2018 Practical Innovation Award Winner: ENGINUITY

Posted on July 25, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As the vision for the Health IT Expo came into view, we realized how valuable it was for the Health IT Expo community to learn about and share practical innovations that were happening in healthcare IT. As part of that effort, we announced the 2018 Practical Innovation Awards. Being the first year, we only had a short time to promote it and get the word out about it. With that said, we’re extremely pleased with the practical innovations that the 2018 Practical Innovation Award Winner has brought to the healthcare IT community and we’re excited to share those with you.

So, without further ado, we’re excited to announce the 2018 Practical Innovation Award Winner is ENGINUITY run by Kelly Del Gaudio, Principal Consultant, Galen Healthcare Solutions and was implemented at Freeman Health System, Valley Health System, and Canton – Potsdam Hospital System. This is a well-deserved honor for Kelly Del Gaudio and the team that worked on this project. Congratulations!

While awards and recognition are great, they don’t mean much if we don’t share the details of the practical innovations that won the award. In order to share more details about ENGINUITY (originally named Project Claire[IT]), we thought an interview with Kelly Del Gaudio would be a great way to share what they accomplished and hopefully help to spread their experiences, insights, and innovations.

Tell us about Project Claire[IT].  How was it started and who was involved?

Project Claire[IT] was what we originally called ENGINUITY. It was a project in honor and memory of my friend and Rule writing mentor at MEDITECH, Claire Riemer. Claire was the original pioneer of the MEDITECH rules engine and led the Clinical Content group there for many years.

The idea for this project started about a few months after I came on as the Principal Consultant for MEDITECH at Galen Healthcare Solutions. Since I had a lot of experience with the MEDITECH Rules engine from people like Claire, and working on a Clinical Optimization Performance Team during my 10 years at the “Tech”, I decided to host a free “Rule Writing 101” webinar that would give users a basic understanding of the MEDITECH Rules engine and offer tips and tricks on how to write some basic rules. We were surprised when we saw the signup list the day of the webinar (which ended up being our highest attended to date), and soon after, the flood gates opened with questions from MEDITECH users asking for help with Rules they’ve been stuck on for weeks, months and sometimes years!

Many of the questions we received were similar (people needing help with calculations, VTE compliance, Problem List Management etc) so we thought maybe we could streamline the process and write the complex rules that everyone seems to need for them; or as we call it: Doing their NerdyWork. Galen was no stranger to this as we have been successful in creating and delivering a similar solution to our Allscripts clients called eCalcs.

I knew I had the unique skill set to write the Rules that these customers needed, but not being a nurse or clinician by trade (although I can occasionally fake it til’ I make it) I knew I needed their help to understand exactly what their frustrations were from both a clinical and IT perspective. The only logical conclusion was to host a focus group, and so our first Galen Focus Group: Operation NerdyWork was born.

Operation NerdyWork was a group of nine MEDITECH hospitals all running MEDITECH’s 6.x/6.1 or higher platform. They represented various areas of the country, from cities to rural/remote, from large Health Systems to small Critical Access satellites. It seems that no matter how big (or small) your IT staff was, the Rules Engine was a bit of a black box for everyone.

Here is our elite nine:

  • Catholic Health Initiatives
  • Salinas Valley Medical Center
  • Randolph Hospital
  • Uvalde Memorial Medical Center
  • Freeman Health System
  • Canton-Potsdam Hospital
  • Peterson Reginal Medical Center
  • Calvert Memorial Hospital
  • Parkview Medical Center

These groups offered their time on Thursdays during the winter of 2016 and provided us with valuable insights into the world of a MEDITECH doctor, nurse, care provider, or pharmacist. From their list of frustrations, we got to work building better, rule driven workflows that will save time, reduce clicks, increase compliance and patient safely and present users with much needed clinical decision support.

We decided to call our platform ENGINUITY because we use the MEDITECH Rules Engine to code a lot of our custom content. It’s also a derivative of the word ingenuity which is the quality of being inventive, clever, resourceful; thinking outside of the box. We pride ourselves on coming up with really clever ways to achieve something that may otherwise be “Working as Designed”. ENGINUITY continues to be crowdsourced and we receive suggestions every day from users of our content. MEDITECH customers drive the future direction of this product because hey, they’re the one that have to use it right?

What have been the practical benefits of this project?

Practical Innovation is all about solutions that can be implemented now that bring value to an organization. We think we are doing just that.

By streamlining the lengthy design process that many of these rules take to write and creating a plug and play solution that has been tested, validated, and thoroughly researched, we can confidently help hospitals achieve optimal compliance, increased patient and provider satisfaction, EMR confidence, realize revenue gains and so much more. If you wanted to implement some of these complex tools outside of ENGINUITY, not only would you need at least one full time dedicated FTE on these projects, but that person would need to have an advanced Rule writing skill set which is not easy to find. You would also need to keep those people on staff to troubleshoot Rules that are subject to change during much needed updates or future workflow changes.

I actually spoke with a client at last year’s MUSE conference who told me that their resident “Rules” person was about to retire so they stopped optimizing their system because she was the only one who could support it. I used this anecdote the next day at our official launch presentation and realized that this was more common than I thought. Rules are complex and there are a lot of unknowns but they are far and away the most efficient way to optimize the your MEDITECH system which is why everyone should have them!

ENGINUITY makes these options an affordable reality for many organizations that simply don’t have the time, capital or resources. The Galen team supports all of our content post-implementation, so our clients can worry about daily system support and education.  ENGINUITY customers also determine “what’s next” in our dev cycle and are always receiving the fruit of our development efforts keeping their system optimized, refreshed and functional for years to come.

What were the keys to success with this project? 

I attribute the success of this project to 5 main things.

  1. First, having a deep understanding of the technical underpinnings of the MEDITECH Rules Engine is crucial to the success of ENGINUITY. I have always been fascinated with trying to figure out this puzzle and I continue to learn more about it daily. For me, it’s fun; for most, its frustrating. Thank you Claire Riemer, Ginny Jacques and Nancy McGowan for teaching me this craft.
  2. Second, having the support of the Galen Healthcare Solutions team. They let me run with this idea to design, develop and mass deliver content to clients who need it and they’ve fully supported it through its infancy to now. We are KLAS ranked and on Modern HealthCare’s Best Places to Work for a reason and I know working at Galen was one of the best decisions I have ever made. I firmly believe that autonomy, support and confidence is really what helps innovation to thrive.
  3. Third, our focus group. They are the ones who brought the ideas to the table and got the ball rolling. Thank you Operation NerdyWork!
  4. Fourth, our ENGINUITY clients who push us and challenge us with new puzzles every day. Their challenges (though sometimes daunting) make us better in the long run.
  5. Finally, getting the word out in major healthcare IT publications! Having published articles that recognize our unique approach to customer collaboration and feature our MU3: Measure 3 content really help to spread the word about what we’re doing.

How does this project impact patients?

We put a lot of effort in the design process of a workflow to make it easy for the doctor/user to use. Many of our tools are “single-click” meaning that as soon as I “click” on something (a query or order) then the algorithm will “fetch” necessary data and bring that to the providers attention immediately. We can suggest, require, suppress or automate responses based on preexisting information which makes ENGINUITY very patient centric. This added clinical decision support is embedded directly into the MEDITECH system (not 3rd party) which significantly increases the confidence that users have in the messages they are receiving. We can then use a combination of hard stops, soft stops, alerts and audit trails to increase patient safety across the board.

We’re currently working on a case study of before and after Implementation of our VTE Compliance protocol, which was designed using the AHRQ’s Best Practice recommendations for VTE Prophylaxis compliance. It is estimated at increasing organizational compliance to over 90% which will significantly impact the lives of many surgical inpatients.

I also worked with some of our product development folks from our VitalCenter Online Archival team to create a way to have Rules evaluate patient Problems and drive care off the Problem List. From my research, this is not just a MEDITECH problem, (pun intended) but it spans across all EMRs leaving most Problem Lists “static”. We are changing that for our MEDITECH clients by driving and automating care off the Problem List making it a truly “dynamic” list.

You call the effort “Operation NerdyWork”.  What’s been your experience getting “nerds” together to collaborate on a solution like this?

Operation NerdyWork was all about bringing a diverse group of people together with some commonalities (trades, users of MEDITECH) and working together toward a common goal. Listening to each other’s pain points and sometimes even solving each other’s problems without my help at all (which was really fun to see). Everyone brought a unique voice to the table. As innovators, the best we can do is shut up and listen, hear what people want and develop what they need.

What practical advice would you give health IT professionals that will help them be more successful in their work?

Find something you’re good at, something you’re passionate about, something that keeps you up at night but also helps you rest easy knowing you could be a part of the solution. When you’ve found it then surround yourself with supportive people and get busy on the Nerdywork.

A big Congratulations to the 2018 Practical Innovation Award Winner: ENGINUITY