ATLANTA - Will, ideas and execution is needed to improve the translation of health IT (HIT) to patient care, according to Don Goldmann, MD, senior vice president at the Institute for Healthcare Improvement during an educational session this morning at HIMSS10.
Goldmann set out to provide a framework for using quality and systems approaches to achieve meaningful use and a demonstration on how IT developers and vendors can work with improvement organizations and providers to improve clinical outcomes.
Stressing its value, Goldmann noted the four phases of innovation:
- Testing and spreading: Research and development (R &D) cycles in 90 days scan the environment for innovative ideas in healthcare and beyond;
- Prototype testing: Specify aggressive goals and high-level measures;
- Pilot testing: Expand the degree of belief by testing in boarder contexts; and
- Spread and dissemination: Employ a durable network of “nodes” and “mentor hospitals.
To achieve system level goals, Goldmann suggests that two or three “breakthrough goals” should be targeted. Otherwise, organizations will not have sufficient focus and employees may not be able to align their work with the most critical organizational priorities, Goldmann stated. “Dig deep and ask yourself ‘Do I have the will?’ What conflicts am I willing to resolve? What will I have to defer in order to concentrate on this work and ‘What exactly am I trying to accomplish,’" stated Goldmann.
The achievement of the “breakthrough goals” was an apex of a triangle in one of Goldmann's presentation slides using a foundation of “Manage local improvements and projects,” “Provide day to day leadership for microsystems” and “Develop Human Resources” at the bottom level and “Spread and Sustain” and “Provide leaders for large systems projects” directly supporting the breakthrough goal achievements.
“You have got to know your staff and make sure they are working to their skill limit,” stated Goldmann. In general, clinical providers have not received adequate training in improvement methods or project management in particular.
To frame the ideas, clinicians have to ask “What is the casual chain between the changes I am implementing and the outcomes I want,” according to Goldmann. Primary drivers are to build provider buy-in, redesign care systems to improve systems and workflow in alignment with aims, create a highly reliable system for decision support and actively support patient activation and self-management.
Beyond drivers, a practical lever for implementing an EMR is that it can provide immediate, practical benefit to caregivers. Additional levers that an EMR provides that Goldmann included were:
- Provide clinical providers and vendors with “extension service” support to ensure that health IT implementation occurs in concert with delivery system redesign with superior health outcomes as the target;
- When vendors and providers achieve success together through agile, rapid cycle learning, celebrate. An example would be to throw an organizational party for completing an objective;
- Create a “business case” for implementation--not as a cost effectiveness case but as a case to justify the investment needed to install, implement, train and sustain the objective;
- Increase joy in work for physician and the care team (decrease the current level of desperation)--care team workers working to their skill limit will reduce unnecessary procedures;
- Tap providers' innate desire to improve care--no implementation should fail to have a measure of unexpected consequences;
- Fully embrace patient and family centered care-link EMR to a fully functional personally controlled health records (PCHR) ; and
- Make PCHRs, electronic messaging and telemonitoring central to improving continuity of care.
Goldmann stated that the focus of telemonitoring on chronic disease management and prevention would benefit from utilizing PCHR's full capacity. “What I care about is my functional status as I age,” stated Goldmann.
Ultimately, you want to frame the ideas as conceptual, with key drivers and as a package or “bundle” of charges with testing and refining, Goldmann said.