Working with Health IT Systems: Potential Issues with Adoption and Installation of an HIT System
For this experience, you will complete the following:
In the VA CPRS, access the system using the DOCTOR login/authentication series. Choose Seventy-Four, Patient.
Follow the prior (Unit 4, The Effective IT System) instructions to resolve a reminder of your choice from Patient Seventy-Four. As you are completing the process, put yourself in the position of a busy clinician.
Identify three pros and three cons of the reminder feature. What aspects are helpful to a clinician? What aspects (in your opinion) may encourage resistance?
For each of the three cons you have identified for the reminder feature, provide several suggestions for how they can be improved.
Answer: The two “first steps” in this activity are done within the VistA for Education system. Students should provide screen print (as provided in earlier units) as documentation of their activity.
The second 2 steps are short answer/narratives.
The students may give a variety of answers to the last two steps. The answers below are an example of what students may provide.
Three pros and three cons
Helps the user remember what to do.
Offers an easy way to do multiple things with one action (ordering a medication automatically sends that order to the pharmacy which makes the process faster or ordering a consult automatically sends the consult to the proper clinic or doctor).
Provides rationale for why a certain test is recommended.
Providers may resent being told “what to do.”
Not every patient fits a guideline, so providers may feel obligated to order something just to resolve the reminder even though it is not appropriate.
A consulting provider may get reminded to do something he is not qualified to do— maybe something that the patient should get, but it is within the practice of the primary provider not the consultant.
Solutions to the cons
I think the reminders should be keyed to the user. If the user is a consulting podiatrist and opens the patient’s chart, the podiatrist should not be getting the reminder that the patient needs a retinal exam. Podiatrists do feet, not eyes. Users will need to be educated as to why the guideline-based care is appearing so they do not think that they are being told what to do. Having them vet the guideline is a good first step. With the current system, it might be helpful to have a dialog box pop up first saying “This patient is a diabetic and the Medical Service here at XYZ hospital has created a guideline that will help you to provide the highest quality care.” Then a check box at the bottom (like in MS products) could be clicked on to “don’t show this message again” so that they don’t get it every time. Students may provide drawings or diagrams that further illustrate their meaning.
Objectives: 1. Identify frequently encountered challenges to adoption and implementation of HIT systems. 2. Design a plan to address barriers to implementation of an HIT system.