2018-11-25

Resisters, Minimalists, Partialists, Partners and Exemplars

The Alberta Health Services (AHS) Connect Care clinical information system (CIS) can facilitate rapid access to health information across the continuum of care. However, the CIS cannot serve if it is not used consistently and effectively by all who share in care. Indeed, the legal record of care is vulnerable to inconsistent or ineffective CIS use. With Wave 1 implementation looming, it is important to anticipate prescriber engagement, adoption and CIS-use patterns.

Inevitably, a few physicians will object to CIS adoption. Whether motivated by principle, workflow concerns, ability or other reasons, the effect will be accept little interaction with the Connect Care record. These ‘resisters’ could be beyond the reach of essential communication, collaboration, decision support and care planning tools.

Other ‘minimalist’ clinicians will do only those CIS tasks absolutely essential to close encounters. Incomplete work on problem lists, medications, allergies, documentation and orders will shift information burdens to others.

Closely related ‘partialist’ phenotypes will use essential CIS features but miss all the efficiency gains to be had from personalization workshops and optimization services.

CIS ‘partners’ will use the CIS safely and collaboratively, while also enjoying decreased information burdens, increased satisfaction and generally improved clinical performance. They will seek and master the personalizations and automations made available through the system.

Finally, CIS ‘exemplars’ will not only master the CIS but additionally develop personalizations and automations to share with colleagues, and so raise the capacity of their clinical community.

As we get ready for CIS testing, training, and implementation, the time is right to look around (and within) to anticipate clinician reactions to Connect Care. We’ll need to manage to these reactions to have any hope of helpful adaptation to massive changes in the clinical workplace.

Backgrounder: Connect Care Prescriber Compliance

1 comment:

  1. An earlier version of this posting used the term 'obstructionist' to refer to clinicians who, for any reason, may both object to clinical information system (CIS) deployment and actively oppose its use.

    Some colleagues rightly pointed out that the word 'obstructionist' has negative connotations and unfairly brands persons who express genuine concern about the effects of CIS use (any CIS or the specific Connect Care adaptation of Epic software) on patient care or professional job satisfaction. Both scientific literature and popular press abound with reports of the negative effects of electronic health records.

    As expressed by another clinician:

    "Unfortunately, because of how a CIS functions, those few docs who refuse to update problem lists, or close encounters, etc will affect other clinician’s ability to utilize the system to its full potential. Other physician responses are also outlined in the update, including “partners” and “exemplars”, ie those docs who essentially take the CIS and run with it, using it to its full potential and helping their colleagues do the same. I’m sure most in your group (and most physicians actually) will fall into these categories. In prior CIS/EMR implementations, it has usually been the significant minority who refuse to meaningfully interact with a digital record of care.

    Anticipating these various responses (and preparing for them) can assist in the massive change to clinical care that will occur as we implement Connect Care. "

    A good point is made, and accepted. We will do our best to achieve benefit, and avoid harm, when implementing Connect Care. However things unfold, there will be some clinicians who (for whatever reason) oppose implementation. This could be passive or active. The effect is the same.

    We have changed the linked backgrounder (and this posting) to refer to "resisters" instead of "obstructionists", as this is a less judgemental term and focuses our attention on the effect of, not the reason for, objecting to CIS implementation.

    ReplyDelete

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