The 2012 Healthcare Informatics/AMDIS IT Innovation Advocate Award

Patty: I think it’s in designing solutions that allow more efficient workflow for end-users, yet also let us meet our quality goals. For example, take our VTE [venous thromboembolism] prophylaxis order set: we had a lot of challenges in designing that set so that it would feed clinicians with some risk-based scenarios to help them select the right treatment, but also to allow them, if they chose not to use the recommended treatment, to use a reason that would be acceptable to CMS [the federal Centers for Medicare and Medicaid services], and not to slow them down too much. In other words, our biggest process-oriented challenges have been balancing the need to meet quality and regulatory requirements through embedding specific tasks into clinicians’ workflows while not slowing them down so that they feel as though that’s all they’re doing.

HCI: In what areas do you think your team’s work has stood out the most?

Patty: Our vendor has a tool called iForms, which are basically HTML-based order sets, so they look like little mini-web pages. We actually brought in some designers to work on these, with workflow in mind, and they are in great demand among our clinicians. We’ve got about 160 out there now; each order set takes the team about 40-60 hours to create, so they’re very labor-intensive to create, but they’re very easy for the clinicians to use, so we can pull in things like decision scenarios. That means that we can present clinicians with a decision tree; can do weight-based dosing on medications, specifically on our pediatric population; and we can pull information in from the rest of the EHR, like labs or other patient values, right at the time a physician is making the decision, so they don’t have to go outside the order set to look things up; so it really improves the workflow of the ordering process.

Getting Physicians on Board

HCI: How do you achieve consensus on order sets with your physicians?

Patty: Rather than creating a new committee for that, we built the design and approval for order sets into the clinical councils, which are essentially departmental meetings. So our team goes to the surgery department clinical council, the cardiology department clinical council, and so on, and talks with the physicians, so that they understand what the challenges are for the providers, but also engage with them on the design and upkeep on the order sets around what is pertinent for them.

HCI: What are the issues around the interoperability and integration of all these clinical systems, for optimized end-user integration?

Patty: Obviously, if we can get a system to integrate with our core EHR, that’s the best; but if not, we try to use our physician portal to help the physicians navigate, so they can have a one-stop shop for getting their work done.

HCI: So they use the portal to access everything?

Patty: Exactly; and the portal is fairly facile about being able to link to other systems that don’t necessarily integrate fully with the EHR, yet in a way that makes it look seamless to the physicians.

Lessons Learned

HCI: What are the key lessons you’ve learned to date around creating process change?

Patty: One of the things I’ve encouraged my team to do has been not just to train on the technical tools, but to engage on the workflow. We involve end-users in designing our training, so that we can make sure that we understand current workflow, and design and train the new workflow based on the best integration of that new tool into the work of the clinician—whether physician, nurse, etc., so that we’re not just training the technical aspects of the tool. In other words, we try not to layer a technical solution on top of a bad workflow; instead, we try to redesign the workflow at the same time, so that we now have an improved workflow for the clinician as well.

HCI: What have been your particular lessons learned as a CMIO directing a team of informaticists?