HIT Think

How to bridge the potential divide between IT and the clinical side

I recently had the chance to speak with Rob Schreiner, MD, president of Wellstar Health System and a member of the KLAS Arch Collaborative. Wellstar Health System was the very first organization to take KLAS up on its offer to participate in the EHR benchmarking study.

The organization had been looking for a way to measure its ability to gauge users’ satisfaction with its electronic health records system. Now, data indicates that the organization is in the top echelon of performance.

KLAS is particularly impressed with how Wellstar Health System has approached the EHR implementation. They’ve recently added 11 hospitals and 250 medical offices, all of which began implementing their current EHR in 2013. Through all of that EHR work, Schreiner says has learned quite a bit.

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When asked about the tension that often exists between clinical and IT leadership, he explained, “I like the word tension. And I don’t want to imply tension is something bad; rather, it’s inevitable, and you can use it as a source for developing insight and improving collaboration.”

He went on to explain that both clinicians and IT professionals are incredibly well trained in the technical aspects of their respective worlds, but both groups sometimes struggle to translate their particular needs and constraints to one another.

From a clinical perspective, it makes sense for a clinician to ask the IT team to develop customized ordering functionality for medical assistants around scheduled vaccinations, medication refills and the like. The IT team, without knowing more than what their clinical colleagues ask, may be unaware of workflow particulars for that area of practice. These knowledge gaps often result in IT and clinical teams giving each other orders instead of coming together to discuss solutions.

Schreiner explained that a little communication can go a long way in helping these two historically contentious teams come together. His advice? “Let’s get out of the business of issuing orders to our IT colleagues and instead enlist their help to identify the problem we want to solve and discuss what IT constraints and options exist for solving that problem.”

I wasn’t surprised to hear his advice. The team at Wellstar Health System has always had a collaborative vibe. Schreiner says that while translating needs sometimes helps to solve the problem, the tension often leads to misaligned goals.

On the surface, it may seem like these two groups have total unity in their goals. Both clinicians and IT staff go to work daily with a focus on ultimately helping patients and families get through some of the hardest times of their lives. However, as you dig deeper into the daily challenges of each group, the disparity becomes clear.

“As a general rule, I think clinicians underestimate the unintended outcomes of seemingly small changes on the EMR platform,” Schreiner notes. “For example, it would be natural for a primary care doctor to want to issue a bulk order for all of her patients to get seasonal influenza vaccine at their next visit. That seems like a slam dunk during flu season. Yet that primary care doctor may have no idea about the myriad downstream problems that a bulk order, if implemented, would create. Those patients may not see the primary care doctor at their next visit; they may instead show up for an MRI, lab draw or pharmacy refill, and those bulk orders are still going to ping.”

Clinical ideas often sound wonderful and simple, but they can be far from it. There is only one way to navigate such problems without destroying the working relationship between both parties: IT and clinical colleagues need to inform and partner with each other instead of merely taking orders, issuing orders, and subsequently ignoring orders.

All this sounds like the world’s biggest “easier said than done.” The “done” often does not come without the “said.” It’s important for leadership teams to understand and begin to exemplify this increased sense of collaboration.

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