Frances M. Brzycki Module 3
How
to design next-generation EHR data models, Shahid Shah URL
Why
was this article, blog, post, or multimedia chosen?
I'm
always interested in learning what experts deem good design when building
and/or modifying existing EHR data models.
I've worked on EHRs that were designed well and ones that weren't. This topic is germane to our database discussion
in class. Today's patient management team provides disjointed care and don't
know what each other is doing for the patient in real-time (Shah, 2012).
What
makes it interesting, appropriate, or reputable?
Working
in information and business for over 30 years it was encouraging to read that
in designing a successful system the people on the project team must be
comprised of both the clinical user and information technology specialist. The significant observation is the team isn't
purely comprised of business users and vice versa not comprised of only
technical experts. It needs to be a team
of hybrid stakeholders. I'm of the
opinion it's all about engaging your user and giving them a great experience
when using the application or system. If this isn't a core objective the system
won't be used.
Is
it an opinion? Case study? Research study? Product review?
This
article is an expert opinion by Shahid Shah who specializes in
healthcare IT enterprise software
with an emphasis on EHR.
What
was the need, problem, issue or trend addressed in the article, blog, post, or
multimedia?
The
author shared with the reader it is important to have clinicians "not a
bunch of engineers and other geeks around a table" (Shah, 2012) when
building a system. Additionally, "data modeling is about
understanding all of the users of the data, the relationships, attributes and
most importantly how the data management will grow and change in the
future" (Shah, 2012).
What
was the solution for which technology had an answer?
Besides
understanding the needs of all the users of the data, building primary and
foreign keys that provide flexibility when searching and querying the data is
paramount in solid data model EHR design. Additionally, Shah supports long-term
storage and change management control of all entity attribute that are updated
in the system.
What
implications might this have in healthcare delivery?
I
have mixed feelings about this data model design. While flexibility is
important to building good EHR primary and foreign keys for efficiencies the
designer can take this too far and over engineer the primary and foreign keys
and bring the system down regarding speed.
The bottom-line the designer needs to be mindful and build a system that
has a good balance between efficiency
and speed.
What
did you learn from it that might have application for your practice?
As a software developer I would be
mindful and build a system
that has a good balance between
efficiency and speed. I would not over
engineer the primary and foreign keys.
References
Shah, S. (2012). How to design next-generation EHR data
models. Healthcare IT News. Retrieved from http://www.healthcareitnews.com/blog/how-design-next-generation-ehr-data-models
Fran
ReplyDeleteThank you for the link...we spend a lot of time saying that we need a hybrid group of people involved in the development of new systems but one of the barriers I frequently see is that all of the people around the table are talking in generalities and not making sure that everyone is heard and listened to...it takes time to appreciate the language of different users because they are going to express their needs differently and all too often, time is not managed to help accomplish real communication that is going to uncover the nuances of how one care provider does their work in contrast to another...would anyone else agree???
Donna
Fran,
ReplyDeleteI have to tell you, I have had this conversation with multiple people as I'm slowly getting pulled into more meetings about the ED. What I find interesting is that although administration has the hospitals best interest in mind sometimes they cannot see the greater picture as they do not have what we call "foot time" in the department. When administration and the so-called "geeks" get together, workflow becomes an issue and can also become a patient safety issue as well. I found a great article where the author states" When the organizational structures and workflows of the system are not taken into account, the results can be devastating, as in the case of a pediatric hospital that experienced increased mortality for a subset of critically ill patients after implementing CPOE (a crucial part of any EHR).15 In this study, the workflow of the unit accepting the critically ill children was altered and hospital policies were revised to meet the needs of the software. Although redesigning workflows is often necessary for an EHR implementation, leaders must establish patient care and patient safety as priorities and insist the technology support it (Fenton et al, 2006).
Reference
Fenton, Susan H., Giannangelo, Kathy, Stanfill, Mary. "Essential People Skills for EHR Implementation Success (AHIMA Practice Brief)." Journal of AHIMA 77, no.6 (June 2006): 60A-D.