EMR Implementation: Building a Team of Informaticists

March/April 2010

EMR Implementation

Building a Team of Informaticists

In “Clinical Informatics and the CMIO” (PSQH 2010, Jan./Feb.), I discussed the importance of clinical informatics in institutions achieving their EMR implementation goals. I talked about why you can’t “just take the paper order set and make it appear on the screen” and how you should brace yourself for organizational change when you start doing electronic order entry. I described these as the “hidden costs” of EMR implementation.

I also promised to offer some insight about how to build an informatics platform. The problem is that informatics is still poorly understood by most people even within healthcare. The first step is to build the team that will help bring about this change. So how do you build this team?

The first step is to look for an informatics team leader — ideally, a chief medical informatics officer (CMIO). But how do you find a CMIO? If you don’t find good candidates internally, look to recruiters in your local area. Do they have anyone with solid informatics experience?

Many large universities (Yale, Indiana University, UC Irvine, University of Michigan, Oregon Health and Science University) have programs in biomedical informatics. Check to see if any of your candidates have training at one of these programs.

There are also degree programs you should be aware of. The American Medical Informatics Association (AMIA) runs a popular program in conjunction with Oregon Health and Science University called the 10×10 program (www.amia.org/10×10). Their goal is to train 10,000 healthcare professionals to be informatics leaders by the year 2010. Look for candidates who have training through one of these programs.
If you have trouble finding the right candidate externally, your hospital may need to find someone internally who can be groomed to be your informatics leader. How do you find this person, and how do you prepare him or her for this new role?

The first, and most challenging part is to find someone who really cares about change. Here’s the hard truth: Change isn’t easy. It requires patience and a high tolerance for frustration. Start by looking at the people who go to a lot of department and policy meetings. Who are the “thought leaders” in your current clinical staff? Examine their ability to manage complex problems. You want someone with patience. And they have to be optimists when it comes to technology.

It’s helpful if your candidate has good analytic skills, good communication skills, and is a strong clinician. Passion for technology is a must. Your candidate should have demonstrated leadership skills and respect from the rest of the clinical staff. Most important, your ideal candidate understands the value of being neutral politically.

Once you think you’ve identified a potential candidate, approach this person and introduce him or her to the concept of clinical informatics. Let them know this is a discipline that ultimately will help change the technology and workflows of your healthcare organization. Make sure this person gets involved with professional informatics organizations such as AMIA (www.amia.org) and HIMSS (Healthcare Information and Management Systems Society, www.himss.org).

Finally, you’ll have to be serious about cultivating your candidate’s informatics skills, and that will take time. Be prepared to cut down his/her clinical hours, slowly at first, and then gradually more as the informatics discussions around your EMR implementation become more robust: First budgeting, then design, then deployment.

Your budding CMIO will begin to draw other clinical staff into discussions and inspire their involvement. Your leader’s passion for informatics should be contagious and inspire other clinical leaders to become involved. That’s the holy grail of informatics development: embedded informaticists. Your new informatics leader spends 25% of his/her time on clinical work and 75% on informatics projects. Think of your embedded informaticists as “mini-CMIOs” with the opposite time division. These are clinicians—nurses as well as physicians—who generally spend 75% of their time on clinical functions and 25% of their time on informatics.

These embedded informaticists make excellent project leaders, and your CMIO can help them succeed at implementing both department-specific and hospital-wide changes. With this new informatics platform in place, you will:
•    Have expert opinions on budgeting decisions for IT.
•    Be able to design more meaningful training programs.
•    Develop a change management mechanism to review your policies and compliance issues.
•    Streamline workflow efficiencies.
•    Be able to approach successful implementation of electronic order entry.
•    Organize the development of your order sets.
•    Better support your IT investments.

Finally, I should mention that there are consultants who understand informatics and will be glad to help. Just remember, they don’t know your hospital’s clinical workflows, so a large portion of their time will be spent figuring out your hospital’s idiosyncrasies. Only after they fully grasp your hospital’s workflows, will they be able to help design meaningful order sets, education, policies, and workflow changes. Their learning curve may be longer, but they can certainly help rescue you in a pinch.

I hope my advice has been helpful! Keep a positive outlook, spend time doing your informatics homework, start the informatics discussion with your clinical leaders early, and success will await you! If you are interested in more discussion, feel free to visit my blog at www.dirkstanley.com. I welcome reader comments!

Dirk Stanley is a practicing hospitalist and the chief medical informatics officer at Cooley Dickinson Hospital, a 142-bed community hospital located in Northampton, Massachusetts. Follow him on Twitter @dirkstanley (http://twitter.com/dirkstanley) or visit his blog at www.dirkstanley.com.