: #cc0000;">Clinical Enterprise Departments</span></b> that <b>support the patient care activities of all of the areas below them</b>, including : Credentialing, Medical Staff Office, Nursing Department, Pharmacy & Therapeutics Department, Laboratory & Pathology Department, Diagnostic Radiology, Interventional Radiology, Non-Invasive Cardiology, Interventional Cardiology, Dietary/Nutrition, Physical Therapy, Occupational Therapy, Speech Therapy, Case Management / Social Work, <b>Health Information Management</b>, <b>Registration</b>, <b>Access Management</b>, <b>Revenue</b> (<i>Billing/Coding</i>), Housekeeping, Call Center, Scheduling, <b>Clinical IT/Informatics</b>, and Biomedical Engineering.</span></div><div><br /></div><div><span style="font-family: helvetica;">While many of these Departments above might be <b><span style="color: #2b00fe;">physically located <u>inside</u> the Hospital</span></b>, it's important to note that the <i><b>majority</b> of these departments </i>serve the needs of :</span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;">the <b>Hospital-based</b> care areas, <i>and...</i></span></li><li><span style="font-family: helvetica;">the <b>Clinic-based</b> care areas, <i>and even ...</i></span></li><li><span style="font-family: helvetica;">the <b>Nursing Home / Patient Home</b> care areas. </span></li></ul></div><div><span style="font-family: helvetica;">Let's now take a walk through the first of our patient care areas, the <b>Hospital-based </b>patient care locations...</span></div><p></p><p><span style="font-family: helvetica;"><b><span style="color: #cc0000;">1.c.i. THE HOSPITAL-BASED PATIENT CARE LOCATIONS</span></b></span></p><p><span style="font-family: helvetica;">Walking through here, we can see a number of hospital-based departments / patient care areas in this room : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">Emergency Department (<i>technically an outpatient area!</i>)</span></li><li><span style="font-family: helvetica;">Inpatient Unit - Med/Surg</span></li><li><span style="font-family: helvetica;">Inpatient Unit - Intermediate Unit (often Cardiac Telemetry)</span></li><li><span style="font-family: helvetica;">Inpatient Unit - Intensive Care Unit (ICU)</span></li><li><span style="font-family: helvetica;">Inpatient Unit - Labor and Delivery</span></li><li><span style="font-family: helvetica;">Inpatient Unit - Nursery</span></li><li><span style="font-family: helvetica;">Inpatient Unit - Pediatrics</span></li><li><span style="font-family: helvetica;">Inpatient Unit - Psychiatry </span></li><li><span style="font-family: helvetica;">Perioperative Services (Pre-Op, OR, PACU) (<i>technically all outpatient areas!</i>)</span></li><li><span style="font-family: helvetica;">Ambulatory Procedural Suites (<i>e.g. Endoscopy, Bronchoscopy, Interventional Cardiology, Interventional Radiology, sleep labs, EKG/Echos, etc.</i>) (<i>technically all outpatient areas!</i>)</span></li><li><span style="font-family: helvetica;">Chemotherapy and Infusion Suites (<i>note : in some organizations these are not hospital-based areas)</i></span></li></ul><p></p><p><span style="font-family: helvetica;">A <b>lot of care</b> is delivered in these <b><span style="color: #cc0000;">hospital-based patient care areas</span></b>! And keep in mind, it's a common mistake to either <b>under- or over-estimate</b> the acuity, complexity, or importance of these hospital-based areas - </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">The clinic-based areas can be every bit as acute, complex, and important!</span></li><li><span style="font-family: helvetica;">Many workflows <b>start</b> in the <b>ambulatory clinic-based areas</b>, and end in the <b>Inpatient/ED (hospital)-based areas - </b><i>And vice-versa!</i> </span></li></ul><div><span style="font-family: helvetica;">So understanding these many hospital-based patient care areas is only a <i><b>part</b> of the story</i>.</span></div><p></p><p><span style="font-family: helvetica;"><b><span style="color: #cc0000;">1.c.ii. THE AMBULATORY (CLINIC) BASED LOCATIONS</span></b></span></p><p><span style="font-family: helvetica;">In the Ambulatory (<i>Clinic</i>) based locations, you can find a lot of ambulatory clinics, along with sometimes some remote radiology services, blood draw services, and even some procedural and infusion services. For example, you'll commonly see Primary Care and clinics including : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;">Neonatology / Maternal Fetal Medicine</span></li><li><span style="font-family: helvetica;">General Pediatrics</span></li><li><span style="font-family: helvetica;">Family Medicine</span></li><li><span style="font-family: helvetica;">Medicine - General Internal Medicine</span></li><li><span style="font-family: helvetica;">Medicine - Geriatrics</span></li><li><span style="font-family: helvetica;">Medicine - Cardiology (General non-invasive and invasive/interventioal)</span></li><li><span style="font-family: helvetica;">Medicine - Endocrinology</span></li><li><span style="font-family: helvetica;">Medicine - Gastroenterology</span></li><li><span style="font-family: helvetica;">Medicine - Pulmonary / Sleep Medicine</span></li><li><span style="font-family: helvetica;">Medicine - Rheumatology</span></li><li><span style="font-family: helvetica;">Neurology - General</span></li><li><span style="font-family: helvetica;">Neurology - Movement Disorders</span></li><li><span style="font-family: helvetica;">Surgery - General</span></li><li><span style="font-family: helvetica;">Surgery - Neurosurgery</span></li><li><span style="font-family: helvetica;">Surgery - Ophthalmology</span></li><li><span style="font-family: helvetica;">Surgery - Plastics</span></li><li><span style="font-family: helvetica;">Surgery - Otolaryngology (<i>Ear, Nose, & Throat,</i> or <i>ENT</i>)</span></li><li><span style="font-family: helvetica;">Surgery - Orthopedics (Bone & Joint)</span></li><li><span style="font-family: helvetica;">OBGYN</span></li><li><span style="font-family: helvetica;">Maternal Fetal Medicine</span></li><li><span style="font-family: helvetica;">Psychiatry - General Adult</span></li><li><span style="font-family: helvetica;">Psychiatry - Pediatric and Adolescent</span></li><li><span style="font-family: helvetica;">Dermatology - General Dermatology</span></li><li><span style="font-family: helvetica;">Dermatology - Mohs Surgery</span></li><li><span style="font-family: helvetica;">Hematology and Oncology (<i>often divides up into several specialty subdivisions of care</i>)</span></li><li><span style="font-family: helvetica;">Radiation Oncology</span></li><li><span style="font-family: helvetica;">Genetics Counseling</span></li><li><span style="font-family: helvetica;">Physical Therapy</span></li><li><span style="font-family: helvetica;">Occupational Therapy</span></li><li><span style="font-family: helvetica;">Speech Therapy</span></li><li><span style="font-family: helvetica;">Diet/Nutrition</span></li><li><span style="font-family: helvetica;">Anesthesiology / Perioperative Medicine</span></li><li><span style="font-family: helvetica;">Urgent Care</span></li></ul><p></p><p><span style="font-family: helvetica;">... <i>and more</i>!</span></p><p><span style="font-family: helvetica;">While they are <b>generally only open during business hours</b>, these ambulatory clinics provide a <b>tremendous amount of care</b> to a <b>tremendous number of patients</b>, and often have acuity, complexity, and safety issues on par with the <b>hospital-based areas</b>.</span></p><p><span style="font-family: helvetica;"><b><span style="color: #cc0000;">1.c.iii. THE OFF-SITE (NURSING HOME) or HOME CARE LOCATIONS</span></b></span></p><p><span style="font-family: helvetica;">For our final stop in our tour of the 'House of Healthcare', we'll be stopping at the nursing-home and patient-home-based care. Yes, house visits still exist! These are growing areas for many healthcare institutions, and especially since COVID, this segment is only expected to grow in the near future. It often requires providers with unique documentation/billing practices, but this is an important source of care for hospice, homebound, and nursing home patients. </span></p><p><span style="font-family: helvetica;"><b>SOME FINAL WORDS</b></span></p><p><span style="font-family: helvetica;">Before we wrap up our walking tour, it's important to note that <b>Population Health</b> is a growing trend, which ties reimbursement strategies to improved health and improved patient outcomes. While much of the focus is on outpatient/ambulatory clinics, it can also impact a number of hospital-based workflows, and so it's important for everyone to understand the role that Population Health plays.</span></p><p><span style="font-family: helvetica;">And for the particular segment that I work in (IT/Informatics), it's important to note that there are essentially <b>four IT/Informatics domains</b> that cover the spectrum of a typical healthcare organization : </span></p><p></p><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b>Administrative</b> (<i>Enterprise</i>) <b>IT/Informatics</b> (<i>often includes Analytics/Data Governance, and infrastructure like servers, network architecture, security, interface management, hardware/software procurement, life cycle management, desktop/application management, etc.</i>)</span></li><li><span style="color: #6aa84f; font-family: helvetica;"><b>Academic/Educational IT/Informatics</b></span></li><li><span style="color: #e69138; font-family: helvetica;"><b>Research IT/Informatics</b></span></li><li><span style="color: #cc0000; font-family: helvetica;"><b>Clinical IT/Informatics</b></span></li></ul><div><span style="font-family: helvetica;">... each with their own unique language, culture, regulations, needs, and stakeholders.</span></div><div><br /></div><div><span style="font-family: helvetica;">I hope this has been a <b>quick, helpful virtual tour</b> of a <b>typical healthcare organization</b> - Remember, <b>many organizations will vary slightly</b>, based on mission and local financial, legal, or regulatory needs. If you have any questions or comments, please feel free to leave them in the comments section below!</span></div><div><span style="font-family: helvetica;"><i><br /></i></span></div><div><span style="font-family: helvetica;"><i>Remember, this blog is for educational discussion only - Your mileage may vary. Have any insights into healthcare structures, or emerging trends that are shaping healthcare? Feel free to leave them in the comments section below!</i></span></div><p></p></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-53667950438827885382021-04-13T00:21:00.012-04:002021-05-25T23:04:19.261-04:00Getting from A to B : Project Management for Clinical Leaders<p><span style="font-family: helvetica;"><i> Hi fellow CMIOs, CNIOs, #HealthIT, and #Informatics leaders and friends,</i></span></p><p><span style="font-family: helvetica;"><b>Change is important</b>. As a clinical leader, you'll want to know how to make workflow changes, either to help <b>fix a workflow</b> that's not ideal, <b>update a workflow</b> that needs updating, or <b>build a new workflow</b>. (<i>As long as there are new journal articles and conferences, there will be necessary updates to clinical practice to stay current</i>.)</span></p><p><span style="font-family: helvetica;">So this week, I thought I'd write about a topic that can help a clinical leader to feel comfortable with making changes in their area: </span></p><p style="text-align: center;"><span style="font-family: helvetica; font-size: large;"><b>"How to get from Point A to Point B"</b></span></p><p><span style="font-family: helvetica;">I once alluded to a problem with making changes back in 2016, when I blogged about the <a href="https://www.dirkstanley.com/2016/02/the-red-sneaker-problem.html">Red Sneaker Problem - And How To Fix It</a>. To help avoid frustration for you and your team, it's helpful to understand '<i>How does anything change?</i>'. Without understanding the change process, it can be <b>hard to make change</b>. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJJJgxQITd_fHSqJ-habR4PIDmDAMw280QtYSThyGOwg2e8c4iiJiYXA9dpH58ccbXHoBFUU0DC5ozXOdDnIOcecP925CX16gbFhJHPmbBZx11uLXbZ6R50IOvdbUwVrhvuvS10-mmVgt3/s1204/PMforClinicians.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="651" data-original-width="1204" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJJJgxQITd_fHSqJ-habR4PIDmDAMw280QtYSThyGOwg2e8c4iiJiYXA9dpH58ccbXHoBFUU0DC5ozXOdDnIOcecP925CX16gbFhJHPmbBZx11uLXbZ6R50IOvdbUwVrhvuvS10-mmVgt3/w400-h216/PMforClinicians.jpeg" width="400" /></span></a></div><span style="font-family: helvetica;"><br />Although clinical leaders often need to focus primarily on clinical services, functions, and expertise - it's still helpful to know the basics about <b>two important things</b>, related to '<i>how things get done</i>' : </span><p></p><p></p><ol style="text-align: left;"><li><span style="font-family: helvetica;"><b>Project Intake / Scoping </b>- Helps you <i>secure</i> necessary people, time, and resources <span style="color: #2b00fe;"><i><b>before</b> you start a change project</i></span>.</span></li><li><span style="font-family: helvetica;"><b>Project Management</b> - Helps you effectively use those people, time, and resources to get things done (<i><span style="color: #2b00fe;">accomplish the change</span></i>)</span></li></ol><p></p><p><span style="font-family: helvetica;">Without understanding these two steps, it can be very hard to accomplish much change. And without regular, smooth, and predictable changes, clinical leadership can seem more daunting than it needs to be. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhowFA-cWHh2FpNk865H_K0YM_nGrSKm-mTudHTWL_OJ4XbepLm4tsaOq5ZXAJ2xdhjAXK1AvJXx8Bi_Huwc6_lUhSIy4YRtaRPBLnG-_wddd6VeCI1XphDJMFHG9K0bs73Tnpq0kq4Fcu7/s786/ProjectMgtForHcldrs.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="428" data-original-width="786" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhowFA-cWHh2FpNk865H_K0YM_nGrSKm-mTudHTWL_OJ4XbepLm4tsaOq5ZXAJ2xdhjAXK1AvJXx8Bi_Huwc6_lUhSIy4YRtaRPBLnG-_wddd6VeCI1XphDJMFHG9K0bs73Tnpq0kq4Fcu7/w400-h217/ProjectMgtForHcldrs.png" width="400" /></span></a></div><span style="font-family: helvetica;"><p><span style="font-family: helvetica;">So as a <b>brief introduction</b> for new clinical leaders, let's review these two items in a little more detail. Borrowing some slides from a recent presentation I did for a group of clinical leaders, I present some high-level overview below. </span></p><p><b><span style="font-size: large;">1. PROJECT INTAKE / SCOPING - </span></b></p></span><p></p><p><span style="font-family: helvetica;"><i>Making change is work</i>. It takes people, time, and resources, to move your <b><span style="color: red;">CURRENT</span> state</b> (<span style="color: red;"><b>Point A</b></span>) to your desired <b><span style="color: #38761d;">FUTURE</span> state</b> (<span style="color: #38761d;"><b>Point B</b></span>). </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjs_IXF7h8K2mGe3OrWYW_mt83SOuKODtVbWaJ9aFzvtvXUif_xca8Fkq0ifzMs3ydGo2K6ZXjb5DwP4UaovLi_hTkzgJGb7eqGAbTbovSBQ_NfYRmfJUkNt-nKsp97dJziIOcoQ1HPvLCG/s575/PMforHcLdrs1.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="523" data-original-width="575" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjs_IXF7h8K2mGe3OrWYW_mt83SOuKODtVbWaJ9aFzvtvXUif_xca8Fkq0ifzMs3ydGo2K6ZXjb5DwP4UaovLi_hTkzgJGb7eqGAbTbovSBQ_NfYRmfJUkNt-nKsp97dJziIOcoQ1HPvLCG/s320/PMforHcLdrs1.jpeg" width="320" /></span></a></div><span style="font-family: helvetica;">Ideally, to make sure you have the '<i>gas</i>' needed to drive your '<i>car</i>' to where you want it to go, you'll first need to understand the <b>scope (</b><i>'size'</i><b>) </b>of your project. Conceptually, think of this as collectively driving your car (<i>with your team inside it!</i>) from :</span><div><ul style="text-align: left;"><li><span style="font-family: helvetica;">Your <span style="color: red;"><b>CURRENT</b></span> state (<span style="color: red;"><b>Point A</b></span>)</span></li><li><span style="font-family: helvetica;">Your desired <span style="color: #38761d;"><b>FUTURE</b></span> state (<span style="color: #38761d;"><b>Point B</b></span>)</span></li></ul><div><span style="font-family: helvetica;"><i>This is why I always advise people to formally map the current and future states</i>. The <b>distance</b> between these <b>two points</b> is what will determine the <b>scope</b> (<i>size</i>) of your project, and the <b>work effort</b> (<i>and resources</i>) needed to accomplish your goal.</span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;">If you <b>have</b> the time, people, and resources necessary to get from <span style="color: red;"><b>Point A</b></span> to <span style="color: #38761d;"><b>Point B </b></span>- <i>Great</i>! </span></li><li><span style="font-family: helvetica;">If you <b>don't</b>... Then you <i>may feel frustrated</i>.</span></li></ul></div><div><span style="font-family: helvetica;">So to make sure you have a <b>thorough, well-documented analysis</b> that you can share with your project team - it's very helpful to formally document, in a folder, your <span style="color: red;"><b>CURRENT state</b></span>, and also formally design your ideal <span style="color: #38761d;"><b>FUTURE state, </b></span></span><span style="font-family: helvetica;">one that is formally <b>signed off</b> by the clinical leaders who oversee the <b>clinical staff who will live in this new future-state workflow</b>. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">People sometimes ask me : "<i><span style="color: #2b00fe;">Do I need to do this much for <b>every change</b> I want to make?</span></i>" <b>My advice</b> : You only need to <b>apply as much rigor as you need</b> to get the change accomplished. E.g. : </span></div><div><ul style="text-align: left;"><li><span style="font-family: helvetica;"><b>For <span style="color: #800180;">small changes</span></b> (<i>e.g. making some small changes to a documentation template</i>) --> <span style="color: #800180;"><b>Usually, less rigor is required</b></span></span></li><li><span style="font-family: helvetica;"><b>For <span style="color: #e69138;">large changes</span></b> (<i>e.g. implementing electronic med reconciliation at all transitions of care</i>) --> <span style="color: #ffa400;"><b>Much more rigor is required</b></span></span></li></ul></div><div><span style="font-family: helvetica;">This exercise will not only help you <b>scope your project</b>, and identify the <i>people, time, and resources </i>you will need to secure - It will also help you formally <b>plan a project</b>, estimate the <b>return on investment</b> (ROI), and <b>secure the necessary approvals</b> <i>before</i> beginning your project. </span></div><div><p><span style="font-family: helvetica; font-size: large;"><b><u>2. CLINICAL PROJECT MANAGEMENT</u></b></span></p><p><span style="font-family: helvetica;">Once you have secured the necessary people, time, and resources, and have the approvals of your leadership to move forward - It's helpful to identify a <b>formal, trained, and experienced project manager</b> to plan, orchestrate, and lead your project. For a high-level overview, you can see the Wikipedia piece : <a href="https://en.wikipedia.org/wiki/Project_management">https://en.wikipedia.org/wiki/Project_management</a> </span></p><p><span style="font-family: helvetica;">For planning purposes, many experienced project managers might develop a </span><b style="font-family: helvetica;">Gantt Chart</b><span style="font-family: helvetica;"> ( see </span><a href="https://en.wikipedia.org/wiki/Gantt_chart" style="font-family: helvetica;">https://en.wikipedia.org/wiki/Gantt_chart</a><span style="font-family: helvetica;"> ), a sort of </span><b style="font-family: helvetica;">ordered series of steps</b><span style="font-family: helvetica;">, with time estimates and dependencies, that will be needed to </span><b style="font-family: helvetica;">finish the project</b><span style="font-family: helvetica;"> </span><b style="font-family: helvetica;">and achieve the desired outcome</b><span style="font-family: helvetica;">. Similar, but also helpful is a <a href="https://en.wikipedia.org/wiki/Responsibility_assignment_matrix"><b>Responsibility Assignment Matrix</b></a>, sometimes called a <b><a href="https://en.wikipedia.org/wiki/Responsibility_assignment_matrix">RACI Chart</a></b>. </span></p><p><span style="font-family: helvetica;"><b>Experienced clinical leaders</b>, especially those who have worked with <b>good project managers</b>, can often help a project by anticipating steps and helping to answer questions <i>before</i> they arise. While there are <b>different types of project management</b> (<i>from the more <a href="https://en.wikipedia.org/wiki/Waterfall_model">traditional waterfall model</a>, to newer <a href="https://en.wikipedia.org/wiki/Agile_software_development">agile methodologies</a></i>), I've stripped down some bare essentials that are helpful to think about before starting any clinical update or improvement project : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiO8rk_83HZy4Igs7qEhNwCM8nYyRKs0Fdd2Wlx0gXbc7fPOVPox3Hfr5W8qzrncX5zB2HSVyDioGQ0QET5RR6FXJn0Dip2S5zK4RTcobXe4tz4FqfsNiVO4k4uweDB4Dy10Cn0M97R_t53/s1440/ClinicalProjectMgt.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="810" data-original-width="1440" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiO8rk_83HZy4Igs7qEhNwCM8nYyRKs0Fdd2Wlx0gXbc7fPOVPox3Hfr5W8qzrncX5zB2HSVyDioGQ0QET5RR6FXJn0Dip2S5zK4RTcobXe4tz4FqfsNiVO4k4uweDB4Dy10Cn0M97R_t53/w640-h360/ClinicalProjectMgt.jpeg" width="640" /></a></div><p></p><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>These are the ten steps (<i>above</i>) that I commonly plan and follow for <b>clinical projects</b>, where the <b>rigors of step two (2) above </b>are often necessary to help adequately scope and plan clinical projects, and help ensure that there are no unanticipated surprises later in the project. <i><span style="color: #2b00fe;">Note: <b>Clinical Informatics professionals</b> often work in steps 2, 4, 5, 6, and 9 above, working closely with end-users, analysts, educators, and project managers.</span></i></span></div><div><span style="font-family: helvetica;"><br />As a clinical leader, you will want to help champion change and updated practices. While there is much more to be said about project intake, scoping, planning, and execution, I hope this little introduction will help my friends in clinical leadership see the value of <b>good project managers</b>, and <b>good project planning, </b>and the role they play in <b>getting things done.</b><br /></span><p></p><p><span style="font-family: helvetica;"><i>Remember, this blog is for educational purposes only - <b>Your mileage may vary</b>. Always ask your local Project Management and Clinical Informatics professionals for guidance, and work closely with your clinical leadership to review, prioritize, and approve your projects before initiating any changes.</i></span></p><p><span style="font-family: helvetica;"><i>Have any stories to share about clinical leadership in supporting clinical projects? Have any tips or tricks to share from your own clinical project management experiences? Feel free to leave them in the comments section below!</i></span></p></div></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-14836861252239922232021-03-21T22:11:00.000-04:002021-03-21T22:11:21.107-04:00Another Trick for Untangling Workflows - Improved Document Design<p><span style="font-family: helvetica;"><i> Hi fellow CMIOs, CNIOs, and other Clinical #Informatics and #HealthIT friends,</i></span></p><p><span style="font-family: helvetica;">In my last blog post, I shared some slides from a recent talk I gave to a group of newcomers to the world of <b>Applied Clinical Informatics</b>, and shared my <b>first trick</b> for untangling and controlling workflows - <a href="https://www.dirkstanley.com/2021/03/untangling-workflows-cupcake-test.html">technical procedure writing (<i>'the Cupcake Test'</i>)</a>. </span></p><p><span style="font-family: helvetica;">For today's blog post, I'd like to share <b>another helpful trick</b> for untangling and controlling workflows - Designing documents, both <b><span style="color: red;">inside</span></b> and <span style="color: #d9d2e9;"><b>outside</b></span> of your EMR, to help clarify and improve workflow.</span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQeEPvwnjygJMFlwiT0X0H1GBHrIG1u8bP77n1kn-9Etfth80yuuJUYelPuOUGzurwpW8UltLS0Y04o9uJ1lMTNn4HQUfttY2tdWySyEo990c8x1ltzghakfahPcHByhcR3CoOy4ja5Tgq/s732/Screen+Shot+2021-03-15+at+10.45.57+PM.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="458" data-original-width="732" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQeEPvwnjygJMFlwiT0X0H1GBHrIG1u8bP77n1kn-9Etfth80yuuJUYelPuOUGzurwpW8UltLS0Y04o9uJ1lMTNn4HQUfttY2tdWySyEo990c8x1ltzghakfahPcHByhcR3CoOy4ja5Tgq/w640-h400/Screen+Shot+2021-03-15+at+10.45.57+PM.png" width="640" /></span></a></div><p><span style="font-family: helvetica;">There's a common saying in both Applied Clinical Informatics and technical document writing : "<b><i><span style="color: #2b00fe;">Control your documents, before they control you.</span></i></b>" This is basically how I learned to love documents - They actually <b>do create standards</b>, but <i>only if you know how to use them properly</i>. </span></p><p><span style="font-family: helvetica;"><b>Documents</b> are tools used to <i><b>record</b> and <b>transmit</b> information</i>. To help better explain the <b>power of documents</b>, it's helpful to look back at patterns set into motion by our earliest human ancestors, when they first learned to document <b>on the walls of caves</b>. Their <b>ideas</b> could be turned into <b>images and symbols</b>, that would in turn <b>put information into other heads</b>. It was the first time that humans really learned the power of <b>documentation</b> : </span></p><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBB5LzN-raQaVHm9vy6j9fKBJrGhTiXtijyObx6W5kgXAqznW-75O-VjYtjjxeOqfUmpWfsPrAPDxAtpqIjiCDjw5FBqnDyMo3e3g4BBbl1FXNdIoJl4GoWiwPTdYi_kyRwlmOth7qqPOt/s720/Slide21.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBB5LzN-raQaVHm9vy6j9fKBJrGhTiXtijyObx6W5kgXAqznW-75O-VjYtjjxeOqfUmpWfsPrAPDxAtpqIjiCDjw5FBqnDyMo3e3g4BBbl1FXNdIoJl4GoWiwPTdYi_kyRwlmOth7qqPOt/w640-h360/Slide21.jpeg" width="640" /></span></a></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">And so, an organization is simply <b>four walls</b>, into which a bunch of <b>people</b> and <b>documents</b> have been placed : </span></div><div class="separator" style="clear: both; text-align: left;"><ul style="text-align: left;"><li><span style="font-family: helvetica;">If the <b>documents</b> are <b>clear and <i>easy-to-find</i></b>, your <b>staff</b> will use them to understand your values and needs, and <b>will create <span style="color: #2b00fe;">predictable patterns and outcomes</span></b>. </span></li><li><span style="font-family: helvetica;">If the <b>documents are vague</b> or <b>not <i>easy-to-find</i></b>, your staff will not use them to understand your values and needs, and <b>will <span style="color: red;">not create predictable patterns or outcomes</span></b><span style="color: red;">. </span></span></li></ul><div><span style="font-family: helvetica;">Interesting to note is that if you were to create a <b>whole new hospital, <u><i>from scratch</i></u> -</b> you would need <b>about 24 document types</b> to effectively run <i>any hospital</i> - About 12 are commonly found <b><span style="color: red;">inside your EMR</span></b>, and about 12 are commonly found <b><span style="color: #a2c4c9;">outside your EMR</span></b> : </span></div></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdSnG1rzEJViFxqMdp5_ui22G2z9FNeVPHlgHEnAfjuhSdRMcjfuxUaX1cYushV1nnJ2ldR1v3QGFpk2SVQV0BTqHxz1wMx4o37LjBPRMS94XJLYb6ofjZRl5MHjhIyNrZ3XZNfy0MljaB/s720/Slide22.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdSnG1rzEJViFxqMdp5_ui22G2z9FNeVPHlgHEnAfjuhSdRMcjfuxUaX1cYushV1nnJ2ldR1v3QGFpk2SVQV0BTqHxz1wMx4o37LjBPRMS94XJLYb6ofjZRl5MHjhIyNrZ3XZNfy0MljaB/w640-h360/Slide22.jpeg" width="640" /></span></a></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">So if we assume that all of healthcare depends on these 24 document types to run, then this helps us simplify change management into three key steps : </span></div><div class="separator" style="clear: both; text-align: left;"><ol style="text-align: left;"><li><span style="font-family: helvetica;">STEP 1 : Define your current-state <span style="color: #800180;"><b>worfklow</b></span>. (<i>"Point A"</i>) </span></li><li><span style="font-family: helvetica;">STEP 2 : Design your desired future-state <b><span style="color: #800180;">workflow</span></b>. (<i>"Point B"</i>)</span></li><li><span style="font-family: helvetica;">STEP 3 : Identify which of the 24 tool(s) (<i>both <b><span style="color: red;">inside the EMR</span></b> and <b><span style="color: #a2c4c9;">outside the EMR</span></b></i>) you need to get FROM the <b><span style="color: #800180;">workflow</span></b> defined in step #1 above, TO the <b><span style="color: #800180;">workflow</span></b> defined in step #2 above. </span></li></ol><div><span style="font-family: helvetica;"><b>Another nice side-benefit</b> to <b>improving your document design</b> is the opportunity to help get people better <b>aligned in their understanding</b> of commonly-used tools and concepts. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">For example, let's say you'd like to help get clinical staff better aligned in their understanding of the term "<b>PROTOCOL</b>". It's a term that is particularly difficult to nail down and define, so many people have slightly different interpretations of <i>what-exactly-a-protocol-is-and-what-it-does : </i></span></div></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpdV6P4jpua8PIEyiVbcA2UEuFD6TGwhJG0GbX8rVSYL5tG54iE4xr7J7xw9TNs9Sww8pgJ80Q_1R-thYgtW-5jrIaUnI2e1uEN54wR07wUok8bDT8c3YCpciyoOkbfbuU7ahKP608IneE/s720/Slide23.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpdV6P4jpua8PIEyiVbcA2UEuFD6TGwhJG0GbX8rVSYL5tG54iE4xr7J7xw9TNs9Sww8pgJ80Q_1R-thYgtW-5jrIaUnI2e1uEN54wR07wUok8bDT8c3YCpciyoOkbfbuU7ahKP608IneE/w640-h360/Slide23.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;"><div>After first reviewing your State and Federal regulations, and then your own operational needs, you can then use these four steps to increase clarity and understanding : </div><div><ol style="text-align: left;"><li>STEP 1 : <b>DEFINITION</b> - Write a clear, simple, one-sentence, policy-grade definition to answer the question, "<i>What is a protocol, and what does it do?</i>"</li><li>STEP 2 : <b>TEMPLATE</b> - After you have a good working definition, design a template for creating protocols. </li><li>STEP 3 : <b>PROCEDURE</b> - After you have a good working definition and template - design a good procedure for drafting, reviewing/vetting, approving, publishing, monitoring, and archiving protocols. </li><li>STEP 4 : <b>EDUCATION</b> - After you have the procedure in step #3 nailed down, you can start to educate your staff about your new definition, template, and process - And soon people's common understanding will increase, with this new foundation and support for this important document. </li></ol><div>This kind of foundational work is especially helpful when trying to get teams of people to work on complex clinical workflows. </div></div><div><br /></div><div>Need some guidance about how to go about writing clear, simple, one-sentence, policy-grade definitions (<i>as in step #1 above)</i>? - For this, I first recommend first working with your legal, regulatory, and compliance staff to review the applicable Federal, State, and local regulations. After reviewing the regulations, you can then use a spreadsheet to draft a "<a href="https://www.dirkstanley.com/2010/08/cmios-checklist.html">CMIO's Checklist</a>", which is very helpful in creating definitions that meet or exceed these regulations : </div><br /></span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZh-lyIevNOqLokZvXDriaMG5yFIOyL5se5pEBeF6Oh0xCP3zhoHkXJPr_C6rgTHc3dLwZq62kz2c96Xoxj2t2TA5q5T7c8Saj5iyuwlFNqHqqD6aCgTK8M9QEca19wVUqyz2qFAq694Tz/s720/Slide24.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZh-lyIevNOqLokZvXDriaMG5yFIOyL5se5pEBeF6Oh0xCP3zhoHkXJPr_C6rgTHc3dLwZq62kz2c96Xoxj2t2TA5q5T7c8Saj5iyuwlFNqHqqD6aCgTK8M9QEca19wVUqyz2qFAq694Tz/w640-h360/Slide24.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>You can use this type of spreadsheet to work on elevating your definitions, for presentation back to your legal and compliance team, for their <b>review</b> and <b>final approvals</b>. <i>With improved <b>definitions</b> comes improved <b>understanding</b></i>. </span><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">In my next post, I'll share two more helpful tricks (<i>from my recent presentations</i>) that clinical leaders and informaticists can use to help untangle workflows. </span></div><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;"><i>Remember - This blog is for <b>education and discussion purposes only</b> - <b>Your mileage may vary</b>. Always review with your Clinical Leadership, Legal/Compliance teams, and Informatics leadership before publishing or changing any definitions or document templates. </i></span></div><div><span style="font-family: helvetica;"><i><br /></i></span></div><div><span style="font-family: helvetica;"><i>Have any experience with redesigning document archetypes to enhance clarity or understanding? Feel free to leave in the comments section below!</i></span></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-76189663637007623852021-03-07T09:51:00.002-05:002021-03-07T10:37:25.046-05:00Untangling Workflows - The Cupcake Test<p><i><span style="font-family: helvetica;"> Hi fellow CMIOs, CNIOs, and other Clinical Informatics friends,</span></i></p><p><span style="font-family: helvetica;">As I mentioned in my last post, I recently had the opportunity to share some workflow design tips with an online group of new physicians who are getting into Applied Clinical Informatics and workflow building. During my talk, I shared some <b>helpful</b> <b>workflow tricks</b> that I use to untangle even the most complex clinical workflows. Even though I've <a href="https://www.dirkstanley.com/2020/09/how-to-untangle-complex-clinical.html">written about this one before</a>, it's so useful I figured I should re-review and elaborate with this new audience. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPZmprvsmB7C68I8KNsih2IRNQ2BTKoMZQiKIz3a-P56fZzLXYsl2UiFz8i6rWKazzC3hlD9YEBlAmXa-u_45R0i7vwbsQ2ylvpxxmMz31NZt09y2sWZSxxbtwHnDTiE9VoTUPkMPBf370/s720/InformaticsMeme.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="540" data-original-width="720" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPZmprvsmB7C68I8KNsih2IRNQ2BTKoMZQiKIz3a-P56fZzLXYsl2UiFz8i6rWKazzC3hlD9YEBlAmXa-u_45R0i7vwbsQ2ylvpxxmMz31NZt09y2sWZSxxbtwHnDTiE9VoTUPkMPBf370/w400-h300/InformaticsMeme.JPG" width="400" /></a></div><p></p><p><span style="font-family: helvetica;">One of my favorite tricks is this <b>very simple one</b> with <i>pretty impressive impact</i>. It's basically just writing a <b>technical procedure</b>, but with a little more detail. I affectionately call it, "<b><span style="color: #741b47;"><i>The Cupcake Test</i></span></b>", </span><span style="font-family: helvetica;">because it uses </span><b style="font-family: helvetica;">good</b><span style="font-family: helvetica;"> </span><b style="font-family: helvetica;">procedure writing</b><span style="font-family: helvetica;"> to help answer the metaphorical question - D</span><i style="font-family: helvetica;">oes this '</i><i style="font-family: helvetica;"><b><span style="color: #800180;">cupcake recipe</span></b>' (or</i><i style="font-family: helvetica;"> '<b><span style="color: #800180;">cupcake workflow</span></b>') actually bake a <b><span style="color: #800180;">cupcake</span></b>?</i></p><p></p><p><span style="font-family: helvetica;">Writing a good </span><b style="font-family: helvetica;">technical procedure</b><span style="font-family: helvetica;"> can be a helpful substitute for the common Visio </span><b style="font-family: helvetica;">swimlane diagram</b><span style="font-family: helvetica;"> that seems to be more of a popular <b>industry standard. </b>From my recent presentation : </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgz6XsebZulpUtCDuClUlffd-RgjQYqLvMYmub3bSEr-XMFS5cp0ekbBocjNBkcu9gYoXDLXjg20mDFEjptJO8xFZ7KT4KRs65cYd58Qlm0HNJnX2cB4DRNd1oWBGLqIMOQbb4fw89df-xV/s720/Slide16.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgz6XsebZulpUtCDuClUlffd-RgjQYqLvMYmub3bSEr-XMFS5cp0ekbBocjNBkcu9gYoXDLXjg20mDFEjptJO8xFZ7KT4KRs65cYd58Qlm0HNJnX2cB4DRNd1oWBGLqIMOQbb4fw89df-xV/w640-h360/Slide16.jpeg" width="640" /></span></a></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">To understand how <b>good procedure writing</b> can be used as a substitute for Visio swimlanes, I need to first explain <b>two important concepts</b> that are necessary to understand before writing a <b>procedure</b> that passes the '<i><span style="color: #800180;">Cupcake test</span></i>' : </span></div><div class="separator" style="clear: both; text-align: left;"><ul style="text-align: left;"><li><span style="font-family: helvetica;">What is a <span style="color: #6aa84f;"><b>TASK</b></span>?</span></li><li><span style="font-family: helvetica;">What is a <span style="color: #2b00fe;"><b>PROCEDURE</b></span>? (<span style="color: #2b00fe;"><i>Synonyms : Workflow, recipe, process</i></span>)</span></li></ul><div><span style="font-family: helvetica;">And so from my presentation, my slide showing the definitions of both : </span></div></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtAfrDKQfSfOu-FIhQEt08O5aSAisoN-_3CeT89PlccoMdvjOz33NbR1g_GpcR_TasR_KWT8Xx1Jjtkg1_ZFN7JLKXfeW9R3xhjs81sHxwe8HQ-c-e0z6IpxqF72rAvNmE-JaGqdYGwwsm/s720/Slide17.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtAfrDKQfSfOu-FIhQEt08O5aSAisoN-_3CeT89PlccoMdvjOz33NbR1g_GpcR_TasR_KWT8Xx1Jjtkg1_ZFN7JLKXfeW9R3xhjs81sHxwe8HQ-c-e0z6IpxqF72rAvNmE-JaGqdYGwwsm/w640-h360/Slide17.jpeg" width="640" /></a></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Using these two definitions, and the <span style="color: #800180;"><b>procedure template outlined above</b></span></span><span style="font-family: helvetica;">, we can now write a simple and clear <b>technical procedure, </b>and even <b><span style="color: #2b00fe;">c</span><span style="color: #38761d;">o</span><span style="color: red;">l</span><span style="color: #ffa400;">o</span><span style="color: #800180;">r</span> <span style="color: #990000;">c</span>o<span style="color: #2b00fe;">d</span><span style="color: #38761d;">e</span> it </b>to help <b>quickly identify</b> and align concepts. Here's a sample of what it looks like : </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgl_0VH1DdFcsVNg9I85N0LK9XxAHVOOuLSCjtNrshAO-LLMi4czqiqMFPKNIEEmXo1YYqZHdpQ9iPeuax8aXUdqZIgBA4hO0dLoJWTPDxUaMxee9yJ6-qsr8ObU0XG-f1xLMiiXiKWelDv/s646/DRAFT+-+PROCEDURE+or+WORKFLOW+-+Sample+Clinic+Visit.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="559" data-original-width="646" height="554" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgl_0VH1DdFcsVNg9I85N0LK9XxAHVOOuLSCjtNrshAO-LLMi4czqiqMFPKNIEEmXo1YYqZHdpQ9iPeuax8aXUdqZIgBA4hO0dLoJWTPDxUaMxee9yJ6-qsr8ObU0XG-f1xLMiiXiKWelDv/w640-h554/DRAFT+-+PROCEDURE+or+WORKFLOW+-+Sample+Clinic+Visit.png" width="640" /></a></div><br /></div><span style="font-family: helvetica;"><div>While this approach is <b>not exactly an industry standard</b>, there are some <b>pros and cons</b> to using it : </div></span><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgol-yz2YHo1_ZdO_7uF5cZqhQGQgBR5QpLlPSaO8HnJVv1gQfFWlOSONnPMC0KdO_cyaepk57racNfL_u9is9K_KrVFJhUVrt0sYul8Pl30AQf06ZlJCv2ABYHiL_KWZ2t5amZb8PutFPg/s720/Slide19.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgol-yz2YHo1_ZdO_7uF5cZqhQGQgBR5QpLlPSaO8HnJVv1gQfFWlOSONnPMC0KdO_cyaepk57racNfL_u9is9K_KrVFJhUVrt0sYul8Pl30AQf06ZlJCv2ABYHiL_KWZ2t5amZb8PutFPg/w640-h360/Slide19.jpeg" width="640" /></a></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">And in my experience, a <b>good procedure</b> can usually be quickly and easily converted to a <b>good swimlane diagram</b> - But sometimes <b>swimlane diagrams</b> can't be as easily converted into <b>good technical procedures</b> that pass this '<b><span style="color: #800180;">Cupcake Test</span></b>'. That is, they are not written with the template : </span></div><div class="separator" style="clear: both; text-align: left;"><blockquote><span style="font-family: helvetica;"><b><span style="color: #6aa84f;">TASK</span><span style="color: #800180;"> </span>=<span style="color: #800180;"> [WHO] will/may [WHAT] </span></b>{<i>how</i>} {<i>where</i>} {<i>when</i>} {<i>why</i>}</span></blockquote></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">... in each line of the <b>procedure</b>. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Not only does this approach include the benefits listed in the slide above, but it's easy to teach, and it also helps you easily generate <b>cost estimates</b> of workflows/procedures <i>before</i> you build them.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Next time you have a <b>complex workflow you're trying to figure out -</b> just start by writing good <b>technical</b> <b>procedures</b>, and the <b>workflow will start to immediately reveal itself</b> right in front of you. If you have any experience with using this approach, please leave it in the <b>comments section</b> below.</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><i>Remember - This blog is for educational and discussion purposes only - Your mileage may vary. If you have any feedback or questions, or experiences writing workflows or technical procedures, feel free to share them in the comments section below. </i></span></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com0tag:blogger.com,1999:blog-8434050931789572015.post-85128300851558654242021-03-06T21:56:00.005-05:002021-03-07T08:42:31.332-05:00Optimizing Lumbar Punctures, Part II<p><i><span style="font-family: helvetica;"> Hi fellow Clinical Informatics, CMIO, CNIO, HealthIT, and other #workflow friends,</span></i></p><p><span style="font-family: helvetica;">Sorry about the delay in following up my last post - As most people can probably understand, the COVD-19 pandemic has been a <i>very busy time in healthcare</i>.</span></p><p><span style="font-family: helvetica;">Anyway, in my <a href="https://www.dirkstanley.com/2020/10/optimizing-lumbar-punctures.html" target="_blank">last blog post</a> - I introduced the surprising complexity of a <b><a href="https://en.wikipedia.org/wiki/Lumbar_puncture" target="_blank">lumbar puncture</a></b> - Not to complicate a fairly simple <i>bread-and-butter</i> clinical procedure that's performed in healthcare settings every day, but to help <b>create clarity and understanding, set expectations</b>, and help <b>reduce clicks</b> while delivering a <b>great user experience</b> that your providers can use to deliver <i>great patient care</i>. </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEuO9vYthA7RdN4nOAJJ9K16WilbH1XP5qDnCgLywVQDrKN2Vo1n0vGLjXe8S68AYj-Q1qmVDAHgbjPWilRiV_Hwm5QTu6L1jd5-yKxUVFb6fi3lV-mtqn_E8JpH6SiFG-wMGif6FLPBBW/s516/OptimizingLumbarPuncturesPartII.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="388" data-original-width="516" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEuO9vYthA7RdN4nOAJJ9K16WilbH1XP5qDnCgLywVQDrKN2Vo1n0vGLjXe8S68AYj-Q1qmVDAHgbjPWilRiV_Hwm5QTu6L1jd5-yKxUVFb6fi3lV-mtqn_E8JpH6SiFG-wMGif6FLPBBW/s320/OptimizingLumbarPuncturesPartII.png" width="320" /></a></span></div><p></p><p><span style="font-family: helvetica;">To help understand the complexity of this workflow, I thought I'd even share this <b>academic poster</b> which was developed by <b>Deandra '<i>Uju</i>' Momah, MS4</b>, an outstandingly talented medical student from UConn Med who I've had the honor to work with. At a recent AMIA conference, Uju presented her academic poster which very nicely summarizes the workflow issues : </span></p><p></p><div class="separator" style="clear: both; text-align: center;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="878" data-original-width="1561" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJKHgP73bfhl9h56e6LqQ8NfZj9pcj0m8uzFdGyh402psnShfbwiCwVOauZIitDejy0rLAnz6F8pDPkgH22YjzSJjAy_-Z4GTEp1OTfdp2nz8eWlmriIVIBrjrupF0SNxIBDijlcj_qQri/w640-h360/LPOrderSetPoster.jpg" width="640" /></span></div><i><div style="text-align: center;"><i><span style="font-family: helvetica;">(Academic poster by Deandra 'Uju' Momah, MS4 - Click to enlarge)</span></i></div></i><p></p><p><span style="font-family: helvetica;">The take-home point : Diagnostic LPs are <b>not</b> one workflow - They are <b><u>at least</u></b> <b>four</b>. (<i>That is, if you carve out <b>intrathecal chemotherapy</b>, <b>epidurals</b>, <b>blood patches</b>, and <b>therapeutic LPs</b></i>.)</span></p><p><span style="font-family: helvetica;">I recently had the opportunity to discuss <b>LPs</b> to an online audience of new Informaticists - below are some of the slides from my presentation, which I'll borrow and annotate here for clarity and educational purposes. </span></p><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">First - A review of some of the complexities of designing a Lumbar Puncture order set : </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaKn038JEs5knR1OhqZJgjVZhsV4kU4YA8-T73AHiUNJW1YQ8IEmXRoGCGm3X0pYqEaVRwyiG6zo2YiYYYxG1vUqGdxQdhys3dydQZdA9XG8doJ-4jcAl879V7lDBFiiJXID_PIXcpugOL/s720/Slide12.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaKn038JEs5knR1OhqZJgjVZhsV4kU4YA8-T73AHiUNJW1YQ8IEmXRoGCGm3X0pYqEaVRwyiG6zo2YiYYYxG1vUqGdxQdhys3dydQZdA9XG8doJ-4jcAl879V7lDBFiiJXID_PIXcpugOL/w640-h360/Slide12.jpeg" width="640" /></a></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Again, it's very important to remember that Lumbar Punctures are <b>not just one workflow</b> - Diagnostically, there are <b>at least four. </b>So for now, we will focus on the <b>third of four</b> below, the <b>outpatient ID/Specialist LP</b>, where in many institutions this is commonly <b>collected by Interventional Radiology</b>: </span></div><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixtV9P0qjhmDjd869pY_X5dS0SUWMON8NwHLkhzlyDoC_rCKLKafVLxNzCj86Bvv_Huq2MZWfc1yGGtZN2lIxXEzwdfs1bGahr440KdLCXak4KMcPlimOJ-kOIOB1V5TlLqcrjmq3FRxc4/s720/Slide13.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixtV9P0qjhmDjd869pY_X5dS0SUWMON8NwHLkhzlyDoC_rCKLKafVLxNzCj86Bvv_Huq2MZWfc1yGGtZN2lIxXEzwdfs1bGahr440KdLCXak4KMcPlimOJ-kOIOB1V5TlLqcrjmq3FRxc4/w640-h360/Slide13.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;">Now before we can examine this in more detail, I thought I'd share the <b>large (</b><i>complex</i><b>) set of stakeholders</b> who all have an interest in how LPs are ordered, performed, and resulted in your organization : </span><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwO0Zl4Cl6yPNiuGB8xF7qLZ4JF47CGkb7KLGJFlxAX8oGUkx0Bs2KwxJQP4GmOdJ09ZNs2jgRfO4D0KPE7y1swrfAocP09o6o1prBhPtjxW8oM2qubc_QIAeQoiK8O_MRZXC7PEBSlQ1V/s720/Slide32.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwO0Zl4Cl6yPNiuGB8xF7qLZ4JF47CGkb7KLGJFlxAX8oGUkx0Bs2KwxJQP4GmOdJ09ZNs2jgRfO4D0KPE7y1swrfAocP09o6o1prBhPtjxW8oM2qubc_QIAeQoiK8O_MRZXC7PEBSlQ1V/w640-h360/Slide32.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;"><br /></span></div>In my current role, I'm very fortunate to be able to work with the great <b>Karen Gurba, RN MS,</b> an experienced and outstanding <b>Clinical</b> (<i>Nurse</i>) <b>Informaticist</b> who I partner with to help investigate and design workflows. (<i>Remember, Applied Clinical Informatics is a team sport!</i>) Karen and I have done a number of interviews with the stakeholders in the list above, and through repeated iterations of <b>blueprints</b>, reviews, discussions, and <b>updated blueprints</b> - <i>The picture starts to become more clear. <br /></i></span><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-CS7ZHQtBVmpxYw59GtTqVXDia6Jkhe3DD8oM68MIQ0tqZYoVEyRR-yeiM25MDyksPn3BD3zkLTowyYh_4RAA1SSTSOpz9AsCPOjODTQ0oyaTI-eUUATbLW_yv2MRqhFDZcAnHvvD-j-9/s720/Slide33.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-CS7ZHQtBVmpxYw59GtTqVXDia6Jkhe3DD8oM68MIQ0tqZYoVEyRR-yeiM25MDyksPn3BD3zkLTowyYh_4RAA1SSTSOpz9AsCPOjODTQ0oyaTI-eUUATbLW_yv2MRqhFDZcAnHvvD-j-9/w640-h360/Slide33.jpeg" width="640" /></a></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">In each of these cases, there are a <b>six main features</b> that almost all clinical staff seem to generally agree on : </span></div><div class="separator" style="clear: both; text-align: left;"><ol style="text-align: left;"><li><span style="font-family: helvetica;">There are some <b>PRE-LP labs</b>, that are typically collected 24 hours before the procedure, to help establish that it's safe to proceed with the lumbar puncture lab. (They often include a simple BMP, CBC, and PT/INR.)</span></li><li><span style="font-family: helvetica;">There are <b>other PRE-LP serology labs</b>, that are typically collected 1 hour before the procedure, for diagnostic purposes. (They often include a serum glucose, serum protein, and in some cases, oligoclonal banding.)</span></li><li><span style="font-family: helvetica;">There is the <b>LP procedure order itself</b>, used to schedule the procedure and plan charges for doing the procedure. </span></li><li><span style="font-family: helvetica;">There are four <b>BASIC LP labs</b>, that most docs use for general purposes, including a <b>CSF cell count and differential</b>, a <b>CSF gram stain and culture</b>, a <b>CSF glucose</b>, and a <b>CSF protein</b>. </span></li><li><span style="color: #6aa84f; font-family: helvetica;">There are some additional <b>speciality-specific CSF labs</b>, which can be very complex and specialty-specific. (<i>Some of these can be very expensive, and so care should be taken so that they are not ordered unnecessarily or by accident</i>.)</span></li><li><span style="font-family: helvetica;">Finally, there are a limited number of <b>nursing orders</b>, mostly importantly a <b>nursing communication order</b> that allows the ordering provider to give the Interventional Radiology nurses a '<i>heads up</i>' on any unique patient needs. </span></li></ol><span style="font-family: helvetica;"> The problem is - When you have so many specialties needing access to <b><span style="color: #6aa84f;">specific labs in #5 above</span></b>, <i>how exactly do you build this out</i>?</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;"><br /></span></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1ymfcf0JbCHsQ7u1XHc-u6nqpF-D2pZ-LMdRtMUjaWh06-EtQ7wX8M89qyBMyEFx5GfRwJsW4bpHV_bGU0oKnBw2Vu4GHmkCoYpCAmemllWil-VIFQY41Y3ge2UHUiax_Pjx-sEQKs1oZ/s720/Slide34.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi1ymfcf0JbCHsQ7u1XHc-u6nqpF-D2pZ-LMdRtMUjaWh06-EtQ7wX8M89qyBMyEFx5GfRwJsW4bpHV_bGU0oKnBw2Vu4GHmkCoYpCAmemllWil-VIFQY41Y3ge2UHUiax_Pjx-sEQKs1oZ/w640-h360/Slide34.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;">And so, now I'd like to present a <b>mockup of an Outpatient LP via Interventional Radiology</b> (IR) <b>order set</b>, that helps address <b>all of these needs</b> in <i>one coherent order set</i>, that relies on cascading logic to help guide the ordering provider to the best-practices for their unique clinical needs. (<i>Pardon my amateur cartooning, which I used to customize my presentation.)</i></span></div></span><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-kGDhjkdagGwUYxgNwYxw5ALrpZ_z6ebcqKv2rQ1YmxMtXvZ-NmM9vcAOhz8BW4Es1pS-5KHBsr58nQXEpHKoOuv8I0jFD4pqaCT3dEKupEhAfFBAieT4DY_Teec6aSZ2RXL6JWNyq9j8/s720/Slide35.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-kGDhjkdagGwUYxgNwYxw5ALrpZ_z6ebcqKv2rQ1YmxMtXvZ-NmM9vcAOhz8BW4Es1pS-5KHBsr58nQXEpHKoOuv8I0jFD4pqaCT3dEKupEhAfFBAieT4DY_Teec6aSZ2RXL6JWNyq9j8/w640-h360/Slide35.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;">And the order set starts with the first clinical decision - Is the ordering provider ordering a <b>DIAGNOSTIC LP</b>, or a <b>THERAPEUTIC LP?</b></span></div><br /></span><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDHbm6vc1mCyom9f3Ld0o0mULAAzJFJqb7eyMt43BBlMBbKro7i2qKgj2XKVjQknze39blthS-Xeh0sqbK-KajxQrCC4GOK8hhoSDDudMOvSxBe5yygjLAl-JJlNJpNC5RIhdwjnSfyu8g/s720/Slide36.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDHbm6vc1mCyom9f3Ld0o0mULAAzJFJqb7eyMt43BBlMBbKro7i2qKgj2XKVjQknze39blthS-Xeh0sqbK-KajxQrCC4GOK8hhoSDDudMOvSxBe5yygjLAl-JJlNJpNC5RIhdwjnSfyu8g/w640-h360/Slide36.jpeg" width="640" /></a></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Let's say in this case, the provider is ordering a <b>DIAGNOSTIC LP</b> : </span></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgcIffl0LVIlV9mAcAE0A4clZCJg6szdIcPiRie1PyJwzKt0KScXR6CDgshyIsUHy1FRXCr1ws16AvQGW0uS5uSODEunhyI4BbcTLXh2dwg0lCB1dSfGKonV7U9MyBX7ER48LhBY2JKpYG/s720/Slide37.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhgcIffl0LVIlV9mAcAE0A4clZCJg6szdIcPiRie1PyJwzKt0KScXR6CDgshyIsUHy1FRXCr1ws16AvQGW0uS5uSODEunhyI4BbcTLXh2dwg0lCB1dSfGKonV7U9MyBX7ER48LhBY2JKpYG/w640-h360/Slide37.jpeg" width="640" /></a></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">This then brings up four choices, seen above : </span></div><div class="separator" style="clear: both; text-align: left;"><ul style="text-align: left;"><li><span style="color: #2b00fe; font-family: helvetica;">FOR ATTENDINGS, FELLOWS, AND RESIDENTS - Routine diagnostic LPs - Mon-Fri 8am-5pm</span></li><li><span style="color: red; font-family: helvetica;">FOR ATTENDINGS AND FELLOWS ONLY - ROUTINE Malignancy Evaluations - Mon-Thurs 8am-12pm</span></li><li><span style="color: red; font-family: helvetica;">FOR ATTENDINGS AND FELLOWS ONLY - URGENT Malignancy Evaluations - Friday-Sunday 8am-12pm</span></li><li><span style="color: red; font-family: helvetica;">FOR ATTENDINGS AND FELLOWS ONLY - PRION Disease Evaluations - Mon-Fri 8am-5pm</span></li></ul><span style="font-family: helvetica;"> This gives us the opportunity not only to confirm the <b>role</b> of the ordering provider, but also to stratify the <b>routine diagnostic workflow</b> from the more complex workflows that require <b>additional notifications or supervision</b> before ordering. This helps us to make sure that unnecessary orders are not added to the workup. </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">In this case, clicking the first option (<span style="color: #2b00fe;">ROUTINE DIAGNOSTIC LUMBAR PUNCTURES</span>) would then produce the <span style="color: #8e7cc3;"><b>list of specialties</b></span> that commonly use this order set : </span></div><span style="font-family: helvetica;"><br /></span><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhk_dPSy-eyLDs7yPn2nfqLf2IBPdd9sSsEq_0FHGQiXRQBae67fGcXVISa6YK4xmCc2PUtgTWisD5Dccg9aaGOsWeJPGUPH0pF8o3fughmsIxIIUHClQWaumNcLjrsgKD8kp7Lg9-Wuogv/s720/Slide38.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhk_dPSy-eyLDs7yPn2nfqLf2IBPdd9sSsEq_0FHGQiXRQBae67fGcXVISa6YK4xmCc2PUtgTWisD5Dccg9aaGOsWeJPGUPH0pF8o3fughmsIxIIUHClQWaumNcLjrsgKD8kp7Lg9-Wuogv/w640-h360/Slide38.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;">And here, if an <b><span style="color: #8e7cc3;">Infectious Disease</span></b> provider were to click their section, the order set can now produce the tailored, specialty-specific orders that the provider needs : <br /></span><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica; margin-left: 1em; margin-right: 1em;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijbMm44yVtR46clXkZswGKDd1ysYxUgZ0AQ1ULAWYjD-2yRW2pHBAgcXIhOG5Ls5YV8wa7JqBYwE7NqGIkHutgrpcS-4VlzRX9qMAfxPcel5jG62SwHz5hYRGN_RnhXqIMIZrmdcfFxROF/s720/Slide39.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijbMm44yVtR46clXkZswGKDd1ysYxUgZ0AQ1ULAWYjD-2yRW2pHBAgcXIhOG5Ls5YV8wa7JqBYwE7NqGIkHutgrpcS-4VlzRX9qMAfxPcel5jG62SwHz5hYRGN_RnhXqIMIZrmdcfFxROF/w640-h360/Slide39.jpeg" width="640" /></a></span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: helvetica;">Using this naming convention and design, we now know : </span></div><div class="separator" style="clear: both; text-align: left;"><ul style="text-align: left;"><li><span style="font-family: helvetica;">Scenario = Specialty, outpatient LP for collection in IR</span></li><li><b><span style="font-family: helvetica;">LP type = Diagnostic</span></b></li><li><span style="color: #2b00fe; font-family: helvetica;"><b>User = Attending, Fellow, or Resident</b></span></li><li><span style="color: #8e7cc3; font-family: helvetica;"><b>Specialty = Infectious Disease</b></span></li></ul></div><span style="font-family: helvetica;">... and so now the order set can allow a tailored, specialty-specific palette of orders that are most commonly used for the user's needs. <br /></span><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNWBXTbpWUOnRshC5bashTrTjeAptYmO3jbY2_Nh2JtkAXobHVRl1SixyUptudDNTb0HJ1DlONEKw7NxHv_kfnpB5glhKn5vpIlFAlHeb0ozy_uDwEAtQp45ZJ0H-Behri1Mwen-yb18Mu/s720/Slide40.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNWBXTbpWUOnRshC5bashTrTjeAptYmO3jbY2_Nh2JtkAXobHVRl1SixyUptudDNTb0HJ1DlONEKw7NxHv_kfnpB5glhKn5vpIlFAlHeb0ozy_uDwEAtQp45ZJ0H-Behri1Mwen-yb18Mu/w640-h360/Slide40.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;"><div><span style="font-family: helvetica;">And with that, a significant reduction in clicks and improvement in utilization, diagnostic accuracy, and diagnostic yield. </span></div><br /></span><div class="separator" style="clear: both; text-align: left;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy2-tSegjGdW0oXUGcMw1CSdyVrGTfJ22O3DD4YMV2O2gdvSeGvzfgIQJBg8XN94NANsIJ14QHgOYa4z-afh9EaTKFktxIV6IZewZj9oirToMGfUQN7UAF_mQGFZs8C9GlI6XXOW66gSCG/s720/Slide41.jpeg" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: helvetica;"><img border="0" data-original-height="405" data-original-width="720" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgy2-tSegjGdW0oXUGcMw1CSdyVrGTfJ22O3DD4YMV2O2gdvSeGvzfgIQJBg8XN94NANsIJ14QHgOYa4z-afh9EaTKFktxIV6IZewZj9oirToMGfUQN7UAF_mQGFZs8C9GlI6XXOW66gSCG/w640-h360/Slide41.jpeg" width="640" /></span></a></div><span style="font-family: helvetica;">We are now working with our department Chiefs to help confirm the final orders (to appear in the fifth section of each specialty-specific area), and maybe once they are completed, I can help publish the final result here. </span><div><span style="font-family: helvetica;"><br /></span></div><div><span style="font-family: helvetica;">Until then, I hope this helps you develop your own strategy for ordering Lumbar Punctures! If you have any secrets or feedback you can share, please leave them in the comments below!</span></div><div><span style="font-family: helvetica;"><br /><i>Remember, this blog is for educational and discussion purposes only - Your mileage may vary! Have any recommendations or tricks to share about designing lumbar puncture workflows? Feel free to share in the comments box below!</i></span><p><br /></p><div><div></div></div></div>Dirk Stanley, MD, MPHhttp://www.blogger.com/profile/09568427937893548660noreply@blogger.com2