From The CMIO | Getting Past the Install a Lot and Use a Little Syndrome

We’ve all been there, whether as physician champions or CMIOs, we are involved in the selection, design and implementation of a new system. Everyone (except possibly some of the end users) is excited about the system and new features. Then reality hits and the aggressive implementation schedule takes precedence over maximizing functionality. Bad habits quickly develop and soon users are complaining about the “extra clicks” and clunkiness of the system.

We at LVHN have experienced this process with several of our systems. Last month, in the April issue of CMIO, I wrote about our data governance efforts and the goal to ensure those data are accurately and consistently entered into the systems. From my perspective, the next step in the process is to optimize our systems to ensure that the users are interacting with the clinical systems in the most efficient and effective way.

Merriam-Webster Dictionary defines optimization as “an act, process or methodology of making something (as a design, system or decision) as fully perfect, functional or effective as possible.”

It’s a lofty goal, given our other priorities and deadlines. For CMIOs in more mature organizations, I believe optimization of clinical information systems is our next great challenge. Now that we have implemented these systems, how do we get the most bang for the buck, the most juice for the squeeze, more bounce for the ounce? OK, enough tired idioms.

For less mature organizations, CMIOs need to emphasize optimization during the design and implementation phases. This usually means additional time and resources early in the process with the payoff coming later. It’s a tough battle, and one that the CMIO is uniquely positioned to address.

At LVHN, we are applying a standard work process to our evaluation of how our clinicians are interacting with our systems. We have branded the process “Systems for Partners in Performance Improvement” (SPPI) and it is based on the Toyota Lean methodology. Lean methods require new language and tools, and there is the challenge of obtaining buy-in from the clinicians in the trenches. Once they realize the benefits, the process becomes self-sustaining. Starting in the ambulatory environment, we are placing physician super-users at the elbow of colleagues in the exam rooms. The super-user will observe the workflow and screen-flow of the physician to gain understanding of inefficient processes. The super-user then can help educate physicians on best practices. Using our SPPI tools, we hope to standardize the process and replicate it as we evaluate our other clinical information systems.  

The one criticism I have of the definition of optimization is the use of the word “perfect.” I don’t think we can get to perfect use of our systems—but even moving the needle just a bit should pay huge dividends in terms of productivity, accuracy and quality of data, and most importantly, physician satisfaction.

Let me know your successes and failures in the world of system optimization.

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