The Physicians' IT Symposium keynote was provided by Farzad Mostashari, MD, ScM from the Office of National Coordinator for Health Information Technology. Dr. Mostashari, in talking about his early experience with EHR projects, referred to “rookie mistakes,” which were common errors of misplaced exuberance with one's first major clinical transformation project.
There were no slides and I don't have access to the transcript yet, but I heard that one of the most common errors was trying to do too much, including using more features than necessary, and “continually insisting on adding new features/functionality” as go-live requirements. This set a wonderful tone, and several subsequent speakers contextualized some of what they had prepared to share what they learned from their rookie mistakes. There was agreement, at this symposium and others such as the CDS-based sessions, that the biggest recurrent rookie mistake was putting in EHRs as though they were technology (aka IT) projects.
Dr. Mostashari urged “simplicating” (the opposite of complicating, and a new word for me) as an important antidote to approach health care transformation and related technology-enabled modernization projects. He urged us all to remember “The Aim Makes The System.” You should always start planning sessions, awareness, acceptance and commitment phases of change management with “tell me what you want to achieve,” or a related “norming” discussion. This is, of course, great advice, because omission, i.e. starting meetings without clear framing on goals (or aims), is a common rookie mistake for people in all industries, not just HCIT.
Dr. Bill Bria, AMDIS representative and co-founder, pointed out several hours later that, as clinical leaders working in the space that includes technology-enabled process, workflow and quality improvement, we still have what seems like the majority of physicians seeing EHRs as technology transfer initiatives, not as essential tools for the practice of medicine. Arguably tools far more essential than the stethoscope. It's much easier to argue that technology is unusable than it is to argue it is essential to have adequate information about a patient and be able to reliably diagnose and treat a patient in a timely, and again, reliable manner. His message was that CMIOs and CMOs don’t routinely get out and advocate what the modern practice of medicine is, what’s needed and possible, framing clinical knowledge management and execution, not the EHR alone, as central.
Here are two important takeaways:
1. The Rule of 888 or less. This came up in a variety of contexts from easily a dozen different presenters. In simplicating your project, whenever it appears there are thousands of items to manage, work aggressively to get that number below 888. For example, one team studying the right number of order sets to roll out determined that just under three hundred ensured that the build, maintenance, revision and updating work was kept to a manageable number. Several of the smartest informatics experts, working independently, have advocated that creating data liquidity by reducing and agreeing on a manageable number of problems, allergies, medications, quality measures, lab findings, etc., can and should be published after rapid harmonization by NQF. Why NQF? They are the neutral conveners who are reconciling the quality measures to measures that will be capable of promoting safe, effective and stable measurement, comparison, and ranking of performance. This derives from active work on eMeasures underway from ONC sanctioned work being done by MITRE.