Guerra On Healthcare: Improve Your Feedback Loop

We need an accurate and fast data-feedback loop. IT data reports that take six months or more to come out don't make the grade.
Two recent reports got me thinking about just how enervating an extended lag between information collection and delivery can be. The first, from the Institute of Medicine, deals with the necessary components of a national digital infrastructure, and is based on workshops held last year.

The problem is that we're already halfway through this year. In the past, that might not have been such a big deal, but with the outside influences that shape your strategic plan shifting with each HIT Policy Committee meeting--and certainly each CMS Notice of Proposed Rulemaking--what people thought a year ago may not be very relevant today.

The second report, from the Annals of Internal Medicine--in which it reviews the operational status of health information exchanges--is based on information collected in early 2010. Though the authors confess progress could have been achieved since that time, such admissions don't make the data any more relevant today.

The problem with these reports is the aforementioned lag between data collection and consumption. We all need information about the effects of our work to continually improve it. We all need an accurate and fast data-feedback loop. On an industry level, reports that take six months or more to come out don't make the grade.

But what about on an organizational level, what about the data-feedback loop you've established to ensure your programs are being embraced (think adoption) and, almost more importantly, that bugs are being fixed and applications optimized for each class of user? Feedback reports that take months, even weeks, to hit your desk, then more time to be absorbed, considered, and responded to fall far short of what is required.

The best feedback loop I know of is in place at Community Memorial Health System in Colorado, where Jon Velez, M.D., serves as CIO--that's because Velez is also a practicing ED doc who uses the systems he oversees. When I interviewed Velez, we joked about whether or not he'd ever called his own help desk with a problem.

Certainly not every CIO needs to be a practicing M.D., but every CIO should have clinicians on their staffs who practice (part time but regularly) in each department where advanced technologies have been rolled out--there is just no other way to get the necessary feedback.

"But we have a help desk, and the clinicians will call if they have a problem. It will get escalated up the proper channels and handled," you say.

"It won't, because you'll never hear about it," I say.

There have probably been 100 times when I've been on a website that has not functioned properly by timing out or dropping me at some dead end of cyberspace. Have I ever contacted the organization to let them know? Not that I recall.

I'm too busy to help them solve their problems. I'd say let them figure it out if they want my business, or, "I'm sure someone else will contact them. I'll try this again tomorrow."

The point is the organizations in question may never have known about the problems I encountered with their applications, even if many users were experiencing them. Only by embedding staff into clinical departments--much like journalists covering combat are embedded with the troops--will you not only learn the system issues first-hand, but the general level of satisfaction users have with them, and IT department overall.

To be clear--these embedded informaticists are not spies, but goodwill ambassadors who want to feel the users' pain, not merely read about it on a trouble ticket. Just like any relationship, nothing says I care like putting in the time. Show the clinicians you're willing to get in the trenches and they will be a most critical ally in your upcoming adoption battles.

Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].

The Healthcare IT Leadership Forum is a day-long venue where senior IT leaders in healthcare come together to discuss how they're using technology to improve clinical care. It happens in New York City on July 12. Find out more.