Prioritizing End Users

Via tedytan on Flickr

Implementing an integrated electronic health record invariably results in competing priorities and competing end users. I've written before that I believe patients are the most important end user. However, that still leaves clinicians, technicians, support and ancillary staff- and the often-ignored institution- competing for high ranking in decision making and resource allocation.

In order to assist in decision making and set system-wide strategy, I utilize a three-tiered approach to ranking these needs. Growing up with a strong Star Trek influence, I've come to agree with the Vulcan notion that "the good of the many outweighs the good of the few."

With this belief in mind, patients, as a group, represent the top tier of importance. This means that with every decision that we make, we are asking "is this what is best for our patients?" If the answer is no, than another path must be chosen.

The second tier is the institution. The reasoning is two-fold.

Via puuikibeach on Flickr

First, the patients are best served through the success of high-quality institutions. The era of the individual physician providing comprehensive care is coming to a close in the US; it's simply too difficult for a single physician to organize and orchestrate the multiple facets of a patient's care. Although many are nostalgic for the days when a doctor made house calls with his stethoscope and bag, modern health care requires advanced diagnostics, multiple providers, nurse coordination, complex billing and an increasing technology.

Second, the institution exists as the governing body of the multiple individuals involved in delivering patient care. A successful institution will create an environment where conflicts are resolved and effective collaboration for the benefit of the patients is possible. The institution can arbitrate the wants and desires of individuals and groups of individuals to meet the ultimate goal of serving the patient.

Via janwillemsen on Flickr

The third tier are the individuals that are employed by or contracted by the institution. Many have tried to rank the importance of individuals and groups within this tier, suggesting that the desires of clinicians should receive greater weight in decision making than support and ancillary staff. However, in order to best meet the needs of the patients, the needs of these individuals must remain balanced. For instance, it does not serve the patient to purchase the fancy equipment requested by clinicians if it cannot be adequately disinfected by environmental services. Ultimately, the collective actions of every individual in the institution determine the quality of care that patients receive.

In order to realize the potential return on investment from integrated electronic health records, this tiered model must be embedded as a core value of healthcare institutions. By focusing efforts on benefiting patients, we will learn to use EHRs in ways that improve care and decrease cost, resulting in benefits for institutions and individuals.