November 25, 2014
When we started this series of posts on clinical optimization, we made the case that many hospitals have installed their systems in a functional, but inefficient way. This is mostly due to the rush to implement clinical information technology to meet Meaningful Use / MIPS. The result of those subpar installations are challenges in everyday use of the systems. These challenges cause doctors and nurses to be unhappy with the system and prevent the hospital from getting the full value from their substantial investment.
In recent weeks, we’ve talked to a number of forward-looking CIOs who say that they realize that they aren’t getting the full return on their investment, and are seeking help to optimize their systems. At the same time, others have indicated that they aren’t sure how serious their optimization needs really are. To help clients determine if they need to optimize their systems, we provide a list of common EMR symptoms that suggest a need for optimization:
High numbers of open work tickets and tickets open for long periods of time. This might be a symptom of short staffing at your clinical service desk, but it’s probably a symptom of a high number of complex requests that can’t be solved quickly by service desk agents, and impose a high workload on analysts.
Conflicting requests from various clinical groups. Whether this is simply conflicting requests on how some functionality should work, or requests to implement the functionality differently in different departments or facilities, this should alert you that you don’t have good alignment between understanding, process, and systems.
Unhappy doctors and nurses. As the users who spend the most time providing and documenting patient care, doctors and nurses are the ones most affected by poorly optimized systems. This might manifest as complaints, or as an outright “refusal” to use the system.
Unclear development priorities. When the majority of development requests are identified as the highest priority, or when there is no clear prioritization at all, there is almost certainly a system optimization issue. Sometimes this is directly obvious from examining the priority list, but it can also manifest itself with overuse of “it’s a safety issue” or “it’s a patient care issue” to circumvent priority levels.
Trouble meeting Meaningful Use / MIPS (or quality) measures. This might be a direct issue with the design, i.e. the design isn’t compliant, a usability issue, or a process/workflow issue. Scenarios where electronic quality measure data does not match manually extracted data certainly qualify here as well.
Duplicate documentation. This is a situation where registration and nursing are both responsible for collecting critical data, such as advanced directive status.
Documented “interface issues.” This issue surprises many people, but our experience in installing and optimizing clinical systems suggests that at least half of issues that are described as interface issues are really data issues, and the clinical systems are often at fault.
Known workarounds. Any time you hear users describing ways they work around the system, you should evaluate the issue as an optimization issue.
As you evaluate your environment as a candidate for optimization, these symptoms can be clear signs that optimization work is required. In our experience, while you can deal with each of these symptoms and the underlying system causes individually, it’s generally far more productive to assess the entire system and the underlying processes as a whole. There are often commonalities between issues that affect prioritization, where changes can be lumped together into a package of process improvements and system changes that can be trained and implemented simultaneously.
Getting a handle on the scope and resources required to conduct an optimization can be complex, but the rewards of doing it right are well worth it. If your hospital experiences any of the symptoms above, find out more about optimization and how it can improve your hospital systems and processes.