closing the clinical it chasm

Closing the Clinical IT ChasmHow IT and Clinicians Can Effectively Communicate for

Success

Live Webinar

August 4, 2009

Sponsored by QWEST

Media Partner

About me

Board-certified emergency physician since 1993;

actively practicing

MIT background—EE/Computer Science;

worked in AI software development

Consultant to multiple healthcare organizations,

vendors, practices, and investment groups on

matters related to clinical IT

Hospital Medical Director for Information

Systems since 1999

This presentation

My observations and impressions on what works, and what does not

My biases: Non-academic settings

Private hospitals/practice orientation

Not a CMIO

Some sweeping generalizations, and some specifics

I am a ―Communicationalist‖ and a ―Practicalist‖

Spend my time where the rubber hits the road

What I’ve learned

Clinicians and IT organizations speak different languages, and have different cultures

Do your best to get the big things right

Harder to fix things after damage done, credibility lost

Unsuccessful projects go wrong for predictable reasons:

Everyone wasn‘t ―on board‖

Different constituents had different goals/expectations

Desired ends didn‘t match the provided means –product, human or hardware

Is it a technology problem

or a communication problem?

People think it‘s about wires and code, but it‘s about people and business problems:

What problem are we trying to solve?

Are we all solving the same problem?

Do we all agree how we‘ll know when the problem is solved?

Good communication—ride out the bumps

Bad communication—produces more and bigger bumps

What you don’t want

“The docs just don’t get it”

“IT just doesn’t get it”

Why we work in clinical IT

To support the clinical mission

Get your IT people out there, somehow

Talk to the nurses

Talk to the docs

Go on rounds

Sit at the PACS workstation

Go to a couple of department meetings

Caring for people is a noble mission—Inculcate it in your IT organization

And don’t forget the mission…

―Mrs. Smith, I am sorry to report that your

husband passed because we couldn‘t

easily access his information. But if it‘s

any comfort, his information is secure…‖

Practicing medicine

Often not black and white

Patient issues tend to trump all

Significant multi-tasking

Medical training can be ―anti-business‖

training:

TV role models—break the rules; don‘t believe

what others say; find what everyone missed

Practicing medicine

Physicians need to make lots of decisions,

often fast, with limited info

Not a 8-5 job

Professionally, short time constant—what

do I have to do today?

Time constrained—don‘t have enough

Docs give realistic news, and can take it

Practicing IT

Black and white—things work or they don‘t

Hierarchical

Multi year planning

Project plans

Needs requirements

Can bog down in detail

Meet the requirements—we succeeded

Contrasting worlds

The world of IT

Specs must be clear

8 to 5 daily schedule;

standing meetings

Multi year project plan

Hierarchical, structured

decision-making

Careful diligence

Organization-driven

Paid for meetings

The world of physicians

Specs may be vague

Varying, unpredictable

schedule

―3 cases this afternoon‖

Collaborative, fluid decision-

making

―I like that sales guy‖

Data-driven

―Meetings cost me money!‖

Tough sells

―It will only take a few extra minutes…‖

―It‘s for the good of the organization‖

―Not doing this will hurt patient safety‖

―It‘s a security standard‖

Easy sells

Save you time

Make you money

Make your life easier

Helps patients (really)

Cool interface

Works well

Compelling data

Respected colleagues advocate

How to sell to clinicians

Use clinical data (that applies to their

world)

Use clinical people

Leverage respected clinicians, get them

on-board (by solving their problem)

Don‘t get bogged down in tech details

Not all physician advice sources are

created equal

Be sure your physician advocates speak

for the broader physician target audience

Understand the underlying physician

dynamics and politics

The best physician advocate—

experienced, established, medical staff

leadership track record, not a hot-head

Engage the Med Exec Committee

Engaging physicians—the big picture

Build clinical relationships

Gather informally

Choose your battles; give and take

Radical idea—treat the docs like adults!

Make sure they understand your

landscape

Be careful of strident messages from

potential outliers

Engaging clinicians—nuts and bolts

On their schedule—often early a.m.

Feed ‗em

Clear process/meeting goals, end dates

Be proactive, not reactive

? Pay docs for key participation

Support your statements with data

Running a meeting with physicians

Start and end on time—even if they don‘t

? set ground rules at the outset—

sometimes

Know who your allies are; prep them a bit

Use docs to manage difficult docs

When there are challenges, let them vent;

Know when things are simmering—don‘t

let it boil over!

Getting a message to physicians

Machine-gun approach

Med staff office

Where they eat

Where they work in hospital

Department meetings

Their office managers

Unit directors or coordinators

Simple; to the point; one page

Other potential pratfalls

Good projects can go bad for a variety of

reasons

A bad implementation can kill a good

system

A good implementation can make a fair

system succeed

Don‘t implement a ―bad‖ system

Avoid blocking/tackling missteps

Can‘t have too many workstations

Can‘t fully predict the optimal form factors

Can‘t have too fast response time

Can‘t have too reliable a network—wired

or wireless

Can‘t have too easy system access

Who owns the project?

Hopefully not IT

Things can go wrong when IT ―owns‖ a clinical

project—careful IT leader, you could be getting

set up

Things go better when the clinicians ―own‖ the

project—nurses, doctors, or a combo

Yet IT needs to manage the project – clinicians

can‘t

Best—trusted clinical/IT relationships; Clinician

leaders own; IT steers

Doing due diligence

Have to do site visits

Take clinicians on the site visits

Need their perspective

Bonding

Wander off on your own—away from the official guide

The CMO, CNO, CIO have important perspectives, but not the full perspective

Talk to multi end users

Talk to the ward clerks, secretaries—they know

Deployments

Think of deployment as a multi-week/ multi-

month process—not a three-day process

Important to circle back two, four and eight

weeks later

Best training is live training, at or right before

go-live

Best trainers are/were clinical (often

nurses)—make sure there are enough

How to kill a good initiative

Solution doesn‘t deliver ―the goods‖

Runs slowly or poorly

Training disconnected from implementation

Difficult log-ins

Clinicians don‘t know how/where to get help

Clinicians don‘t know who to turn to—who to

communicate with

Summary

Effective communication will:

Help you make the right decisions at the outset

Help you manage expectations

Help you work through the inevitable hiccups

Win advocates

Help you get it right

Make for a happier career and IT org

Get in touch

Mark Radlauer, MD

[email protected]


What Qwest has Learned in Working with

Healthcare Providers

• Understand approach to serving patients first

• Work with stakeholders to develop solutions that

• Improve cost efficiencies of providing care

• Improve productivity of staff

• Result in improved patient outcomes & experiences


Really…

• Improve Ability for Clinicians to work together

• Real Time Images

• Scan Images at the click of a mouse

• Collaborate

• Video

• Telemedicine

• Improve Ability for Staff to address increasing

demands of patients

• Call routing

• Appointment reminders

• Voice mail to e-mail

• Fax to e-mail


How We Help IT Staff

• Help lessen the daily fires to allow for longer range planning

• Improve performance and access to applications running on the network

• Simplify Network Administration

• Consolidate communication services & vendors

• Reduced trouble tickets

• Easily add new sites to the network

• Centralize support and control while decentralizing access

• Security Services

• In partnership with IBM

• Private Networks

• Share our experience from working with many Healthcare customers

• Benchmark architectures and communication platforms

• Advise issues other providers are seeing, what they purchased to resolve

and results they received

• Provide dedicated account teams, service support and best in class migration

and project management help

Questions?


To learn more about Qwest Healthcare

solutions, visit:

www.qwest.com/healthcare

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closing the clinical it chasm

Documents

problem dont

clinical data

use docs

world use clinical people

clinical mission

rules dont

meetings meetings

difficult docs