Digitizing workflows →
And we are back!
Sorry for the long delay, especially when things were so new around here. I made an executive decision to get the draft of my dissertation FINISHED - which I did - so my writing efforts were tied up temporarily. But there’s so much to talk about, so let’s get back to it, shall we?
It’s 2011. Why isn’t every single doctor in this country on electronic health records?
Because, Leah points out, the transition to EHRs will require a bit more rigorous thinking than “Technology GOOD, paper BAD.”
Right? And that’s the thing that gets to me: What a pervasive attitude and how totally - stay with me, folks - wrong.
Of course, there are aspects of the paper system that are terrible, obsolete, unwieldy, frustrating, unnecessary, even unsafe. Small aspects and big aspects. But to dismiss the entire system as BAD and to hold up the new technology as GOOD, as Chris points out, misses some really important points.
Such as:
- Is everything about it bad? Are there good things about it you might be missing, things that are important to its users? What about things that are so familiar and ingrained in their routines that they rely on them in ways you might not have imagined? And will disrupting those routines without understanding why they’re important and why the old system facilitates them cause more problems than you realize?
- Is everything about the new technology good? Are there things about it that might be problematic in ways you haven’t thought about, because you’re excited about it for one set of outcomes and someone else might use it for a related but different set out of outcomes? Or even - do you define your goals the same way?
Here’s what I mean. One of the ideas I discussed in my dissertation is that people pattern their daily routines and practices based on the way they interpret the broader institutional logics that surround them. By “institution,” I mean the organizations and the industries that provide the backdrop for my study - so the healthcare and the health IT industries. The big health organization my research sites were a part of is also included.
Two of the big “logics” about EHR in both healthcare and health IT are that EHR improves efficiency and patient care. This makes sense, right? Those are great reasons to implement a new technology, to go through the pain of such an enormous cultural and organizational change, if it will make your work more efficient and ultimately improve the reason you do your job.
But what if a doctor interprets a logic in one way and an administrator interprets it in another? Take efficiency. What if a doctor wants to be able to refill prescriptions as quickly as she did before, and an administrator wants to be able to get information to billing faster than ever? What if a doctor wants to be able to enter data in the way that makes sense for quick charting the way he defines quick charting and an administrator wants to be able to have data entered in a way that streamlines charting for everyone, even if there were 50 doctors charting in 50 different ways prior to the implementation?
Either you’re going to have to come to a compromise or someone’s going to win out. In the situation we’re describing here, chances are whoever’s in charge of the implementation will win out, and I have some idea of how that’s going to work out down the line.
Oh, as for the good/bad dichotomy, let’s not forget one other important thing: The human factor. Hey, the paper system is a technology, it’s just an outdated one. One problem with the system has always been the human factor. People make mistakes. People misfile. People lose things. People forget.
The thing with new technology, particularly computerized technology, is that we see NEW! COMPUTER! and we think oh hey look, silver bullet! As if it’s the instant solution. But the EHR will still be run by humans, right? Who will have to learn and who will still make mistakes, no matter how much better the new technology may in fact be.
The new technology is an improvement. It can be even substantially better, leaps and bounds. But the good/bad is a mistake, and it sets you - us! - up for failure.
Even at the very basic level, it’s shocking to see how little people seem to know about the workflows clinicians perform now, with the charting systems they already have. Or even what a workflow is.
What I like? Is when a management team maps out a workflow on a wall-sized chart after interviewing a few individuals on the team, and expects that by simply showing the other members of the team the chart that everyone will jettison their own individual work habits and communication channels and behave as the chart expects them to.
I watched this happen except for the part of getting shown the chart in some cases. Some people didn’t get shown workflows before implementation. Oh wait, technically they did - the DAY they implemented.
Also? When the management team spends three-plus years developing a content management system built to service the workflow that only the chart believes exists. With the aid of technology teams and UX consultants, who by referring to the chart as their functional spec never get the opportunity to realize that the core functionality/metaphor of the software might be wrong.
Because for the small group of team members whose work is redirected through the system first, meetings begin to sound an awful lot like yelling.
I love when Chris writes about this stuff. Chris, please write more. This is so true. This is what I saw and it’s avoidable. Or at least it should be.
