Ramblings: Staying in Context to ensure Health IT success

This is something I really wanted to share with you folks, it is about staying in context.
I’ll explain at a later part why it is relevant to Health IT initiatives.

I conducted a workshop on “EHR Interoperability Design and Implementation” recently and I did my usual;

  • Have the participants introduce themselves and state their objectives in attending the workshop (so I can cater to their needs)
  • Ask the participants to list any questions related to the workshop (off the top of their head) that is relevant to them and their facility (in this case, related to interoperability, adoption of standards, workflow and EMR/EHR adoption since that is the theme of the workshop)

Among the questions posed were;

  • Is Healthcare different from other industries?
  • Why do Health IT budgets almost always overrun?
  • Should a ‘Big Bang’ approach be adopted for projects implementation?
  • Why governments allocated less than 0.5% budget on Health IT projects
    (I can’t even validate the question since there are so many governments on Planet Earth)

You might have already noticed, that the last question is totally out-of-place. As an educator, I tried to first understand the rationale behind the last question so I queried on the ‘why’ since it was not even remotely close to the theme of the workshop.
(I re-emphasis the theme to the person again before asking for the rationale).

The answer might shock you (it took me by slight surprise) – “because without sufficient budget from the government, we don’t even have Health IT projects and we won’t even need to talk about interoperability”.

The immediate reaction in my head was “great, why don’t we talk about global warming or  low birth rates in Singapore (I conducted the workshop in Singapore) while we are at this, or how about the rumored end of the world that will occur in 2012” since by extending the logic given, every single illogical scenario will somehow affect the theme on-hand.

To provide more background information, during the self introduction, the audience already explained who they are, the organisations they come from and what they want to achieve out of the workshop.

The attendees are mostly from private health organisations and interesting, some from the prison service, all looking to understand how to best avoid pitfalls in implementing health IT projects and how to obtain success. Government’s allocation of budget is totally irrelevant to the workshop.

If this happened in a university setting with a younger audience, I’d explained to the person why it was so out of context (a university education is really all about educating students on how to analyze, think and learn) but since it was a workshop for professional adults, I decided that I should let it go. To also cut the story short, the person who posed the question is a person friend (I know him quite well) and he was definitely not there to learn but rather, trying to gather information from the participants as he is working as a ‘consultancy firm’ (which I guess that is why the question is relevant to him – and him only in the given context).

Is staying in context important in Health IT projects? Yes.

I’ve witness many Health IT projects failing because people involved go out of context for many reasons;

  • Not understanding how healthcare really works
  • Not understanding what exactly Health IT is
    (e.g. confusing policy issues with technology issues)
  • Trying to appear more intelligent
  • Trying to say something for the sake of it
  • Many more weird reasons (it is a weird world out there)

His questions (there were many more) derailed the theme several times during the workshop. I only had 3 hours for the workshop and he took a fair bit off (I had to speed up, cut the break-time short but I still overran by 13 minutes).

Now here is a question for educators reading this post – What pedagogy would you have used to help him?

For me, I decided to utilize peer learning.

You see, I have tried time and again to explain how healthcare really works to this particular friend but it has always been of little success because he thinks he understand healthcare very well.

It was a classical case of “not knowing what one doesn’t know” because that person has never worked in a clinical setting nor in non-clinical setting in any aspect of healthcare, he has only worked with (not in) some high level health related projects (hence the reality is an abstract to him).

During the workshop, for every statement he made about Healthcare or Health IT that was ‘totally wrong’, be it administrative, operational, clinical and technical (he initiated a lot of those on his own initially), I turned to a suitable participant (I asked each participant about their training and work area during the introduction), asked a probing question so they can provide relevant answers to help this friend understand what really happens in the real world and I think it worked very well (three cheers for peer learning!).

So seriously, it is important to stay in context when working on Health IT projects (ironically, I had an entire section in my workshop on ‘staying in context), it will help you reduce eventful episodes in your health IT projects and reduce scope creep as well as expectation management (be in implementation or operation).

Maybe I will write an article on how to stay in context for health IT projects 🙂


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