Abstract: In our initial implementation, we developed a robust governance process with all prioritization decisions (outside of break/fix and maintenance) made by committees of subject matter experts from all sites live on our instance of Epic. The structure ensured that all build reflected clinical consensus for all impacted sites, and gave ownership of all "enhancement" decisions to the customers (the sites) rather than the project team. By extension, the ability of the project team to use their knowledge of available (but not yet implemented) and soon to be released functionality to guide strategic decisions was limited. In 2017, we piloted a different approach for in the clinical decision support space, allowing our physician informaticists to take full responsibility for approving and prioritizing all optimization work, and charging them with a full review of existing build. A small, integrated team of data analysts, ambulatory and inpatient analysts, and clinical informaticians using agile methodology were able to review our full portfolio of existing decision support, turning off a number of alerts, making significant improvements to many alerts, and creating a new data driven approach to guide the assessment of all new interruptive and passive alerts. Given the success of this program, in 2019, we piloted informatician guided agile build in three additional clinical domains, and expanded build access for a small number of our clinical informaticians, giving them to freedom to pursue major projects independent of analysts on the project team. We also increased our use of custom code (custom extensions) to deliver more efficient workflows to end users. This approach necessarily shifted ownership of the prioritization process from clinical end users to the project team, but has delivered faster, more impactful build in the pilot areas, substantially increasing satisfaction with both the system and with the project team.

Describe the new knowledge and additional skills the participant will gain after attending your presentation.: Attendees will understand the benefits and impact of streamlined governance, empowering clinician informaticists (both for decision making and direct build), agile build methodologies for a small integrated team, data-driven evaluation of build need sand perofrmance, end-user feedback, and use of custom code to optimize system performance and end user satisfaction.

Authors:

Alistair Erskine (Presenter)
Partners Healthcare

Gianna Zuccotti, Partners Healthcare
David Rubins, Brigham Health
Rajesh Patel, Brigham Health