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Curbside Consult with Dr. Jayne 7/23/12

July 23, 2012 Dr. Jayne No Comments

Last week was the first in a series of pieces about vendors using physicians and other clinical experts in design, implementation, and support. I mentioned that some vendors were awfully quiet, which seemed to shake loose some additional responses. As one of the first folks to reply to the original challenge, HIStalk reader Dr. Lyle sent a few thoughts:

I’ve actually spent a long time balancing clinical care and product development (and have been at various levels, from actual programmer to high-level vision guy), but a few key things always come to mind:  Don’t just ask what docs want – observe them and their workflows to see what they really need. No matter where you start, you will need to evolve, so keep a system in place for quick iterations to get to a better product. And as you implied, even if you have a doctor who can bridge that gap between clinical and IT, the vendors rarely use them that way. I have been medical director and consultant to a number of EMR and IT companies over the years and I finally grew tired of trying to explain things and then watch a product get twisted by IT and marketing to a point where it was no longer usable. I started a new company last year where the core team is me, a human factors engineering expert, and an IT guy. We think that threesome is what it takes to make great healthcare software. We are focusing on building physician efficiency software tools which integrate with EMRs to help automate and task-shift work. We had a nice writeup and I blogged a bit more about it. It’s been fun and quite an experience to move from the idea to building to launching to actually seeing a vision in place. Our first client found that our software cuts their doctor’s refill workload by over 50%, saving them 15-30 minutes a day. Finally, HIT which makes life easier for docs!

What Lyle says about observing physicians to see what they need is so true. I’ve found that clinicians can rarely articulate their workflows in a way that matches exactly what they actually do (except for surgeons, who are usually spot-on) so asking them often misses larger pieces of the puzzle.

I received a nice response from HIStalk sponsor Iatric Systems with a thorough write-up of its Physician Design Team, which was created to develop its IatriCare and OrderEase solutions. They win the prize for accompanying their submission with professional head shots, which I know always makes Inga and Mr. H happy. They also get points for showing that they actually read Curbside Consult:


Iatric Systems’ Physician Design Team is made up of physicians, nurses, and programmers. The providers on our team have years of clinical experience. For example, Suresh Nekuri MD is the medical director and a practicing hospitalist at Roane Medical Center (part of Covenant Health) in Knoxville, TN. He participated in the implementation of CPOE and the development of order sets for all eight Covenant hospitals. Michelle Schneider, a registered nurse on the team, has clinical experience in cardiac and intensive care. She worked for 14 years in a healthcare system that uses Meditech before joining Iatric Systems. The team’s focus was to design a CPOE solution that streamlines physician workflow so doctors can provide quality care to patients in less time.

Dr. Jayne, you indicated priority placement of postings would be given to companies with witty submissions, but it turns out there’s nothing fun or witty about our team’s development process; it was all business! Since members of the team had worked with deficient CPOE systems before, there was a mutual intensity, a real motivation to create an exemplary solution. Michelle Schneider confessed to being a taskmaster in design team meetings. She said, “We had new software developments to show in every meeting, and we needed to get the team’s feedback. So for example, if a meeting lasted 60 minutes, 56 of those were intense.”


Members of the team brought a diverse wealth of knowledge to the table, ranging from emergency department and inpatient experience, to skills that provided outpatient and private practice perspectives. So the team was able to focus on development of a solution that accommodates best practices while keeping in mind personal user preferences, too. Nurses and programmers on our team are full-time Iatric Systems employees, and they remain intimately involved in implementation and support. Because we choose physicians who are practicing providers, we employ them in consultative arrangements.

Since the initial development phase is over, the vast majority of enhancement feedback we receive now comes to us directly from physicians and clinical IT staff at hospitals that use IatriCare and OrderEase. But we retain the physicians on our Physician Design Team as needed. In fact, Dr. Nekuri joined Iatric Systems this month at the 2012 International Medical User Software Exchange (MUSE) Conference in Orlando, speaking with customers and participating in MUSE’s Physician Summit, where he and four other physicians discussed a variety of CPOE topics including standardization, physician engagement, training, support, order sets, policies and more. We are committed to quality patient care and user satisfaction, and we believe our Physician Design Team configuration has served us well in reaching those goals. One might sum it up by reiterating your father’s mantra, “If a job is worth doing, it’s worth doing well.”

I did receive a couple of e-mails from people who seemed to not read the request I originally posed. Just citing the number of full-time physicians on your staff wasn’t what I was after. There was also one addressed to “Diane” that sort of grazed the issue. If I haven’t yet replied to you, you might want to check your Sent Items folder then edit and resend.


E-mail Dr. Jayne.

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