The 80/20 rule, Health Information Systems and Clinician Engagement

Vilfredo Pareto’s 1906 observation that 80% of the land in Italy was owned by 20% of the population gave rise to the 80/20 rule. He probably had no realisation that it would be quite so applicable to business and other phenomena such as Health Information Systems.

Over the past decade in Australia, healthcare organisations facing large systemic administration problems have often opted to:

1. Wait

2. Implement a full EMR and/or

3. Implement a partial EMR solution.

Solution [1] and [3] are the most popular as many organisations struggle with the sweat, money and advocacy needed to implement a full EMR.

We have clients telling us that a huge effort was undertaken to install EMR components, only to have 14-19% of clinicians making use of the solution.  Management have undertaken maximal efforts (80-100%) to solve big problems with large scale solutions and they are left with less than 20% engagement.

If we graphed resources (time and money) on implementing a complex solution and benefits we would expect to see benefits increase proportional to resources expended.  So the more clinical records, features and decision support the solution has, the more business problems it should solve, leading to more benefits.  This is often true for the operations and administrative side of the business.  Yet clinician engagement when added to the same graph tends to wane beyond a certain point.

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20% of the expenditure provides 80% of the benefit – and that’s the area that Verdi focuses on by pulling together your existing systems. This not only saves costs but also makes using Verdi incredibly simple.

When we interact with clinicians to find out why they don’t engage with EMRs more, they express a lack of interest in entering data or engaging with complex systems:

“You’re competing with the time it takes me to use pen and paper”

These time-poor professionals will only spend a few minutes entering data and have difficulty finding the time to attend software training sessions.

Thus Verdi’s simplicity and ease of use makes it very popular around the hospital – we’ve even had clinicians make their own “We love Verdi” T-Shirts.

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