The Divide

The Clinical and IT Divide

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

They joined the study after I spoke with Dr. John Morris, an old friend and member of the Wellstar Health System. I’d mentioned this new idea we’d cooked up about measuring organizations against a benchmark of EHR satisfaction. Lucky for us, Wellstar Health System had already planned to go down this path, and we quickly launched the Arch Collaborative survey with them.

I spoke to Dr. Morris after we’d received some early results, and he said, “Taylor, I’m trying to decide how depressed to be.” At the time, we didn’t have any data to measure against. Fast forward to today, and we’ve been able to determine that, compared to the benchmark, Wellstar Health System doesn’t have a lot to be depressed about—they are in the 97th percentile!

We are 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, Dr. Schreiner has learned quite a bit.

I asked him to talk about what I feel is the elephant in the room for healthcare leadership: 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, etc. 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.

As we talked, Dr. 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’m clearly an outsider of the Wellstar Health System, but I have regular contact with their team, so I wasn’t surprised at all to hear Dr. Schreiner’s advice. The team at Wellstar Health System has always had a collaborative vibe. As we spoke, I pressed Dr. Schreiner further on this IT/clinical tension. While translating needs sometimes solves 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.

Dr. Schreiner continued. “As a general rule, I think clinicians underestimate the unintended outcomes of seemingly small changes on the EMR platform. 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.

While I understand that this all 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. As my dear friend Adam Gale has said on numerous occasions, “What you measure, you focus on. What you focus on, you improve.”

If you’d like to learn more about Wellstar Health System’s success or more Arch Collaborative data in general, reach out to us at archcollaborative@klasresearch.com