Monday, June 9, 2008

Aligning Clinicians and IT

Each year when I publish the IT operating plan summary, I'm careful to relate the projects to their strategic importance, impact on patients, improvements in quality/safety, and return on investment.

This was nicely stated by Ian Furst who commented on my blog about Marketing IT. He noted that a statement such as "Our goal is to be 100% computerized by 2009" sounds like an IT goal. Ideally, goals should start with "we will improve the patient care/experience/life expectancy with....."

To align Clinicians and IT, I have a Clinical Information Systems Steering Committee which includes membership from 11 subcommittees:

Chair of the Laboratory Information Systems Committee
Chair of Radiology Information Systems Committee
Chair of Critical Care Information Systems Committee
Chair of Inpatient Information Systems Committee
Chair of Ambulatory Information Systems Committee
Chair of Health Information Management Committee
Chair of Community Information Systems Committee
Chair of Decision Support Information Systems Committee
Chair of Revenue Cycle Information Systems Committee
Medical Executive Committee Representative
Operating Room Executive Committee Representative

The work of all these committees was recently presented to the Clinical Operations Coordinating Committee, the joint administrative/clinician governance of BIDMC. The presentation I used illustrates the major clinical accomplishments for FY08, the goals for FY09 and plan for future years. Each slide describes the clinical benefit of the projects.

When I execute complex clinical projects each year, I'm typically asked three questions about my approach to aligning clinicians and IT.

What are our biggest challenges running large clinical information systems projects?

Every project must start with a charter that identifies the stakeholders, roles/responsibilities, the purpose of the project, the milestones, and metrics for success. The only way to balance scope, timing, and resources is to have an unambiguous definition of who cares about the project, who does the work, why the project will be done, when the project will be done, and how project success is defined. As the project proceeds there will be many requests to expand its scope, add more features, increase the number interfaces, and expand the the stakeholder population being served. The committee providing governance to the project, guided by the charter, must resist the change in scope. If change in scope is deemed critical to the project's success then the charter should be changed to reflect the impact on project timing and resources, ensuring that change is broadly communicated.

What are the biggest mistakes?

Projects must ultimately be driven by their business owners, such as the doctors, nurses and staff who will be using the finished system, not by IT. Having clinician driven projects ensures the application becomes "the clinician's system" and not the "IT system which administration forced on us". Also, software should not be used to change workflow. Before implementation of the software, business processes should be optimized and workflow documented. Then, software can automate that workflow. If software is used to force behavioral change, clinicians will blame the software for any frustrations they have about the process change.

What are the top 3 best practices to ensure success?

Big bang IT never works. Pilots and phased implementation of applications reduces the risk of failure and ensures the resources are available to respond to any infrastructure or application issues which occur during roll out.

Broadly communicating the benefits of the project and the urgency to implement it really helps with clinician acceptance/adoption.

Project management is key. Ensuring the scope is constrained, milestones achieved, and participants coordinated are prerequisites to a successful project.

As a clinician myself, I use the systems we create. Being a physician CIO/CMIO helps me understand the clinical impact of every project, engage the clinicians in every project, and establish trust with all the doctors and nurses in the hospital.

1 comment:

Ian Furst said...

this year we're converging a system for referral management over several cities which inlcudes a VoIP implementation, new programming to the existing system and staffing changes. It's already underway but the charter looks like a good way to align the clinical/HR and IT roles in the project. Thanks for the suggestions.