Jackie Piekarz
Lab Leader
Oracle Health
View Bio
Continuous Managed Services
The Moment
What I do when it matters most
A health system came to us wanting nine separate wound care power plans, one for each type of wound they treat. What they had was a single wound care order and a single wound therapy order. Neither one carried enough information for a provider or a wound and ostomy nurse to select what they needed at the bedside.
I don’t start with the build. I start with the workflow. Nine plans would have been nine places for a clinician to get lost, so we designed one main power plan with nine subplans underneath it. I’ve been a nurse and an analyst for more than twenty years focused on this work. This is exactly why I know that any piece of technology is only as good as how it fits into what a clinician does every day.
We’re in healthcare. When you’re the one in the hospital bed, or it’s your family or friend receiving care, the physician and nurse walking into the room can’t be replaced by a computer. What I do day in and day out impacts a clinician, a nurse, a respiratory therapist, and so on. That work reaches the patient at the end of the line. I may not be physically helping a patient, but at some point what I built is.
“A stethoscope is a tool, just like a computer system is a tool. If I'm wearing it around my neck, it's certainly not doing anything but being a piece of jewelry. Somebody has to know how to use it, and know what the data it gives back actually means.”
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legacy orders rebuilt from the ground up with clinician-ready detail
9 to 1
nine requested power plans consolidated into one plan with nine subplans
The work
A Recent Engagement
The client is an academic health system with multiple inpatient facilities, a children’s hospital, rehab, behavioral health, urgent cares, and long-term clinics. Their director of wound care and ostomy programs needed a tool that would guide providers and wound and ostomy nurses to the right therapies, orders, and labs for each specific wound type. I was brought in to support this request and help them achieve their targeted result.
Over about two months and multiple design sessions with the director, we rebuilt both existing orders from the ground up. We adding fields, removing fields, and built in the wound therapies and dressing types that were missing.
Wound therapy alone has multiple modalities. I did the research to make sure every one of them was captured in the order before I took it back to the client. We also embedded published reference material and wound care best practices directly into the plans, so the guidance travels with the order.
Then we collapsed a nine-plan request into one main power plan with nine subplans. I partnered with one of our analysts on the build, which is the collaboration this service is designed for: I bring the clinical workflow and the design, the analyst brings the technical system knowledge. It’s built in the development domain now and I’m validating it field by field before it goes back to the director for final review.
The outcome we’re driving towards is better wound care delivered at the bedside. Every decision comes back to the nurse standing in front of their patient, knowing exactly what to order for the wound in front of them.
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Listen before you design.
The biggest piece of this job is actually listening. What is the problem? Why isn't this working for you? Tell me more about that. Then take it back and think it through from both a system perspective and a clinical perspective.
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Ask them to show you.
When a clinician pushes back, they're usually not upset about the software. More times than not, they're stressed because they can't take care of their patient. Stop, acknowledge that it's critical to them, and ask them to walk you through it. Make it clear that you're the person who's there to help them through the issue.
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Speak the clinical language.
You need some kind of clinical background, but it doesn't have to be nursing or medicine. I've worked alongside informaticists who came from respiratory therapy, OT, PT, and speech. Everyone in a hospital uses the EMR. What matters is that the client knows they're talking to someone who understands what they're trying to accomplish.
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Critically think, then pivot.
We say "critical thinking" a lot in nursing, and it applies here. Sometimes you have to work a problem through quickly. Systems change constantly, so you have to catch on fast. And no two days look alike. One day I'm working tickets and calling end users; the next I'm in a spreadsheet testing all day. You have to be able to drop something, help someone, and come back to it.
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My advice to any health system
Get the right people at the table from the start. Whether it's a new implementation, ongoing support, or project work, having clinical informatics in the room to look at workflow and how the design will fit into people's daily practice is what makes the difference between technology you installed and technology people use.
what it takes
Advice for Success
Clinical informatics sits in the gap between the clinical teams we support and the analysts who build the system. Analysts are great: they know the system, they know the back end, they know how to do the build. Across the industry, what most of them don't have is clinical experience, so they build exactly what clients hand them without seeing the implications of that build or the workflow behind it. At Healthcare IT Leaders, our clinical informaticists marry those two pieces together.