Sunday, May 6, 2012

Sociotechnical systems and EHR implementations

One of my students posted this in a recent course discussion online:

"Postscript: An EHR alone can't improve an organization.  It's just technology.  Engaged, motivated people with the right tools to do their jobs (possibly including an EHR) have the power to improve an organization."

Usually when an instructor reveals their position on a posted question, it kills the thread, but this time it was worth noting that governance and people are probably the two most important success factors in EHR implementations. 

We often forget that the focus of HIT is people, whether they are patients or clinical end-users. And that an organization’s real measure is the quality and motivation of its employees, and the EHR is just a tool to help the organization meet its business and clinical objectives. 

In any complex sociotechnical system there are two areas that need to be addressed - the social and the technical. This implies that the people need as much attention as the EHR, something that I have seen many organizations forget in their haste to put in “the best” EHR system.

Of course, if the leadership in an organization is able to understand the implications of HIT implementations and use their knowledge to motivate their employees to manage change appropriately, then the chances of success are greater. 

Wednesday, March 14, 2012

To test or not to test...

I was asked to write a guest blog at Trends in Graduate Education and Instruction about utilizing tests in online courses. Here's what I had to say:

As a student, I never particularly liked tests. But as an instructor, I’ve warmed to them. Especially those that enhance the learning experience and offer value to the course I’m teaching. 

I now use tests in my course for two reasons. Firstly, they allow students to check if they have met the learning objectives that I have set for them, and validates their learning. A good test allows students to examine the concepts they have been exposed to during the course, rather than rely on rote learning.

Sakai (the learning management software my department uses) has made my life distinctly easier. I can upload a test which is timed, has immediate feedback (so students don’t have to wait for their results), allows questions to be displayed randomly or in specific blocks, (which improves test security), and automatically exports their scores to the gradebook (so I don’t have to).

I use the instant feedback feature on Sakai to not only explain why the student picked the wrong answer (or provide positive reinforcement if they made the right selection), but also to explain why I developed the question, and why the concepts associated with the question are important to their learning. I’ve found that explaining the raison d’ĂȘtre for the question also preempts any concerns that students may have about the validity of the question itself.

The second reason why I deploy tests is that they allow me to calibrate the course for future offerings. I can modify course content, emphasizing concepts that students find challenging in the tests, and at the same time shore up potentially simplistic content. It’s a great way to adapt the course to allow maximum learning, and in conjunction with student feedback, an excellent way to incrementally improve the course.

But, as I realized when I took the recertification exam for my internal medicine boards, I still don’t like taking tests. I guess some things never change.

Tuesday, January 31, 2012

Where the world has not been broken up into fragments by narrow domestic walls

I was at a faculty retreat today when I was struck by a thought: that the folks siting at the table around me were extraordinarily diverse - in background, expertise, and interests  - but they all identified themselves as informaticists, and not just as physicians, or computer scientists, or as computational biologists.

I’m fortunate to work with folks whose backgrounds are incredibly diverse - a librarian with an MBA, for example, or a PhD in computer science who plays the french horn professionally. Some of my colleagues are hard-core quantitative researchers who define evidence-based practice, while others conduct qualitative research that sounds suspiciously like ethnographic studies. And some of them (for example the bioinformatics folks) describe their extraordinarily complex research projects in terms I don’t understand well, but I find their work to be incredibly interesting.

Things were never this diversely complicated when I was a full-time internist. My physician colleagues and I, we may look different to outsiders but fundamentally we are all cut from the same cloth, we worship the same gods. An internal medicine conference is a familiar place where we discuss the best methods to manage disease in a familiar way that is comprehensible to all. 

But informatics conferences are very different. My informatics colleagues and I, we are all very different, and professionally we do very different things. It seems we spend a lot of time at these conferences trying to figure out exactly what informatics is.  But we all identify ourselves as informaticists, and that’s not a bad thing at all.