EHR Participatory Deployment Vs Black box Deployment methods
EHR Participatory Deployment Vs Black box Deployment Methods
EHR acquisition and deployment has been and still being one of the hottest topics within the Health IT circles. There are several approaches to EHR projects, some are based on general information technology project management theories and principles others are specific to individual technology vendor and many others to acquiring institutions existing project management programs. The goal of this article is neither to sketch out all the existing approaches to EMR acquisition and deployment nor to compare and determine which approach is superior to the others, rather this a phenomenological analysis in sense that it only describe our first person perspective as both student of Informatics on one hand, and most importantly as practitioner of the two methods above described on the other.
In this article we will briefly describe the underlining theories of the two approaches(1) , how in practice either of these methods is applied(2) and finally examples of environment where in our view each method might be the most advantageous(3). The notion of participatory EHR Deployment is borrowed from the principle of participatory design, defined by Wikipedia as “ an approach to design attempting to actively involve all stakeholders”this principle stipulates that a good design heuristic is based on the involvement of the end users during the processes of acquisition, implementation, deployment and ongoing maintenance of systems. Applied to health information systems, the approach consists of getting the end user involved in the decisions leading to system acquisition to it use ,this means users will need to participate or at least to provide input in the decision processes to the purchase and the different steps after system acquisition . It is our experience that this approach tends to be more prevalent in certain types healthcare organizations.
• Types of organizations
As we alluded to above EHR Participatory Deployment is a user -centered approach. This method in our view is more prevalent in (and in some respect )more suitable to organizations with high level of capability maturity, this means the organizations who have established processes in terms of workflows, dataflow and roles to name a few. In such organizations there are existing structures that drive information technology operations, this include process analysis and process validation committees, change management processes and established Information technology infrastructure. In these cases the stakeholder is knowledgeable of organizational strengths and its limitation and how EHR technologies and Informatics principles can be leverage to maximize organizational strengths and minimized its limitations. One aspect of this user center approach is also the choice of the appropriate EHR system.
• MOTS used as example of Participatory Deployment
MOTS or Modifiable off the Shelf applications are the type of EHR(s) that requires a great deal of customization. These types of applications software are usually customized to fit organizational requirement s and specifications. The software application can be configured globally or locally depending of the needs of the stakeholders. It is important to observe that end-user involvement can be as little as or a much as the organization desires. For example the end-user might be consulted on the content of encounters data capture but not necessary in the choice of the software layout or the color scheme used in Laboratory Information module. The key here is to understand how participatory deployment principles are applied. The main implication of this method is the notion of user ownership. In order for this technique to bare fruits in our view, the ownership of the system is a share responsibility between end user and technical teams.
As explained in the introduction there are more than one method to deploy EHR, our second approach will focus on what we dubbed the Black box method.
• The black box Method
This deployment technique is predicated on the notion that EHR deployment and use of EHR systems are two distinct activities and therefore the will be no need of overlap. Thus the process of acquisition implementation and ongoing maintenance will be the prerogative of deployment team most of the information technology department end user role in term of input is minimal. This method maintains the end user at the receiving end rather than in the mixt of deployment activities.
• Types of organizations
Unlike it counterpart, the black box method is more directed toward in a lower capability maturity organizations as well and small organizations and practices. In this case the control of the system is centralized. The deployment team controls every aspect of the system. Once the system is deployed the end user is trained to use the system following a pre-established and enforced work and data flow. Organizations such as small practices, primary care setting as well as some specialty care settings such as physical therapy or standalone Clinics are most likely to benefit from this method in part because there is very little process variations in their processes.
• COTS used as example of Black box Deployment
COTS or Commercial off the shelf EHR are the most common software programs. These programs are destined to be used as “as is” or sometimes refer to as one size fit all. The key feature of these types of applications is the fact that they are highly standardized with a very minimal configuration and very limited customization ability. Because of the highly structured nature of COTS, they tend to have much bigger influence on user processes and workflows than the MOTS systems. It is important to mention that COTS are usually easy to install and maintain and are much suitable to role based techniques.