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Training Can Get You Started-But a Good Coach May Be Necessary to Finish and Win

March 9, 2012
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A good coach can have a profound effect on your EMR to improve quality care and patient safety

In working with my team to evolve EMR technology, one of our most important considerations is to provide the flexibility users need to customize the system to meet their unique demands and organizational policies.  To accomplish this goal, we often depend on those users to guide us in creating the functionality they feel is important to derive the greatest benefit for their hospitals and patients.  

Over time, I’ve learned how important it is to periodically have a coach help me to ensure I can keep growing in my profession by refining my actions, often by simply holding up a mirror.  I find it very therapeutic.  In looking at your needs and goals for the EMR in your hospital, I think you can benefit from the experience of a CMIO I know, which will be the focus of this blog.

Dr. Ken Stevens (pseudonym), CMIO at one of the most progressive hospital systems in his state, was working on the next system rollout.  Ken had his analyst building tables to support the care of patients with congestive heart failure.  They included problem lists, flow sheet displays, orders, and feedback report profiles for the physicians he serves. 

In prior months, Ken had reviewed his health system’s heart failure data from the last several years.  He considered quality indicators, case volumes, case mix, severity measures, reimbursements, costs, and patient satisfaction survey data.  Even the meeting minutes from the clinical services team were reviewed.  Ken is a talented hospitalist who maintains an ambulatory practice, in addition to his management and CMIO roles.  He knows what patients with heart failure need, as well as the needs of clinicians taking care of those patients.  In short, Ken did a thorough and thoughtful job of identifying and documenting the needed requirements.

During the course of reviewing the analyst’s proposed EMR screens in the development system, Ken found several clinical data elements missing.  Elements that Ken had painstakingly documented.  When he asked his analyst about the omissions, Ken was told the information in one case that needed clinical data elements was simply not available.  In another, he was informed that a physician user could drill down in an exhaustive catalogue view to find the information.  That is, if it happened to be available for the patient whose chart was open. 

Dr. Ken was extremely frustrated.  He was frustrated by the ignorance of the analyst that the details mattered, and his attitude, which seemed contemptuous of clearly stated requirements.  He also found it incredible that in 2012, a user should have to seek out whether new information is available through active navigation, effectively well buried.  This would entail, for example, clicking over to ask for a specialized report or view in case there might be clinically relevant information there.  At times, that buried information would be critically important.

Where does this lead us?  To Ken’s fascinating response to his frustration.  He sought out coaching on what to do, because the problem was a little more complicated than simply ordering a subordinate to change his behavior.

The New Yorker recently published a PERSONAL BEST article by surgeon Atul Gawande entitled “Top athletes and singers have coaches.  Should you?”  In it, Dr. Gawande discussed tracking his performance against national data.  “My rates of complications moved steadily lower and lower,” he wrote.  “And then, a couple of years ago, they didn’t.  It started to seem that the only direction things could go from here was the wrong one.”  Atul Gawande solicited help from a coach.  Read his story:  http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande
The point is we all need coaches, whether it’s to improve our active listening, structure how we look at situations like Ken’s, or simply using the technically uninformed sounding board of a peer.  We need those external ears and eyes.

In Dr. Ken’s case, the external coaching led to multiple improvements for him and his entire extended community.  His frustration level dropped as he learned how to better interact with subordinates to achieve the desired results.  His analyst, in this instance, responded by being more receptive to building all of the required elements in an efficient, user-friendly format that satisfied the needs of both physicians and patients.  The rollout was a success, and the system was recognized as a highly beneficial tool to treat heart failure.   

Often, a good coach simply holds up a mirror.  The results can be very powerful.  They can also have a profound effect on your EMR to improve quality care and patient safety.

When was the last time you sought coaching?  

Joe Bormel, MD, MPH
CMO and Vice President
QuadraMed Corporation
"mailto:jbormel@quadramed.com" jbormel@quadramed.com

Coaching helps you take stock of where you are now . . . and how that compares to where you would like to be. 

   - Elaine MacDonald

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