optimizing ehr governance to improve the user experience · to improve the user experience session...

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Optimizing EHR Governance to Improve the User ExperienceSession #66, March 6, 2018

Paula Scariati, DO, MPH, MS

Medical Director Health Informatics, Dignity Health

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Paula Scariati, DO, MPH, MS,

has no real or apparent conflicts of interest to report.

Conflict of Interest

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Agenda

• The Problem

• Quantitative Outcomes

• Transformation Process

• Qualitative Outcomes

• Lessons Learned

• Next Steps

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Learning Objectives

• Recognize the importance of the User's Experience (UXP) in driving the optimization of EHR Governance

• List three tools that can be leveraged to re-engineer your EHR Governance process

• Explain why EHR Governance is a dynamic, iterative and ongoing process

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Why Am I Here?

What Do I Stand For?

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Why Am I Here?


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Dignity Health • 5th largest nonprofit health

system in the U.S.

• 22-state network of 9,000

physicians

• More than 400 care centers

• 62,000 employees

• Provides more than $2.2

billion in community benefit

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Team UXP

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The Problem

• Provider dissatisfaction

• On average, only 60 change requests were being released into the live

environment quarterly

• Not unusual for a change request to take more than a year from the

time it was submitted to the time it was finally seen by the end user

within Cerner

• Lack of tools for tracking the lifecycle of a change request

• Provider apathy regarding Cerner optimization

• Pervasive sentiment that EHR Governance was a black hole

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Why Am I Here?


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Why Am I Here?

What Do I Stand For?Does the Team

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Core Values

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Lead With the Data

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Number of Tickets Approved to Released, by Quarter*

*All tickets,

9/17/13 – 12/31/16

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Mean Number of Days Approved to Closed, by Quarter*

*All tickets,

9/17/13 – 12/31/16

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4-Prong Approach

1. Reengineered Change Request Intake

2. Established a Gatekeeper Function

3. Standardized Ticket Lifecycle Process

4. Enhanced Transparency & Accountability

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4-Prong Approach




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Reengineered Change Request Intake

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4-Prong Approach




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Routing = Gatekeeper Function

• Physician

• Nursing

• Pharmacy

• Ancillary

• Technical

• Optimization

• Build

• Quality

• HIM

• Compliance

=

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Routing: Complete & Technically Feasible

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Routing: Into the Weeds

• Meets every week for up to 2 hours (occasionally meeting runs a little longer)

• 25-40 change requests routed every week

• Regions (8) are limited to 4 ticket submissions per week

• Additional tickets come from Enterprise initiatives and projects

• Ticket assigned to one or more decision body/bodies based upon impact

• Tickets touching 3 or more physician specialty groups roll up to larger inpatient

and ambulatory decision bodies

• Tickets without a specialty decision body (e.g. radiology) roll up to larger

inpatient and ambulatory decision bodies

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4-Prong Approach




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Ticket Lifecycle Process Standardization

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Physician Decision Bodies

• Enterprise Content Group (ECG)

• PCA Content Group (PCG)

• Hospitalist Medicine CCG

• Cardiology CCG

• Oncology CCG

• Orthopedics CCG

• Nephrology CCG

• Pediatrics CCG

• Pathology CCG

• Emergency Medicine CCG

• Perinatal CCG

• Neonatal/NICU CCG

• Critical Care CCG

Note: CCG = Clinical Consensus Group

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Working as Designed — Intended Consequences

• Round robin build queues

• Weekly release cycle of changes into production

• Tickets impacting physician workflow released only once

per month to minimize change fatigue

• Standardized communication processes

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4-Prong Approach




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Transparency & Accountability

• Key Performance Indicator

(KPI) Dashboard

• Black Hole Dashboard

• uTrace App

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Outcomes

• 4-fold increase in throughput

• Turnaround time reduced by more than 50%

• Re-engagement of users and key stakeholders

• Increased credibility and trust

• Ownership of optimization

• Cross-disciplinary collaboration and teamwork

• More mature (and complex!) requests that drive value

• Improved adoption and user experience (A3, EKG)

• Better standardization of processes and system

• Better IT support — potentially fewer incidents and easier to maintain due to standardization

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Lessons Learned

• It’s a team sport

• Core values anchor expectations

• Providers engage when they see their input makes a difference

• Quantifiable return on investment

• No software survives contact with the end user

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Design

Safety

User Experience

Quality

Next Steps

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Where to Begin

• Don’t be afraid!

• Land & expand

• It’s not a destination, it’s a journey

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Questions Paula Scariati, DO, MPH, MS

Medical Director Health Informatics

Dignity Health

[email protected]

Please complete online session evaluation –

your feedback makes us better!

mailto:[email protected]

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