Lessons Learnt Implementing electronic orders
As healthcare organisations seek to create greater staff efficiencies and improve patient care, it comes as no surprise that at the top of the project list is the replacement of paper-based diagnostic test requests with electronic ordering. Customers who have successfully implemented Eclair electronic orders for laboratory and radiology note how they have seen increased efficiencies in time and resources, but more importantly, a decrease in errors and unnecessary test procedures, and a reduction delays in diagnosis and treatment.
When each of these customers started down the path of implementing electronic orders the question most often asked was ‘why does it seem so complicated to get electronic orders up and running?’ Many assume it should be similar to an online shopping experience where the laboratory order form operates like an online shopping cart and users pick items to add to the cart. Then instead of checkout, the order is printed and sent electronically to the laboratory to await specimen receipt. And, for the clinicians requesting diagnostic tests and procedures, it is this simple.However, making sure this process remains simple for clinicians but still accomplishes the key goals of accurate order capture and report delivery requires a great deal of complexity behind the scenes. The assistance of an experienced business analyst and the investment of time by project stakeholders who review and identify the various components of the order form configuration are key to managing this complexity.
After identifying the current state, the business analysis can collate and document the business requirements. For example, will the phlebotomist use printed order forms or a mobile collection application to view the awaiting collections? What data is required on the specimen label? In these situations, the business analyst may use a focus group to allow users to express their ideas and opinions about specific activities in the workflow.
As the business analyst captures requirements, various pain points are highlighted, and the project team can refer to the current state to identify and recommend process improvements. This can be a difficult time in the project as there is often resistance to change and the process can trigger discontent amongst users and stakeholders. To mitigate the risk of user dissatisfaction, the business analyst can hold a workshop to discuss the project goals and possible solutions. Prior to the workshop, information should be circulated to minimise any misunderstanding and to measure the impact. For example, which users are impacted? Is the impact positive or negative? Does the impact cause further problems? The workshop allows the users and stakeholders to discuss and decide on the changes. However, past experience has shown us that these challenges do sometimes have the potential to expand scope and increase the project timeline.
There are several aspects that need closer inspection at the start of an electronic ordering project. Before an organisation can look at standardization or how to improve the ordering and the specimen collection process, the current state must be documented. This step ensures all relevant stakeholders(clinicians, collection staff, laboratory staff, IT department etc.) are identified and workflows documented. At this stage of the project the business analyst’s key role is to observe and understand the integration between the various systems and document each process. For example, what data do the phlebotomist and laboratory require? Why is this data needed? Is additional data required? If that data remains in Eclair and does not go to the laboratory, what is the impact? By observing the activities of the users, the business analyst can understand the rationale and identify any additional processes not yet documented. Once understood, the current state becomes the foundation of the project as it helps to decide the project scope and highlight dependencies. For example, is the project focus community or hospital orders?
Accurate identification of the requirements and workflow processes is a vital component in any electronic ordering project. The number of workflows identified can determine the implementation process. The majority of customers start small with a pilot project where they select a niche demographic and/or identify a ward or collection room to validate the electronic ordering process. As issues arise, these are assessed and incorporated into the electronic ordering process tonsure the solution delivers the expected benefits and value.Without question, moving from a paper-based diagnostic test request system to electronic orders can deliver a whole range of benefits to healthcare providers, not just in the streamlining of processes but also in the delivery of increased quality of care for patients. But the complexity required behind the scenes to make this process simple can sometimes be overwhelming. Utilising the skills of an experienced business analyst to review and identify current processes and document business requirements can overcome these challenges and ensure the successful completion of the electronic orders project.
Written by: Derryn Strong
Derryn Strong is a Business Analyst at Sysmex. Her previous roles have included software testing, training and project implementation