Going Beyond Technology with Informatics Improvement

I often tell the story of my first clinical informatics fellowship rotation. We visited an ambulatory clinic to observe clinical workflows. Right after we arrived and introduced ourselves as the new informatics fellows, one of the physicians jumped up and was so happy to see us as she needed immediate help! Was she going to ask for help implementing a different set of steps between ordering and administering vaccines? Was she going to ask us about how to revise her documentation and ordering templates in order to decrease care variation and documentation time? In fact, the printer had broken and she asked if we could fix it for her. Turning it off and back on didn’t work, so we assisted by calling the IT help desk.

The People in Healthcare

Healthcare's core isn’t found in its technologies or even its processes, but in its people. Whether it's the patient anxiously awaiting a diagnosis or the clinician diligently recording observations, human interactions define the healthcare landscape. 

In the informatics world, an illuminating example of this comes in the form of order set governance and reviews. Getting clinicians involved in this process is crucial to its success, but it's frequently cited as a hurdle. The reasons are understandable: after a grueling shift, it's challenging for anyone to sift through a pile of emails or attend another meeting. A technology platform won't compel a tired clinician to answer these emails or engage with a complex process.

Technology as a Catalyst

There's no denying the potential of technology in healthcare. The printer example highlights how ingrained that tool is in delivering a comprehensive clinical visit. Ultimately, the technology serves as a catalyst to make existing operations more efficient and effective. It doesn't seek to replace the human element but rather to enhance it.

Again, take the task of order set reviews. On one end of the spectrum, imagine a method of sketching out the design of the order sets with pen and paper, manually observing clinicians to record data about usage, and perhaps even mailing draft suggestions for further review. Compare this to a technologically-driven method, where previews of order set design, performance metrics, guidelines, and communication channels are all consolidated in a single view. As a participant, I’d certainly prefer the latter method given the convenience and efficiency. By lowering barriers and streamlining tasks, technology amplifies the effectiveness of human effort.

Cultivating a Culture of Engagement

Beyond technology and human engagement lies another pivotal element: fostering a culture of involvement. Establishing this culture in healthcare and informatics operations is the bedrock of any improvement, especially concerning EHR workflows.

But how does one create this engagement? Oftentimes, it requires a combination of incentives and empowerment. Many organizations have found success in offering direct financial benefits, whether that’s buying down time from participants or granting stipends. These gestures, although typically relatively small, serve to acknowledge the added effort extended by healthcare professionals.

Further deepening this engagement, initiatives like provider builder programs can help engage end-users. These programs demystify the intricate domains of IT and informatics, breaking down barriers and creating champions within different service lines. By integrating end-users into the improvement process, these initiatives ensure a more grounded and holistic approach to refining healthcare operations.

Bringing it Together

In our efforts to optimize healthcare operations, it’s vital to recognize that each of the three elements – people, process, and technology – holds a unique place in the equation. They are interdependent and support the mission of delivering efficient and compassionate care.

While technology acts as an accelerator and catalyst, making tasks easier and faster, it's rendered moot without the human will to engage. But even the combined force of people and technology is incomplete without the right culture and processes to guide their interaction.