Foreword by Dr. Halamka

What is the ideal medication workflow?

Simple – from doctor’s brain to patient’s vein without handwriting, handoffs, or hassle.

Although Beth Israel Deaconess Medical Center (BIDMC) has not used handwritten medication orders since 2001 and has an e-prescribing rate of 96%, the medication workflow is not ideal. For 20 years, we’ve automated many existing processes – provider ordering, pharmacy supply chain, positive patient identification, medication administration records, and billing. However, automating an imperfect process does not make it better.  Automation just makes it faster.  Over the past year, we’ve spent 3000 hours re-examining the entire medication workflow using a multi-disciplinary LEAN process.   What’s the best way to package and deliver medications?   How should care delivery teams reconcile medications and communicate issues?  How do we involve the patient? We’re now turning this idealized design into a detailed specification that we can automate.

Doing this work takes 3 kinds of people – medication experts with domain knowledge of the workflow, IT experts with domain knowledge of available hardware/software, and project managers who glue the two together. As an IT professional, I’ve worked on hundreds of projects.   The most successful are those with business owners who understand their requirements and can communicate them to IT implementers.   In one recent very large project, we taught systems analysis to the stakeholders because the project bottleneck was communicating the idealized workflow.   The project is now on time to go live.

Dr. Alexander Scarlat’s Electronic Health Record: a Systems Analysis of the Medications Domain is important for two reasons.

First, it provides a framework that will enable clinicians to communicate with technologists.   As the pace of IT change accelerates, so does demand for workflow automation.   Technology is no longer the rate limiting step.   Translating user needs into IT products and services is the biggest challenge we face.  Dr. Scarlat’s clear explanations empower healthcare professionals with tools that will enhance any IT project.

Second, the medication domain is the highest priority area for healthcare stakeholders to improve quality, safety and efficiency.   Meaningful Use Stage 1 included numerous medication list, e-prescribing, allergy, reconciliation and decision support requirements. Meaningful Use Stage 2 will include even more medication related activities, emphasizing the importance of automating these processes correctly.

I plan to use this book in the BIDMC medication work, which seeks to achieve zero defects, cost reductions, and patient engagement.   Both clinicians and IT professionals should find the book to be a valuable resource as they create the reformed healthcare delivery system of the future, beyond Meaningful Use.

John D. Halamka MD

Boston, Massachusetts,  September, 2011

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