Advice to the new National Coordinator

Two and a half years ago, John posted an entry with this title – and I recall that it was a good summary of the state of the industry.  While I didn’t agree with all of his suggestions, I enjoyed the review and it offered a good set of guiding principles.  Since I was Acting National Coordinator for about the same duration as Vindell will serve, (Fall of 2013 – after Farzad Mostashari departed, and before Karen DeSalvo arrived) I’ll offer some thoughts from one who has been in his position.


  1. Certification.  The health IT certification program is the core of ONC’s responsibility to the nation.  While some have called for the eradication or reduction of the certification program, I would argue that this would be akin to scaling back Dodd-Frank.  Yeh – crazy.  As a product of ONC’s certification program, we now have health IT systems that do what their developers claim they do.  Before this program existed, creative health IT salespeople would assure customers that systems had functionality that simply didn’t exist, or was nonfunctional.  The program, like certification programs in other industries (telecommunications, transportation, etc.) is in place to assure the purchasers of products that these products do what developers claim.   Is the certification program perfect?  No.  Of course not.  The program needs to iterate with the evolution of the industry and the standards that are evolving.  Revisions to the certification program must therefore continue, so that the certification requirements don’t point to obsolete standards.  A focused “2015R2” certification regulation would therefore be an appropriate component of ONC’s fall work – so that something can be “shovel ready” for a new administration for ~ February release – with final rule in ~ April/May of 2017.

  2. The 2017 Spend Plan.  The 2017 federal budget appears to be on track to pass @ some point soon – and ONC’s appropriation for 2017 is looking like it will land at a steady ~ $60M ($65M if the extra $5M for narcotic abuse prevention lands).  The National Coordinator defines the “spend plan” for how the organization allocates this money – and the plan needs to be developed and executed at the beginning of the fiscal year: October, 2016.  The new National Coordinator is therefore making decisions now about how the funds will be spent over the next 12 months.  Office Directors are preparing proposed budgets for the year:  new FTEs, new projects that they want to launch.  Every year, it’s the same – just as it is in any large organization – proposals are submitted and the proposals represent 2x-3x the $$ available.  Tough calls need to be made.  The NC makes these calls. It’s hard to do this when you don’t know who your successor will be in January – or what their preferences will be.  When I was in this position, I worked closely with the Office Directors and the ONC Chief Operating Offer (Lisa Lewis), to identify the components of the organization’s work that were essential, and which were not.  We delayed decisions on about $2M to give Karen some flexibility to fund programs that were important to her.  As I mentioned in my response to Politico’s request for comments on the next phase of ONC’s path, my view is that it’s time to wind down ONC’s grants and health IT evangelism activity.  Perhaps it’s just my personality coming through here – as I am a well-known introvert, with little interest in quadrant 1 of the sizzle-substance 2 x 2 matrix (kudos to Janhavi for its invention), but I am concerned that it’s not government’s role to convince the public of the value/need for health IT.  If health IT has value (and I believe it does) then this value will be tangible and self-evident to the public.  If not, then no annual conference, blog post, or challenge grant will change this fact – or anyone’s perception of it.  ONC’s annual meeting – an event that costs several hundred thousand dollars and attracts the same participants every year – adds rather little to the nation’s progress toward improved health through the strategic use of health IT.  Kill the conference.  Kill the health IT flag-waving.  There’s already plenty of that to go around, and the taxpayer need not pay for it.

  3. Focus on quality.  No – not quality measures.  Quality of health, quality of care, quality of decisions.  Do these need to be measured?  Of course they do – and with the growth of value based payment in federal programs upon us, measurement of quality is imperative.  But we have conflated the concepts of quality and measurement.  As many know, I’ve long been concerned that the way that we use clinical quality measures in health care is fundamentally flawed.  Indeed, it was my concern about these flaws that led me to join ONC in the first place:  as the CMIO at Allscripts, I was responsible for helping our EHR development teams meet the requirements of Stage 1 of the EHR incentive programs (“meaningful use”) and it became clear that the accuracy of quality measure reporting would be terrible across the industry.  Why was this?  Because the 2011 certification criteria and Stage 1 meaningful use requirements were too vague about the data that would be used to measure quality.  For example, a quality measure might express that patients with “severe congestive heart failure” would be expected to be on a certain class of medications.  But there was no clarity for how “severe” was to be assessed, and many EHRs didn’t even formally capture ejection fraction, which would be an imperative component of an assessment of the severity of one’s CHF.  For Stage 2/2012 certification, we changed all of this, and while most readers don’t know or care about the details, these quiet changes represent the first important step toward improved quality measurement:  the data elements that are required for quality measures are explicitly identified in the certification regulation, and no measures are required that exceed the scope of these data elements. Read the last sentence again if you need to – as it’s very important and this guiding principle remains ignored by NQF, by many commercial health plan quality measures, and by many state Medicaid programs that are trying to implement quality programs.Simply put:  it’s impossible to report on data that was never captured.  A “quality measure” that assumes the presence of information in an IT system that is not present will be an invalid quality measure.  Period.  I thought / hoped we solved this problem in 2012.  Unfortunately, we did not.  Quality measures are still proposed without consideration for the data that EHRs have captured.  It’s now easy to know what the EHR can capture (what it can capture and what it has captured may of course differ).  Start with the NLM’s Data Element Catalog (Jesse James won the naming competition).  If the concept that you want to measure isn’t in here, then re-design your measure, because the EHRs don’t capture the data in a uniform manner.   If it is there, then the likelihood is high (but not certain) that the data can be captured, queried, and transmitted.

    Recall that I said our method of measuring quality is flawed.  Why is it flawed?  Because all of our focus is on quality measures rather than quality improvement, and improvement is a product of measurement and decision support.  Let’s parse this statement, beginning with the difference between measures and measurement.  A measure is an explicit logical statement about care delivery and its alignment with a very specific expectation.  For example, there is some evidence that individuals with diabetes will live longer if their blood sugar is well controlled, so there is a quality measure for this:  IF (individual has diabetes) AND (blood sugar is well controlled) THEN (quality measure satisfied).  Each of the logical expressions can be defined explicitly.  This measure can then be applied to thousands of care providers and their “scores” on the quality of care they presumably offer can be compared.  But what if blood sugar control isn’t so important?  What if there becomes a better way to measure individuals’ optimal health?  Measuring care quality with a list of measures is like having a speedometer in your car that measures 10, 15,25, 37 and 55 miles-per-hour and nothing in between.  It’s a set of measures -hard-coded into the system rather than measurement:  a fluid, adaptable system that enables us to see how we are doing and therefore enabling us to adjust our work dynamically if necessary.   How do we adjust?  With clinical decision support (CDS)!  As you will read in the chapter I wrote for Eta Berner’s just-published book on CDS, the federal government has done a great deal of work to enhance CDS capability in health IT systems, and to align it with quality measurement.  We’re not there yet – but we are well on the way.  Keep this on the front burner, and the path to the triple aim will be shorter and much less bumpy.

  4. As my friend Jerry Osheroff always says – focus on the most important things:  TMIT.  Are we helping improve the health of people?  That’s most important.  Don’t lose sight of it.  Karen DeSalvo taught me many things – but the one I’ve internalized the most was something that she taught me very early in her time at HHS:  we need shift our conversation from how to improve “health care” to how we improve health.

It’s not about the technology

I got a call from a friend last night.    He's the CMIO for a large hospital.  He's smart, works 80 hour weeks, and he's passionate about getting his EHRs to work right, the providers trained right, the order sets configured right, and (most importantly) the patients treated right.

He's been in the role for a number of years – and he's good at his job.  Very good at his job.  He knows the systems (from two EHR vendors – an inpatient system from company A and an ambulatory system from company B) better than many employees of the companies.    He's memorized the criteria for Meaningful Use down to the section and subsection numbers.  It's amazing.  I had a similar role once – about ten years ago – and I vividly recall mentoring him into his new position back then – thinking that his hospital would do so much better than mine – as he'd see the puddles we had already stepped in.  .. 

He's an incredibly gifted physician too – and continues to see patients at least 20 hrs a week – with a full call schedule.  

But tonight he called me because he wants to quit his IT job and go back to being "just a doctor."

Because the politics of the IT world have been too much for him.

"The analysts didn't finish the order sets and blamed the doctors for not reviewing them."

"And the doctors insist that they WANT to review them, but the analysts tell them that they're not ready to be reviewed!"

"We're behind schedule and all they do is blame someone else."

"Why are they lying?  Why do they get mad at me when I point out what's going on?" 

I listened.  And listened.  It sounds dreadfully challenging.  He's implementing TWO EHRs, and getting CPOE up and running in an outlying hospital, and migrating a community of physicians to new workflows, new processes and new habits.  This is no simple task – and he's got the technical details down cold.  

And he's done a great job with all of it …

Except his relationship with the IT team.    

This is not uncommon.  But there is a solution.  An easy one, in fact.  

"Your should pretend you're a doctor."  I said.

    "I am a doctor!"

"You're a doctor when you are with your patients. But it doesn't sound like you're a doctor when you're with the IT team.  It sounds like you are an angry parent!"

We talked about this for a while.  He wasn't sure where I was going – but he was intrigued.  He knew that somehow I have found it less difficult to navigate the political mine fields of hospitals, academia, industry and government.  Indeed – his minefield is my Fenway Park!  Am I serious that I want him to treat the IT team like they are his patients?

Yes!

"If your patient tells you that they have been dieting and exercising but they are still gaining weight – what do you say?" 

    "I would say that I believe them 100% – that they are dieting and exercising and that I want to find ways to help them."

"Do you really think they have been dieting and exercising as much as they say?"

    "No.  Of course not."

"So why do you not challenge them?  Why don't you point out how wrong they are – and that they are fibbing?"

    "Because it's not important if I am right.  That won't help them."

"So why is it important that you are right that the analyst streched reality a bit about doing the order sets for Dr PooBah?"

    "Because they didn't do what they are supposed to do.  I need to point that out."

"Why?"

    "OK – I can see what you are saying but it still doesn't make sense.  How will my NOT judging them make them get their work done?"

So this is the key leap of faith for him.  It seems like these are different settings, different goals, and he should use different skills.

But it's not necessary.  The same skills that make a great empathic physician will also make a great empathic results-oriented CMIO.

He's built a (medical) career of great habits that we can leverage.  The habits he'd built are the ones he uses every day to care for his patients in a collaborative, meaningful, non-judgemental way.

The key to his success in the IT world is to say (to himself) just what he says to his patients:

  "Because it's not important if I am right.  That won't help them."

The focus shifts from blaming them for being lazy, lying IT enemies – to "folks who need my support."

Dr CMIO – you already know how to do this!

I could tell he was interested – but still wasn't quite at the point where he could make the leap.  We talked about the dysfunctional team of IT analysts, how they gossip and argue and sidestep work.

"It sounds like they are very unhappy"  I say.

He got quiet.

"Yes – they are – and they make everyone else unhappy."

"So what do you think would happen if they felt like you were an ally?  Like you wanted them to be successful?"

We went on like this for an hour or so.  It's a hard shift – but quite powerful.  He remarked that I was soundling like a buddhist – and I pled guilty – but pointed out that this is not just a buddhist principle to avoid judgment – it's a core component of many of the "success in management" books too – most of which avoid invoking religeon or spirituality.    A few good ones to consider – probably required reading for any CMIO:

Energy Leadership

Five Dysfunctions of a Team

7 Habits of Highly Successful People

I'm giving a talk to a bunch of CMIOs in a few weeks.  Maybe I'll leverage this vignette into a little sermon powerpoint.

 

12 years of blogging .. about medicine, technology and their intersection …

This post from November 26th, 1999 – was the first on this blog.  There were a few months of previous posts, but due to several platform changes back then – these seem to be lost.  

No matter.  12 years is a long time.  My blog is now officially an adolescent.  I wonder what it will be when it grows up!  Long-time readers are of course observant that I've been remarkably quiet for the past few years.  This is due to my evolving work for an HIT vendor and now the Federal Government.  

So I've been operating with this in the background for the past six years:

The opinions expressed on this blog are my own and do not represent the veiws of my employer.

And there is a rough "social media policy" (google docs – you have edit rights .. feel free to steal or enhance … ) that I have in my head as well .. so in general I have done my best to observe and occasionally point to important publicly available information, but take care not to comment too deeply – for fear that others would interpret my commentary as a telegraph of my employer's next steps.  This wouldn't be appropriate for me to share – and increasingly – I am concerned that most of my public thoughts could be interpreted in this way – so I've been holding back from any public commentary.

So for now – here we are. 

I'll push the envelope a teensy bit and comment on some events of the past few months:

Tim HISTalk covered my arrival at ONC in a post about a month ago.    He asked the right questions about the topic at hand – but he didn't get to the one that I am hearing often these days – which is .. "Why did you leave your leadership role at one of the top health IT companies, choose to spend weekdays away from your family, AND (with two kids in college) take a giant pay cut?"  

The answer is easy:   It's the right thing to do.  

Health Care in the United States  is at a turning point.  It is well known that despite great advances – we don't provide the quality of care that we would.   It is also self-evident (to me) that technology – carefully applied – will improve both the quality of care – and the efficiency, sensitivity, and ease with which it is delivered.  Yes – some of those words may not be familiar to you – but why WOULDN'T we want it to be EASY to deliver great care?  Why shouldn't we deliver SENSITIVE care (sensitive to your hopes, religion, fears, preferences) – in addition to efficient, evidence-based and (of course) cost effective) care?

 So I have always tried to focus my work on helping others meet their true potential.   In my first career – as a 16 year old sailing teacher, I helped kids find the freedom and autonomy that a good breeze and a sunfish will provide.   As a teacher of junior high school kids – I witnessed breathtaking intellectual growth in a herd of 12 year olds who were otherwise distracted by adolescence and its daily challenges.  Working with (some say "caring for") patients as a family physician - I found that my most important work was not to take control and "fix" my patients (as some of my mentors had advised in medical school) but to partner with my patients – serving as a resource – without any judgment or critique.  As Bill Miller and James Prochaska have demonstrated (motivational interviewing, transtheoretical model) – people change when they choose to – and no sooner.  Can we facilitate growth in others?  Of course we can.  But "facilitate" and "cause" are inherently different.

As a leader in a large health IT software company – my role was often to help our teams align the software products we were producing with the needs of our customers.  This is not unlike the role of a good physician:  we need to listen carefully and critically so that we understand the needs (which will sometimes differ from the "wants") so that we can facilitate success.

And isn't that the role of government too?   Perhaps that's a political question.  Some would argue that government should get out of the way, while others would argue that there is an important role for government to provide an infrastructure with which success can be facilitated.  Is a healthy happy nation something that is important?  Are there ways that government can facilitate a migration toward these goals? 

I think so.  Keep an eye on my occasional tweets , g+ posts (rss), and posts here on this blog.  It will continue to be sparse here on the blog. 

Can we solve these problems with IT?

My fax machine has too many faxes in it every morning

 

Analog office:  .. My fax machine has too many faxes in it every morning
which my staff put on a pile on my desk and then I try to read them and act on them  by scribbling illegible notes on them and putting them in piles on someone else’s desk. 
 
Digital office:  My fax machine has too many faxes in it every morning .. which my staff scan into my EMR and then I try to read them, and act on them often using a separate system functionality – so need to leave the “reading” work stream, do the action, then return to “reading”
 

Reassuring Lab Results just arrived (by fax, mail, local printer, etc)

 

When I get labs back – most of them are normal.  I can:
 
Initial them (digitally or pen/paper) and put them in the chart (paper or digital) Tell the patient that “no news is good news” (which is  terrible customer service, BTW)
But some will call (they should!)
So the chart gets pulled (paper office)
And someone calls them back (usually nurse)
And sometimes answers the questions
And sometimes the patient still wants to talk with the provider
So now it comes to me Like 50 other ones
I stay in the office until 8 PM calling my patients back And they ask other questions when we are on the phone Or they are not home so I leave a message So there is a loose end that I have to manage tomorrow.
 

 I am a specialist – seeing a new patient for the first time.

 

I don’t have any records – so my nurse or AA calls the referring provider, pharmacy (for medication list), and hostpial (for recent H & P/Discharge summary)
 
I wait Some of it arrives via fax Most of it arrives tomorrow I call the preferring provider’s office.
 
 wait The provider comes to the phone
 
Can’t remember much about the patient
 
Asks her staff to pull the chart We wait and talk about our kids in College
Our waiting rooms fill up with angry patients and well-dressed drug reps with too much cologne
Chart is “not found” – it must be in a big pile somewhere
We both get frustrated – referring provider hums a few bars from memory. 
We hang up. I make decisions with the patient based on incomplete data
I dictate my progress notes
I sign them (barely review them) when they come back in 3 days from the transcriptionist
They go into the chart (digital or paper)
My staff faxes a copy of my note to the referring provider.
 

I am a provider writing a prescription for Clarinex

The patient has seasonal allergies

Has tried “everything else”

The drug reps left a pile of these and I gave some to the patient last time she was here

They work “wonderfully”

She wants more

So I write a prescription

Which she takes to CVS 

And they want to charge her $107.50 

Because it’s not covered 

So she calls my office

And my nurse says she’ll work on it 

So she gets the chart 

So she looks up the insurance company (BlahBlah Healthcare)

And then she calls the “prior authorization” phone number 

And waits on hold 

Until a person answers  

Who sends a fax  

Which the nurse gets 4 hours later

And gets the chart again

And she fills out the form on the fax

And she puts it on my desk with a “sign here” sticky note on the signature line – and pointing to the (empty) justification section 

I get it on my desk the next morning  

I fill in the blank sections of the form and put back on the nurse’s desk

Who faxes the form   …

3 days later the patient calls and asks if this is done.

Different nurse pulls the chart and sees the copy of the fax that was sent to the insurance company – so she says yes.

Patient goes to CVS who tries to charge her $107.50 again

Patient goes home and calls the office

Nurse pulls chart again

Nurse calls BlahBlah Healthcare.  Turns out they haven’t processed it.  They will process it and will let us know if it’s denied (They won’t let us know it it’s approved).

Nurse calls patient and tells her to try CVS again in a few days.

Patient gets angry and yells at nurse

Nurse was depressed anyway and quits her job – slamming the door on her way out, hitting a child in the head as he comes in for his 3-year well-child visit.    He is conscious, but has a laceration on his forehead that will require repair.  The kid’s mother says she’ll sue the physician “for everything he’s worth” as she drags the kid off toward the emergency room.

She hits a raccoon on the way home, barely missing an Oak tree as she tries to avoid little Rocky.

She calls her physician and requests some Xanax to “calm my nerves” – beginning a life of dependence on benzodiazepines and poverty.  She stops making payments on her mortgage, loses her home, and was last seen living over a ventilation grate near the Misys offices in New York City.

Faughnan’s a grown-up now!

John's recent post on my "medical office mashup" comment is, as my colleague Paul would say, "spot-on." What I learned from his discussion:

  • Long ago in a Minnesota far-far away .. where Gopher was born .. and professional wrestlers were still wrestling … John used to look up at that cold sky and dream of medical mash-ups.
  • In a weak moment – you can still see that little kid in John – but he's been hangin out with the suits lately – and they make him say things like this:

    "Building a 98% reliable solution from x integrating parts requires (1- x*y*z…) reliability from each component."

Of course – he's right. That's the problem with the CIO types that he hangs out with — they're usually right.  Too many points of failure, too many dependencies on "foreign" systems, etc.  Gotta do it the "enterprise" way. 

But we've got to be able to dream these dreams – because they are the right ones to have. Sure – Google's calendar API will change and I'll zig with their zag – because for a user base of 1 person – this software is neither "mission critical" nor 100% reliable.

If we did everything the enterprise way – there would be no Internet.  TBL's vision was that by connecting things – we can derive enormous value.  Consider this section of one of his most famous essays:

 … For all these visions, the real world in which the
technologically rich field of High Energy Physics found itself in 1980 was one
of incompatible networks, disk formats, data formats, and character encoding
schemes, which made any attempt to transfer information between dislike
systems a daunting and generally impractical task
. This was particularly
frustrating given that to a greater and greater extent computers were being
used directly for most information handling, and so almost anything one might
want to know was almost certainly recorded magnetically somewhere.

Design Criteria

The goal of the Web was to be a shared information space through which
people (and machines) could communicate.

The intent was that this space should span from a private information
system to a public information, from high value carefully checked and designed
material, to off-the-cuff ideas which make sense only to a few people and may
never be read again.

The design of the world-wide web was based on a few criteria.

  • An information system must be able to record random associations between
    any arbitrary objects, unlike most database systems;
  • If two sets of users started to use the system independently, to make a
    link from one system to another should be an incremental effort, not
    requiring unscalable operations such as the merging of link
    databases.
  • Any attempt to constrain users as a whole to the use of particular
    languages or operating systems was always doomed to failure;
  • Information must be available on all platforms, including future
    ones;
  • Any attempt to constrain the mental model users have of data into a
    given pattern was always doomed to failure;
  • If information within an organization is to be accurately represented in
    the system, entering or correcting it must be trivial for the person
    directly knowledgeable.

Lots of what TBL said in 1996 (about physics in 1980) still applies to healthcare in 2007.  shame on us!

So my tiny project (total time invested <2 hrs) is an example of how we might start thinking about the parts fitting together.   It's 2007 and there are companies out there that have already started to develop and deliver webservices that provide important parts of the EMR infrastructure.   They work today – and will do more tomorrow.

Of course I've been wrong before … a professional wrestler as Governor?  Never.  🙂

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What makes a good doctor = what makes a good plumber.

Medical Decisions are hard to make.  Even when they seem easy.  

I'd say that the TV show "House" is popular because Dr House seems to focus on giving patients what they need (honesty, transparency, certain treatments) and not necessarily what they want.   In his case – the difference between the two are entertaining.   Does that make him a good doctor? 

In real life – this is much harder.   There's ample evidence that physicians' decisions are based on many factors.  What's best for the patient is simply one of these factors. 

We've had a medical student working on our office recently – and it's been interesting to see my practice style mirrored in her eyes:

  • I "actually listen" to my patients (who doesn't?   I wonder …)
  • I spend lots of time with my patients (no wonder I come home late every day!)
  • I hear what they mean – not just what they say (the hardest part)

I re-told this story to her – in abbreviated form.  I posted it nearly 5 years ago – but the principles I tried to highlight then remain important yet under-represented on the Internet today.  Medical blogs are now far greater in quantity – yet I still think there are rather few of them  that express the transparency that the initial work a few of us were striving for back then.   There are so many competing interests – for our time, our money, and our attention.  Without good principles – I'd argue that there is no way for physicians to stay the course – and really make the best decisions for our patients.

The National Physicians Alliance is a relatively new organization that's building steam – based on good principles.  It's great to see an organization that is committed to "Advancing the core values of the medical profession: Service, Integrity, and Advocacy."   You can also read the NPA’s ISSUE BRIEF outlining reasons why physician prescribing data should not be made readily available to pharmaceutical companies.  The issue brief mentions describes how to opt out of pharmaceutical industry data gathering by enrolling in the AMA's Physician Data Restriction Program (PDRP).  Cool.  Check.  Done. 

Integrity is so important – yet so often suspect when there is opacity.  Exposing our patients to the uncertainties of our profession is a cornerstone of shared decision making – yet it takes so much more effort – and so much more time – I'm not surprised that so few physicians actually do it. 

The same goes for plumbers.  We had a "free" cleaning of our furnace performed by these folks last week.  The service rep called my wife at work and told her we needed a new humidifier element for $45.  He happened to have one.  Said OK.  We also needed a new solenoid for the humidifier for $89 "on order."   Turns out – I replaced the humidifier element about 6 months ago (should be done once/year) and the solenoid seems to work just fine to me.  You can listen to  his explanation – left on our voicemail.   Now -  look at the picture. Water running pretty well, if you ask me!   I filled an 18 ounce cup in under 30 seconds.  If that's a "very small amount of water" – I think Gary needs to go back to plumbing school.

Either Gary is stupid – or he's lying.  Either way – I can't trust him or his company ever again – as I suspect that he's got his interests above mine.  I could buy the solenoid (see link above) for $45 if I really needed one.  And I'm a little mad that he took my 6 month old humidifier element with him when he sold me the new one (it's the honeycomb thing in the picture).  Either way – he can't be trusted.

We need trustworthy plumbers, doctors, bankers, lawyers, software developers, etc.    The principles of the profession  must guide our decisions.  If not – we will always be distracted or seduced by the many other choices on our path.  Plumbers who invent problems, doctors who self-refer, and software developers focus more on the icing than the cake – all compromise their integrity in the same way – and will ultimately lose.   

Misys Healthcare Hiring Physicians for Clinical Insight Group

The Misys Clinical Insight Group Application is now online. This is a great opportunity for clinicians with interest and skills in informatics to work with a top-notch research and development team as the next generation of the Misys EHR and PM systems are designed and implemented.

It's a part-time role (as much as 5 hrs/week) that involves detailed analysis of clinical workflows, review and analysis of use-cases, user interface designs, business requirements, and functional specifications, brainstorming with graphic and functional design analysts, and a few days of travel roughly every 6 months. Ideal candidates will have informatics education and/or significant implementation and/or development experience, and have a good understanding of usability principles and appreciation for the importance of human factors engineering in clinical applications.

Questions? Fee free to contact me about the team and the work we're doing.