D'Arcy Gue

Improving Clinical Systems – Three Truths to a Clinical Systems Optimization

August 20, 2014

IT Project Management, Meaningful Use / MIPS 4 Minute Read

Almost every hospital and health system in the country is dealing with new or significantly upgraded Electronic Health Record (EHR) technology. In most cases, these technologies were installed without the level of expertise required for such a significant installation. The solution to the challenges you’re facing as a result of these sub-optimal installations is usually a clinical systems optimization.

Creating a productive environment for the success of an optimization can often be one of the biggest challenges. For your team to be successful, there are three basic truths that need to be understood. While these truths might seem obvious, they are often misunderstood. To avoid misunderstandings and ensure that your optimization project is set up for success, you must first confirm that your team is on the same page.


Three Truths to a Clinical Systems Optimization

An EHR project is never done. Time and time again, I hear clinicians complain about their EMRs. One of the most common complaints is that the system was implemented before it was finished. This statement may be true, but it’s also misleading. The installation of an EHR is never over. The evolution of medical standards of practice, system capabilities, and regulatory requirements means that the implementation of capabilities will be an ongoing process.

Even without the ongoing development, many major vendors realize that, despite the extreme customizability of their systems, it is advisable not to attempt to fully customize the system at install. Most of the major EHR vendors had at least one “failure” at an early EHR project because they attempted to do too much customization at go-live. It is common for vendors to recommend a fairly “vanilla” installation, with ongoing customization to increase the success of the initial install.

EHRs are incredibly complex. This is another obvious fact that is often overlooked. An example from a recent install makes this clear.

This is a partial list of tasks and orders created from a single physician order of the antibiotic gentamycin:

At the time of the order, the system:

  • Validates the dose against the stored height and weight in the system
  • Checks Drug-Drug interactions
  • Checks the patient’s drug allergy information
  • Checks to see if renal function tests are on file, and if not, places an order for that

At this point, a number of tasks are created in the system to support the administration of the drug. These tasks include:

  • A Pharmacist task to review the prescription
  • Administration tasks for the nurse for each dose
  • Timed lab orders for blood levels of the drug prior to scheduled dose administration
  • Timed blood draw tasks for the phlebotomist work list

Finally, the system drops a charge to the billing system after drug administration.

The point here is simple — EHRs are probably the most complex systems ever designed for hospitals. There will be issues, and minor changes can have significant downstream impacts that affect clinical activities and charging. The more complete the user understanding and acceptance of this fact, the better the working environment will be for the implementation and optimization teams. This is also the reason that a robust change management methodology is required.

It’s not about the system, it’s about the work. This is often a challenge to IT’s traditional role in the organization where systems are implemented based on the configurations designed by the IT department and the vendor. These systems are really clinical tools, provided by the IT department for the clinical needs of the care providers. IT can provide —

  • Tools
  • Expertise to deal with integration needs
  • Project management for the install (and for optimization activities if project management expertise is lacking in other areas of the hospital)
  • Broad-based understanding of the system’s functionality

However, the design and ongoing updates to the clinical functionality of the EHR must be a clinically-driven processes. Chief Medical Information Officers and Chief Nursing Informatics Officers should lead this effort. In organizations where these positions don’t exist, it’s important to ensure that there are clinical users in leadership positions to guide the clinical support team.

If your IT team and key users both understand and support these three realities, your clinical systems optimization will go more smoothly and be far more effective.

If you think your organization can benefit from a clinical systems optimization and want to talk with an expert, let us know! 


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