Clinical Process Must be the Monarch

Why should the clinical process be given such priority?

Healthcare delivery, especially at a large scale, is a complex business with many actors playing different roles. However nearly every activity is dependent upon the clinical process or exists to facilitate or support the clinical process.

In the early days, most EMRs were created by giving priority to the administrative, financial and business functions, and the functions that deal with the very core process of healthcare, the clinical process, were added in subsequently.

Let's say, there are these important processes, which are non-clinical but need to be managed with the help of information technology.

In healthcare, all such processes have to take data from, and give data to, the clinical process — the process in which the data from the patient is directly collected, and decisions based upon the data are acted upon. If no adequate computerized version of the clinical process, with hooks to allow the data from it to be collected, is already in place, the software engineers proceed to create alternative representations of the actual clinical process. Each such representation has its own interpretation of the clinical process and a unique way to collect the real clinical data for it. Each representation works for each of the ancillary process for which it was created, and seemingly the system works as expected.

This resulted in most of the systems end up not just being ill-suited for the use by the clinicians and other healthcare professionals, they also turn out to be fragile, because each time the core process undergoes any change, each of the ancillary system has to be altered to allow them to continue to work. Much of the frustration that a overwhelming number of clinicians express about working with EMRs is also a consequence of the clinical process being added to the system as an afterthought.

Ideally, the clinical process should be created first, all other processes dependent on it are created later, with clear idea about how they would interface with the clinical process for the data-interchange purposes.