Abstract: With rapid evolution of healthcare knowledge, best clinical practices, and care delivery methods, how can the electronic systems underpinning modern healthcare delivery keep up? Over the last decade, use of Electronic Health Record (EHR) systems became nearly universal. Large EHR vendor software systems now pervasively support multiple workflows: clinical, operational, and financial. So given the rapid pace of environmental change in healthcare, how can one best innovate and adapt on top of one of these vendor EHR platforms?
Agile methods increasingly enable rapid-cycle, responsive configuration and evolution of EHR features (such as clinical decision support tools) by individual teams. But can scaling agile EHR configuration in a healthcare organization leverage principles proven effective in scaling at other types of organizations? In this report, we describe our experience scaling up agile EHR configuration at a large academic medical center, and share lessons learned in four areas: team collaboration, governance, shared architectural modeling and design, and tooling to support our journey towards scaled agile.
Lessons Learned from Your Experience: - Team Collaboration: Pros and cons of shared iteration schedules, shared release schedules, or both.
- Governance: Coordinating organizational span of a given project/initiative with the corresponding level of EHR and operational governance groups.
- Shared Architectural Modeling and Design: Value of high-level 1-page scoping models such as Use Case Diagrams, Feature Breakdown Structures, Workflow Diagrams (with nested diagrams as needed) for effective cross-team and multi-stakeholder collaboration.
- Tooling: Challenges and benefits of shared tooling. Providing visibility into backlog and progress relevant to specific customer subgroups in the setting of multi-stakeholder, multi-jurisdictional governance over a single EHR platform.
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