Sometimes, the Obvious Is Also the Overlooked

Jan. 3, 2012
This month, the Oakland-based California Health Care Foundation (CHCF) released a series of helpful reports related to electronic health record (EHR) chart abstraction, training strategies, clinical documentation, and workflow analysis. Each of these reports has a great deal of useful information, but I found the workflow analysis report particularly interesting. The report’s author, S.A. Kushinka looked at a spectrum of types of EHR implementations, and came up with some very helpful points.

This month, the Oakland-based California Health Care Foundation (CHCF) released a series of helpful reports related to electronic health record (EHR) chart abstraction, training strategies, clinical documentation, and workflow analysis. Each of these reports has a great deal of useful information, but I found the workflow analysis report particularly interesting. The report’s author, S.A. Kushinka looked at a spectrum of types of EHR implementations, and came up with some very helpful points.

Early on in the report, Ms. Kushinka offers three key recommendations:

  • Bring together a multidisciplinary team
  • Make sure the process analysis—written narrative or a process map—includes, at a minimum, a review by staff actually doing the work
  • Don’t rely on the vendor for workflow analysis

On the face of it, these pieces of advice are fairly straightforward, and perhaps even, to some, self-evident. But as the CHCF report notes, with regard to process analysis, “Managers may not be aware of the level of variation in process that has evolved over time, or the ‘on the fly’ steps involved under various circumstances.” The review process will also, the report points, out provide the opportunity to examine how team responsibilities have evolved over time in an organization.

Indeed, time and time again, as I’ve interviewed healthcare IT leaders regarding successful clinical IT implementations, I’ve been told that one of the keys to success along the way (and everyone is of course on a journey with clinical IT—no one has reached ‘nirvana’ with regard to any particular industry-wide goal) has inevitably been the simple fact of bringing the front-line clinicians who are also end-users into the room for key discussions prior to, during, and after go-lives. It is these front-line end-user clinicians who will, everyone knows, buoy or sink any clinical IT implementation. Yet CIOs and CMIOs have told me time and time again how easy it is to forget the centrality of these important folks to the success of go-lives, particularly as IT professionals move into the “white heat” of pre-go-live periods.

What’s more, as anyone who has been caught up in that very intensive pre-go-live period of development, one of the easiest “Hail Mary pass” moves one can make is to desperately speed-dial one’s vendor’s implementers for an immediate answer during any particularly desperate moment. Yet the reality, as everyone is learning, is that no one knows one’s workflow as the clinicians who do the flowing know it—even if those are also the people feeling the most cranky and out of sorts at the moment.

So whether or not one has the time to read and absorb helpful industry reports like this one, all the signs continue to point back to the basics. Let’s hope everyone keeps those basics in mind during this next phase of intensive IT implementation now beginning to take place industry-wide.

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