Using Innovation Technology to Enhance Patient Care Delivery

The ultimate goal of using innovative technology is to deliver more effective patient care—effective both clinically and fiscally. This goal presents complex challenges. Effective patient care is the result of the coordinated efforts of an extensive, multidisciplinary patient-care team, all of whose members must have what they need to provide optimal care. Five elements are essential to any system of effective patient care— selecting the right outcomes to achieve, having the right clinical data, using the right presentation of that data, making the right decisions, and implementing the right processes—then validating that the outcomes are achieved. Technology implementation is most likely to be successful when it optimizes these elements. Planning for the effective use of technology must proceed from the ground up, drawing less on corporate information systems priorities or vendor product offerings than on the diverse workflow needs of clinicians—what they need to meet patients’ needs. An information system must provide actionable information that matters to the clinicians. The central focus is always on the patients’ needs for care. The effectiveness of this approach is evident from extensive experience in assessing and prioritizing various clinical information technologies and from the recent introduction of a new medication safety technology at the point of care. This report used these examples to discuss what we know and consider what could be designed. The ultimate purpose of this presentation is to suggest a way of looking at technology to identify what will be useful clinically. Throughout this report, the focus will be on the use of technology by clinicians in providing hands-on patient care in the acute-care setting. The end result of implementing technology effectively is that the nurse’s role changes from a hunter/ gatherer of data and rules to a clinical decision maker who tests the reasonableness of the rules and, as appropriate, implements them. The clinician remains the central figure in the use of innovative technology to deliver more effective care. (Note: The term clinician is used to describe any member of the patient-care team who makes decisions regarding patient care, whether physician, nurse, pharmacist, or therapist.) CLINICAL INFORMATION TECHNOLOGY Some of the concepts in this report are based on work performed by the author and others at Catholic Healthcare West (CHW), a 48-hospital system based in California, Arizona, and Nevada. The challenge was to craft a strategy for moving forward on the issue of clinical information systems. To meet this challenge, the multidisciplinary team developed an innovative auditing and planning process. This process was used to develop clinician-driven standards for inpatient clinical information system functionalities, measure the level of technology use in each hospital against system standards, and provide tools to help hospital executives prioritize clinical system investments across all CHW hospitals. Clear, complete descriptions identified the clinical functionalities to be included in an integrated information system and the order in which they should be introduced to ensure optimal utilization of the various system components. The underlying premise was that the central focus of clinical systems planning must be the diverse workflow needs of clinicians and that their in-depth involvement is critical to success. Defining functionalities. Because of an extremely diverse group of stakeholders, the team first defined 55 functionalities needed for caregivers to function efficiently in the acute-care setting. These were defined and reviewed by the physician Medical Informatics Information Officer (MIIO), nursing leadership, physician informaticists, and a variety of information technology (IT) department leaders. For each of the 55 items, the team defined the technology capabilities required, the likely users, the rationale for its implementation, barriers typically experienced, and any other functionalities that would need to be implemented before the functionality under discussion could be put in place. Prioritizing Functionalities. Once this comprehensive list had been defined, the next step was to engage a diverse group of stakeholders to prioritize the functionalities. Stakeholders included hands-on caregivers, both nurses and physicians, and front-line supervisors, managers, executives, and representatives from such departments as quality, medical records, clinical laboratory, radiology, and pharmacy. A series of regional meetings brought together 15 to 40 clinical personnel from each region’s acute-care facilities to participate in the prioritization process. The criteria used for prioritization were whether the functionality was required for clinical decision-making and would be used regularly, would have a favorable impact on service or financial outcomes, would be welcomed by the people affected by it, and fix something that indeed was broken. In other words, Richard Kremsdorf is president of Five Rights Consulting, Inc., San Diego, California.