System Improvement Comes through Partnerships

Because of the IOM’s 2000 seminal work, “To Err Is Human” (IOM, 2000), 96% of hospitals and 86% of physician offices have successfully adopted electronic health records (Glaser, 2020). Unfortunately, the challenges of EHR implementations have been replaced by frustration due to system optimization delays and their impacts to patient care and excessive demands on clinical users (Liu, et.al. 2019).

How are we as informatics leaders to manage the demands for system enhancements, including defining propriety and prioritization of requests to address gaps, practice changes, and strategic goals? Models vary from queue-based approaches in which requests are prioritized according to order of submission, i.e., “first in, first out”, to governing bodies managing the oversight of work, to the “squeaky wheel” model in which the person who “yells the loudest, wins.”

This presentation will report the outcomes experienced with the implementation of governing bodies, philosophies of accountability and design standards, and objective impact assessments to prioritize work, minimize waste, and maximize implementation effectiveness and efficacy.

Effective management of system enhancements requires the following resources:
•    Governance
•    Standard work for design, build, and implementation
•    Prioritization assessment tool

Governance: Having governing bodies to direct EHR and technological developments in support of operational strategic goals is essential. Equally important is the availability of a governing body possessing a boots-on-the-ground knowledge to successfully assess new EHR enhancement requests for cogency with operational policies and procedures, as well as define the prioritization of the new request against the backlog of work appropriately (KPMG, 2017, p. 3).

This governing body will also assign subject matter experts (SMEs) involved in or affected by the change to ensure outcome will meet operational needs while ensuring engagement required for the successful implementation of the request.

Standards: Informatics leaders can support timely implementation of work through the use of standards, including those for estimation of time required for designing and building specific work types and the turnaround time of deliverables to minimize waste during implementation.

Prioritization: A tool that marries estimated work effort with evaluation of operational impact yields a more objective means of prioritizing the backlog of system enhancements in the queue. To ensure the implementation of system optimization requests are prioritized with the goal of achieving the greatest operational benefit, a scoring tool can help eliminate subjectivity and ensure resources are used to achieve the greatest operational benefit.

Outcome: After the implementation of these tools, my organization experienced a 15% increase in EHR system optimizations.