By Vicent Moncho Más (*)
“Working hard for something that we don’t care about causes stress, while working hard on something we do care about generates passion.” This is one of the phrases Simon Sinek employs to describe “The Golden Circle” and the W-H-W triad.
What if we were to ask these three questions during an Electronic Health Record (EHR) implementation project?
In my opinion, they are all very relevant as the answers can help to resolve some classic organizational, cultural and paradigm change problems that arise during the EHR implementation process. Next, I will carry out an intellectual exercise:
Why?
What is the reason, cause or belief that has led to such a far reaching project? It could be for reasons of technological leadership, as hospitals with EHRs have a better image both externally and internally, it could be due to the belief that the organization’s administration could be improved by IS, it could be an effort to optimize patient care and improve safety, etc. etc. etc.
So, every organization has to define its reasoning very clearly: answering the why in a clear manner can make it the guiding light for the project.
How many IT or EHR projects have been embarked upon without a clear idea of why? Without this clear idea it will be difficult to assess whether the project’s objectives have been achieved, difficult to value the benefits, and difficult to define the phases or even when it has ended.
How?
How are we going to manage the project to achieve the above objectives? By applying scientific method based on experience, it is possible to anticipate major mistakes in the different “hows”; mainly because we are faced with a project of cultural change, a change of paradigm, with such a large organizational component that it could be regarded as one of the biggest revolutions in medical practice in recent decades.
This obliges us to address clinical leadership itself, committing (“clinical”) resources to design, administration and management. Prior experience tells us that even in the best cases a model with a clinical leader surrounded by technical “consultants” is very likely to fail.
Transformation on a clinical level is essential in the development of a project and the key to its success is communication between equals.
What?
This is the simplest question, as it regards the improvements that we will achieve in our processes thanks to IS, which must meet minimum standards for functional coverage, usability and sturdiness to facilitate professionals’ work from day one.
The technology cannot fail, because if a professional does not have access to clinical information a stressful situation will arise that puts the patients’ health at risk. Other sectors that invest in IT, such as the financial sector, can allow for planned stoppages at night but these pauses are unthinkable in the 24×7 healthcare environment.
So it must be a solid, robust, stable, finished, and integrated system as one cannot experiment in our environment. A few years ago, a CIO described his care IS as being like an airplane being built in mid-flight, with continuous accidents along the way, and which had to continuously recalculate its flight path.
All EHR implementation projects must have a very well defined mission; the “why” and the scope. But the methodology cannot be classic, it cannot be thought of as doing the same things just in electronic format, as that will not provide any improvements or benefits. It is better to think in terms of a guiding light that can illuminate the entire organization.
Finally, leadership should have a sufficiently powerful and complete clinical component to achieve the cultural revolution that is involved in a process of this nature.
Now, all the above would not be possible without an information system that meets basic requirements such as ease of use, support for clinical practice, sturdiness, feedback and other aspects, in fact, one could draw up a list of 20 basic principles without which the solution could not exist in the clinical environment.
(*) Vicent Moncho Más is a member of the Governmental Council on Healthcare Information and Management Systems Society of Europe, and at the Annual HIMSS Conference and Exhibition Latin America he will give the talk “New implementations of HIT and the greatest scope for the adoption of the clinical health record.” In addition to leading the IT team at the Hospital de Denia (the first Spanish care center to obtain Level 7 HIMSS certification), he is a consultant for the Universidad Abierta de Cataluña.
