As I wrote last time, when you are designing the content of
an EMR you have to consider the dimensions of clinical culture, information
flow, specific data capture and the use of controls. Good design also means
finding solutions to meet the often competing needs of clinicians, management
and, yes, the software. It’s a
complex process. I don’t claim to have all the answers, but over the past eight
years as EMR implementation manager and then consultant for Netsmart Technologies, I have struggled
extensively with the issues.
First and most importantly, as the project manager for the
implementation at UBHC, I did not struggle alone. We cast a wide net to recruit
a workgroup of 30 members. The members were supervisors and line clinicians
from all disciplines and levels of care as well as the leaders of all
stakeholder departments. Here is a list of the participants if you want more
details. Our charge was to design the structure and content of our electronic
health record. We met for half a day a week for three months. The learning
curve was steep. (more on workgroup education next time) The process was
intense. The turf issues and, shall I call it, specialty narcissism were very
much present. Together they created the major threat of “Content Creep.” This
is a situation in which Staff want the details of their specific domains included
and in their customary formats. The back-and-forth process eventually made it
clear that to accommodate this range of domains would result in content that
was too lengthy and complex. The phrase: “That item means 100,000 clicks per
year…Is it worth it?” became a regular refrain.
By the time we were done, the participants had had the
opportunity to understand the needs and concerns of wide range of functional
areas and all LOC. They were then able
to make recommendations based on detailed knowledge of the information needs in
balance with the realities of staff time and the software. The focused group
process was powerful in setting the stage for the necessary compromises.
Patience and determination were essential to discovering the solutions.
