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Bad News...Good News

February 19, 2008
by James Feldbaum
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A physician is often called upon to be the bearer of bad news. A consultant tasked with implementing clinical IT can often be faced with a similar task.

Commonly, the initial component of a consultation is the evaluation of clinical process and policy in preparation for documenting the “gap” between present and future state. All too often, an evaluation exposes a second “gap” – the one between policy and practice. While all will agree that incorporating flawed practice into an electronic order is inappropriate, it becomes an unpleasant task to be the one to tell the client that they have hard work to do before they are able to undertake an implementation. Often an institution is lacking the governance structure that can readily evaluate policy and practice to make the necessary quality improvement decisions that must precede creation of an electronic process. I have found it to be politically easier to describe these “problems” as “opportunities to modernize and streamline” practice. Such “modernization” is often “outside of scope” for a consultant’s contracted implementation which will wreak havoc on budgets and timetables.

Once recognized and addressed, improvements in policy and procedure will often yield improved patient care even before the implementation of the EMR. And that’s the good news.

“Opportunity is missed by most people because it is dressed in overalls and looks like work.”

Thomas A. Edison
US inventor (1847 - 1931)

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James Feldbaum

Jim Feldbaum is a physician consultant specializing in clinical transformation, CPOE, and...