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Are Your Physicians ‘Yammering’ to Each Other? Texas Health Resources’ Docs Are

March 12, 2013
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Enterprise social network solicits input on how to modify the EHR and work flow
Ferdinand Velasco, M.D.

At Healthcare Informatics, we’ve written several articles about how health systems are thinking about incorporating social media in their patient engagement strategies, and that was a hot topic at HIMSS13 in New Orleans. But social media also holds promise for enhancing communication within a medical community and project team members. And at HIMSS, the health IT leaders of 25-hospital Texas Health Resources (THR) put on a great presentation about their efforts to create a platform of openness and transparency to foster collaboration on ongoing projects.

Ferdinand Velasco, M.D., THR’s vice president and CMIO, and Luis Saldana, M.D., the associate CMIO, first laid out the problem. They have 5,500 active physicians, a large percentage of them independent, as well as 7,500 registered nurses spread across a vast geographic region. Reaching out to them is always a challenge.

THR had created workgroups to develop standardized, evidence-based specialty order sets. But those groups had largely been reliant on traditional committee structures and in-person meetings, Saldana noted. They were anchored to slow and outdated modes of communication. “The process was time consuming and becoming unsustainable with existing resources,” he said.

 “We were trying to figure out how to keep order sets current and relevant to all these entities,” he said.  “You have to feed and water them to maintain them.”

In 2009 they decided to try to build an environment of co-ownership and co-creation that could overcome the logistics of geography and the constraints of synchronous communication.

“We thought this was an area ripe for a disruptive approach,” he said. They looked at several tools, but decided to begin by creating Virtual Forums using Microsoft SharePoint 2010 around order set content management and the EHR optimization process. They linked to the site from within the EHR, the intranet and the web-based physician portal. It has turned out to be a very good way for specialists to request, discuss and vote on changes to order sets. In 2012, there were 242 order set requests submitted and 76 were approved and completed, Saldana noted. The EHR optimization forum allows users to vote on prioritization of EHR projects.

Dr. Velasco described how the next step for THR was an enterprise social networking platform, and it chose to use Yammer, which he described as the internal equivalent of Twitter. The benefits of enterprise social networking, he said, are that it can help engage physicians in initiatives, take advantage of “crowdsourcing” and solicit feedback. “We use Yammer to solicit input on how to modify the EHR and work flow,” he said. A hospitalist may ask a question about how to document something or on the use of a problem list, and a family doctor from somewhere else in the organization will answer. Or a medication may be in short supply and a physician will ask if an alternative can be used in its place. “It is great to see conversations happening on our platform. We have more than 250 Yammer groups, and some people don’t even use e-mail to communicate anymore — that’s how integrated it is into their work flow.” (One issue they had to address was privacy. THR decided it was important not to share protected health information via social networking, just because some employees could potentially get confused about public vs. private social networking.)

People working on clinical decision support teams may work from home. They share what their upcoming weekly priorities are on Yammer each week. Velasco said CIO Ed Marx uses Yammer extensively to engage with employees and get feedback. “You know what he is doing constantly,” Velasco said. The dozen THR staffers attending HIMSS use the Yammer platform to share insights on what they are learning at the conference with colleagues back home.

An enterprise social networking project does require investment and active curation to ensure adoption, but Velasco says that as the organization seeks to get clinicians to participate in IT improvement projects, “the transparency lends authenticity to the process and adds to the credibility.”

The last slide of the Texas Health Resources Powerpoint presentation: What Are You Doing at Your Organization?