Week 6: Roles – Underappreciated derailment of otherwise successful go-lives
“Why is everyone making a big deal about roles? This seems easy, we can just give this to some administrator or systems person and it’ll be fine right?”
And this is how MHS GENESIS deployments go horribly wrong…
What are “Roles” and why do they matter?
Legacy systems had some broadly identified “roles” which were generally simply copied from an active user onto the new position. Like much of the legacy system, it was crude, but it worked. In contrast, the assignment of roles in MHS GENESIS provides the privileges and preferences for each individual user in GENESIS. Because of the added complexity, the role that a user had in the legacy system may be either inappropriate or inadequate for them to successfully complete their required tasks in MHS GENESIS. Privileges and preferences may dictate who has access to certain tracking boards, who can perform point-of-care testing, or who can independently order immunizations. For instance, if your immunizations technicians are given the LPN/Med Tech role, they would be unable to give immunizations based on the role designation.
One of the most difficult settings is the provider indicator. This setting determines which users can have orders placed against them. In a civilian fee-for-service environment this setting is clearly dictated by the credentialed provider so that it can be reimbursed. But the requirements of military medicine require a level of creativity and understanding when roles are assigned to ensure that care (especially readiness) requirements are appropriately being met.
You can be granted multiple roles, which may seem like a good plan. This is a terrible plan. Changing roles requires the user to completely log out of MHS GENESIS and log back in for the effects to take place. Although this procedure doesn’t take long, it is a huge annoyance and every effort should be made to find the “right” role.
Roles also dictate the training requirements for each user. Getting this wrong may delay a user getting the proper training to have the role at go-live. And without the training they can’t be granted the proper role which may delay them days at go-live.
How are roles assigned?
Roles are assigned by the user role assignment coordinator (URAC) using a user “role tree”. Unfortunately, this too is more complex than it sounds. Despite standard roll assignments there are still a variety of account configurations that must be determined and set.
Now you may be thinking “I’m at a small site, this’ll be easy”. Well, it will be easy-er (you just have less people). However, we’ve also found that smaller sites that failed to appropriately determine the requirements for end-users struggled as much or more. Often smaller sites utilize resources (people) differently and in ways that may bridge multiple traditional roles but may be able to use a single role with a thorough understanding of the privileges and preferences.
Who should we choose to be a URAC?
I posed this question to current sites and the answer was unanimous. The URAC needs to have a strong understanding of CLINICAL workflow. Madigan used a clinical workflow analyst (another talk for another day) with clinical experience, but most Air Force sites should probably use a medical technician or RN. It is best if they have a broad understanding of multiple disciplines throughout the MTF. This allows them to bridge the “language barrier” when trying to understand and articulate the needs of an end user who does not fit neatly into the Role Tree algorithm. They should also be able to work well with a multitude of people as they will be required to interact with end-users, leadership, and LPDH constantly during pre-deployment and sustainment.
Next Week: Timely topic – infection control and prevention strategy using telehealth (and how GENESIS may change that workflow)
GENESIS 101: Covid-19 Alerts. Alerts are a complex solution but can be used to provide an agile way to update the clinical requirements. After the CDC made recommendations on isolation and testing, the DHA team was able to immediately institute an alert which would notify the clinical team ONLY if a patient met the criteria for isolation or testing without changing the normal workflow process.