Finding Clinical Informaticists, Part 2: “The Change Recipe”

In my previous post, we looked at why clinical informaticists are often “hidden” and how to establish the need for one by combining a 10-step change management recipe with a Responsibility Assignment Matrix. Below, we’ll take a more detailed look at the change management process, and help dispel myths about the roles of Applied Clinical Informaticist and the Clinical IT Analyst.

When we look at the first phase of the change recipe (documentation of request and expectations, or intake) it’s easy to see who has primary and secondary responsibility: both the clinical end user and the official requestor — their supervisor, director, chair, or chief — who need help supporting the request.

First Phase of Change: Documentation of Request and Expectations (‘Intake’)

As we move to the second phase of the change management recipe (Analysis, scoping, prioritization, resource allocation, and project approval), we can see that suddenly the Chief Information Officer picks up Accountability, while the Applied Clinical Informaticist has primary Responsibility for the literature search, sponsor identification, workflow gap analysis, workflow development, scoping of deliverables, and identification of stakeholders.

Together with a number of Consultants — including Clinical IT Analysts, Medical Librarians, Compliance, Regulatory, and Finance — they will also help review regulations and estimate total cost of ownership and ROI, providing much more helpful information for Senior Executives who will need to prioritize and approve this project before it can be assigned. [*Note: By serving this important workflow analysis role, the Applied Clinical Informaticist will also become an SME for other experts who will be Responsible for later steps.]

Second Phase of Change: Analysis, scoping, prioritization, resource allocation, and project approval

When we arrive in the third (Project Planning) phase, now the Executive Sponsor has picked up Accountability, while the Project Manager has primary  Responsibility for working with the Applied Clinical Informaticist, Clinical IT Analyst, and others to plan the necessary parts of the project, including Gantt charts, RACI Matrices, and/or other formal project plans:

Third phase of change: Project Planning and RACI Matrix/Gantt Chart Development

 

Assuming all of the above phases have been completed, this now brings us to the fourth phase of change: The drafting of workflows, for which the Applied Clinical Informaticist has primary Responsibility, typically in conjunction with the Clinical IT Analyst, Compliance, and the End-users.

Fourth phase of change: Drafting of Workflows

While some organizations may not yet have implemented blueprints in their development process, this step can be very helpful because:

• Blueprints help to create understanding, align clinical stakeholders, let you conduct tabletop workflow discussions and reviews, and obtain preliminary approvals before the Clinical IT Analysts begin their build (in the next step).
• Once approved, and with a few small changes, blueprints can also become your downtime forms, in case your electronic system is ever down for planned maintenance or other unplanned reasons.

This now brings us to the fifth and sixth phases of change, the building of deliverables and testing of workflows, where the Clinical IT Analyst now has primary Responsibility to build and test the deliverables, typically in conjunction with the Applied Clinical Informaticist and the End User (for end-user acceptance testing).

For the seventh phase of change (Final workflow approval), the Applied Clinical Informaticist now assumes primary Responsibility and works to secure the necessary final approvals in conjunction with Senior Leadership and a number of other stakeholders. [*Note that the Executive Sponsor still has Accountability for this step.]

Seventh phase of change: Final Workflow Approvals

Finally, for the eighth (Communication and Education/Training), ninth (Implementation/Publication) and tenth (monitoring and support) phases of change, the Clinical IT trainers, Clinical Education/Training team, Communications Team, and End-Users now all share Responsibility, and typically do their steps in conjunction with the Applied Clinical Informaticist and the Clinical IT Analysts.

Eighth, ninth, and tenth phases of change: Communication, Education, Implementation, Monitoring, and Support

Conclusion

What does this exercise (combining change management recipe with a RACI responsibility assignment matrix) teach us? Five helpful take-home points:

1. Clinical change management is a team sport that requires the participation of a large number of stakeholders to work together in a clear, highly detailed, highly-coordinated fashion, where different roles will be Accountable for some steps, have primary Responsibility in some steps, serve as a Consultant in other steps, and need to be Informed of other steps.
2. The roles of the Applied Clinical Informaticist and Clinical IT Analyst are separate and distinct roles that often work together, but serve in distinct and unique capacities, and thus should have separate and distinct job titles and descriptions.
3. Before projects are approved, the Applied Clinical Informaticist has primary Responsibility for the analysis, scoping, prioritization, and resource allocation, typically in conjunction with Consulting expertise from the Clinical IT Analyst, End-users, Compliance, Regulatory, Finance, Executive Sponsor(s), and Senior Leadership.
4. The Applied Clinical Informaticist also has primary Responsibility for the drafting of workflows (blueprints of deliverables), typically in conjunction with Consulting expertise from the Clinical IT Analysts, Compliance, and End Users. These blueprints will help to create understanding and alignment, and later serve as downtime forms in the event of a planned or unplanned downtime.
5. The Clinical IT Analyst often provides Consulting expertise during earlier analysis and scoping phases of the change, but then assumes primary Responsibility for the building and testing of electronic deliverables, before providing additional Consulting expertise during the implementation phase of the change.

I know there’s a lot to unpack here, but I hope this review helps to demystify the process, and helps you look at your own change recipe and the roles that are Accountable for, Responsible for, Consulting on, and Informed of each step. I also hope it helps to dispel the misunderstandings and confusion about the roles of the Applied Clinical Informaticist and the Clinical IT Analyst, two important roles that often work together but each of which require their own skill sets, job titles, job descriptions, and support.

This piece was written Dirk Stanley, MD, a board-certified hospitalist, informaticist, workflow designer, and CMIO, on his blog, CMIO Perspective.