Who is The SME?

Craig Joseph, MD
By: Craig Joseph, MD
Date: January 31, 2018

As I work with large, complicated, and sophisticated hospital groups around the country, I often see IT decisions that seem, well, that seem wrong. Maybe it’s not that they’re wrong so much as they are short-sighted. I can probably best explain with an example:

Imagine an electronic health record (EHR) configured in such a way that 20 options were presented to a physician, even though he or she might commonly be expected to use only four or five. I’m a big believer in the 80/20 rule: if the user (in this case, our smart physician) is not going to use an option at least 80 percent of the time, that option should likely be hidden so that it takes a click to get to it. Makes sense, right? Put the common stuff in front of the user, and put the uncommon stuff over in the corner or hidden in a dropdown menu. This helps keep the screen clean and helps the user focus on what he or she needs most of the time.

Even though keeping a clean, uncomplicated user interface is a basic tenet of technology usability, I often see it ignored. I see 20 options, when I expect to see only a handful. When I ask the analyst who configured the screen if he thought it was a good idea to build so many options, I usually get the same answer: absolutely not. “Wait a second!” I say. “If you thought it was not a great idea to build so many options, then why did you build it that way?” If you’ve been around healthcare IT for even a few years, you can probably already guess the answer: “I built it that way because that’s what the SMEs wanted.”

SMEs. You know: subject matter experts. In my line of work, this term usually describes the doctors, nurses, therapists, dietitians, and countless other healthcare professionals who take care of patients all day (and night) long. These folks certainly are subject matter experts in their clinical fields. They know how to cut out cancerous growths, administer complicated chemotherapy, and rehabilitate a patient back from a stroke. Here’s something they are typically not experts at: configuring an electronic health record. Ay, there’s the rub!

When it comes to configuring the complicated and integrated software that physicians use every day, the SME is not the doctor: the SME is the IT analyst! The IT analyst understands that when you change the order of the drop-down list items for an endocrinologist, you might be negatively affecting the cardiologist. The analyst understand that the abbreviation ROM probably stands for rupture of membranes for the obstetrician, but he considers that it likely represents right otitis media for the pediatrician and range of motion for the orthopedic surgeon. The analyst knows that everyone should be recording the asthma control score in a standard way even though the allergists want to just enter the final score while the pulmonologists want to enter each component and have the system automatically total the final score.

Exceptional IT analysts do what their users want when it’s the right thing to do. If that sounds vague, it’s probably because it is vague! But grizzled veterans of EHR implementations likely know what I mean. If a desired configuration option violates usability rules, then it’s a bad idea and should be avoided. But the exceptional IT analyst doesn’t just say “No!” to the clinician. She explains why it’s a bad idea and how the same end can be achieved via a different route. As the saying goes, “We don’t say ‘No’; we say, ‘No, but . . .’”

If you want to learn how to diagnose pneumonia, your doctor friend is the SME. But if you’re working on technology that supports the doctor, the IT analyst is the SME. Great analysts actually analyze (hence the name!) the situation and provide the best IT option; they don’t simply take orders. What kind of analyst are you? What kind of analysts do you work with? To improve the physician experience, involving the right subject matter experts can mean the difference between a system that brings simplicity or one that sets complexity in motion.

Craig Joseph, MD, is the Chief Medical Officer at Avaap where he works with healthcare leaders to implement and optimize EHRs in order to increase physician satisfaction, improve efficiency, and ensure full value of the technology.

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