Peer to Peer – A Formula for IT Alignment

Why would someone complete medical school and residency training, then spend a decade in IT to become a CIO? Colleagues ask me this when they hear my background. My response reflects the growing importance of integrating business professionals with information technologists.

Health care, like other fields using automation to transform business practices, requires a fusion of IT expertise and subject matter expertise. This need has given rise to multidisciplinary project teams that couple clinicians with information technologists, and to the emergence of individuals who are trained dually as clinicians and IT professionals.

During my medical training in the 1980s, I observed clinicians hampered by primitive information management tools. Information sharing among health professionals within any single hospital was suboptimal. Sharing across healthcare settings was extremely limited. Efforts to improve this situation were insufficient, with limited clinician involvement in IT.

The magnitude of the problem—and the potential benefits achievable by attacking it—captivated me. With a naive understanding of the challenge ahead and no evident career path, I decided to focus my professional life at the intersection of medicine and IT. Over the past 20 years, the most important lesson I have learned is the value of blending IT professionals with the subject matter experts they support.

The Business-IT Mind Meld

During the past decade, our academic health center has created multidisciplinary teams to implement an electronic medical record (EMR). Though we are deploying commercially available products, this undertaking has proven to be ambitious for us—as it has for the entire healthcare industry. We have succeeded thus far because we have engaged clinicians to work alongside IT professionals, not just as consultants or focus group participants, but as this-is-my-job-and-passion members of the EMR team. Several clinicians have stepped away from direct patient care, driven by a desire to advance their professions and a recognition of IT’s potential to assist. A dozen nurses, pharmacists and medical laboratory professionals now devote themselves full-time to improving patient care processes, applying automation where it can help. Several physicians remain clinically active but dedicate up to 40 percent of their time to our EMR initiative.

We ensure that each project team integrates clinicians from different disciplines, since collaborative planning is required to design effective team-based care processes. Physicians, for example, know what care is required and why but often are unaware of the downstream workflows used by nursing, pharmacy, radiology and laboratories to deliver this care. Similarly, most clinicians know how they would like the computer system to work but require the expertise of the IT professionals to make it work that way. Together, and only together, does our team of clinicians and IT professionals encompass the experience and expertise required for effective process automation in health care.

Our EMR team members have benefited one another professionally. The members from IT have learned the clinical relevance of the systems they install, providing meaning and personal rewards not previously realized. The clinicians, meanwhile, have learned IT skills, such as workflow analysis and project management principles, increasing their ability to leverage automation to improve clinical processes. Most have, without deliberate career planning, developed hybrid skills that will make them more valuable for the rest of their careers. Several of the clinicians have made permanent career transitions to IT roles.

Implementing computerized physician order entry—a critical EMR milestone that enables physicians to order diagnostic tests and prescribe medications and other treatments—had been a personal goal for 15 years. Upon finally reaching this milestone recently, I was overwhelmed not by a sense of technical accomplishment but rather by pride in our team—how it had grown together, the passion and commitment it demonstrated, and the fact that it was unstoppable with or without me.

How to Align Your Project Team

The strategies for creating such integrated teams are straightforward:

1. Forge the project team from individuals who are respected subject matter experts and who are inspired by the greater goal of the initiative (for us, improving the quality of the care we deliver). If backfilling the vacancies created by these individuals in their work units is not painful, then you probably have selected the wrong individuals.

2. Establish two leaders for every project team: a project leader from IT to perform traditional project management functions and drive technical decisions, along with a process leader from the business unit to drive workflow redesign decisions. This pairing mirrors the inherent duality of IT-enabled transformation: technical execution married to effective process redesign.

3. Require that team members have a common space, common goals and a functional dependence on one another to succeed. If you demand that they interact intimately on all aspects of project work, the cultural differences that exist among them will soften over time to create a new, shared culture.

4. Establish a forum for integrated decision making, where team members from all disciplines (for us, nurses, physicians, pharmacists, clinical technologists, medical records personnel and IT professionals) must contribute. This forum becomes the nerve center of the project. Eradicate decision making in silos, because there are few decisions that affect only a single discipline within a team-based workflow.

5. Allow no party to proceed along an independent path. Nourish the commitment to multidisciplinary integration where it exists; force it where it does not; and highlight the successes achieved through collaboration.

We all will complete major projects in our careers. Some will fade, especially as advances in IT transform our grand accomplishments of the past into trivial exercises in the future. But the memory of our EMR team’s maturation will never leave me. I am excited by the new generation of clinicians who are embracing IT early in their careers, working alongside IT professionals who are learning the processes of health care. Through this evolution, the landscape of healthcare IT will never be the same.