Developing a Systematic Planning Process

A Summary of a Case Study - Catholic Healthcare West

Richard Kremsdorf, M.D., Information Officer, Medical Informatics

Susan Perry, R.N., Information Officer, Enterprise Clinical Applications

Catholic Healthcare West

Catholic Healthcare West(CHW) is a heterogeneous group of 48 hospitals in California, Arizona and Nevada. The hospitals range in size from an average daily census of over 350 to under 25. They are located in small farming communities and large urban centers. They have hospital information systems from nearly every vendor, with a range of implementations from rudimentary to sophisticated.

How can such complexity be described and clinical information systems planning be systematically performed? That was the question we faced.

The answer is CLINT: the CLINicians' Toolkit, a detailed planning process designed to focus our IT investments on those missing functionalities that would best assist caregivers to be more effective and efficient.

The process has 3 stages:

I. Define Needs

II. Assess Status of Current Tools

III. Design and Implement Solutions

I. Define Needs

We held a series of consensus conferences , bringing together diverse groups that would represent the clinical and administrative constituencies of each Region. A strawman document was used to focus the discussions. It described 55 Functionalities thought necessary to provide acute care. The document itself was revised and the Functionalities prioritized, using defined criteria:

• Clinical Importance: Is the Functionality used to make essential clinical decisions?
• Linkage to Service and Cost Outcomes or Increased Revenue: What is the impact on service quality and financial performance?
• Ease of Organizational Adoption: Will there be immediate acceptance by users?
• Urgency to Replace Paper/Manual Methods: Do the current paper methods' inadequacies cause major disruptions?
• Technical Feasibility: Will this be hard or easy?

The meetings were structured to provide opportunitiesfor small and large group work. There was a combination of individual and group prioritization. Areas of agreement were identified quickly, so that most of the discussion time focused on the more controversial Functionalities.

Functionalities were grouped into 3 tiers, the highest of which was "Core," defined as "Minimum functionalities that should be in each and every acute care facility based on their direct link to improved patient outcomes (quality, service and cost). The other tiers, Mid-level and Mature, have Functionalities that build on the higher ranked tiers and are more difficult to implement.

II. Assess Status of Current Tools

Having defined the Functionalities, we could now objectively assess whether they existed at the institutions, from the perspective of the caregiver. Previous listings referred only to whether a product had been installed, while the focus of this assessment would be:

• Does the application have the capabilities that the caregivers had said they needed?
• Is the application easy to use, based on defined criteria?
• How broadly deployed and how routinely is the application used to accomplish the tasks appropriate to the Functionality?

A scoring system and data collection tools were created. Three knowledgeable Assessors visited all of the hospitals and made individual judgments, which were captured on handheld computers and aggregated into a comprehensive database for analysis.

The results were then displayed in a grid, with each hospital's data representing a column, and each Functionality a row. The numeric score was summarized as a color, based on CHW demonstrated Best Practice.

• Red: Hospital does not have functionality in place or the functionality is not being used
• Yellow: Hospital has functionality in place, but system is lacking in functional richness, ease of use, or deployment
• Green: Hospital has functionality in place; functionality is in full use by clinical staff

III. Design and Implement Solutions

The prioritization of the caregivers has been further structured into a logical sequence, putting those "building block" Functionalities first and the more complex ones later. Then, for each hospital, these Phases are combined with the hospital's Assessment results, thus identifying the highest priority Functionalities that are missing.

In some hospitals, the gaps represent implementation issues while in others they come from historically-different priorities. Sometimes, the existing system will be able to accommodate implementation of the new Functionalities.. In others, new products will be needed. By being clear about what is working and what isn't, we can focus on those high priority Functionalities that are most deficient.

Through this analysis, we can help define the optimum affordable solution for each facility.

For more detailed information: download a PDF version of the entire report.

For CLINT Functionality descriptions: CLINT Functionalities.doc

  

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