Starting Somewhere: Who Are We Helping Today?

• Who are you, what is your role, and which clinical unit(s) are we talking about? Options: CMIO, CNO, Clinical Informatics Director, VP Clinical Operations, Clinical Manager, IT Lead, Other
• How would you describe the current urgency to address clinician documentation burden or missed charges right now? Options: Immediate — must start within 30 days, High — next 2–3 months, Medium — this quarter, Low — 6+ months, Undecided
• Which EHR and version does this unit run on (select all that apply) and do you have release cadence constraints we should know about? Options: Epic (specify version in next answer), Cerner/Oracle (specify version), Meditech (specify version), Allscripts, Other EHR, We have multiple EHRs
• Very briefly, what triggered you to explore automation now? (burnout survey, revenue audit, quality audit, staffing shortage, other) Options: Burnout survey, Quality audit, Revenue/coding audit, Staffing shortage, EHR upgrade/change, Other
• Who will be the final decision owner for a pilot and who else must sign off (roles, not names)? Options: CMIO, CNO, VP of Operations, Revenue Cycle Director, IT Director, Legal/Compliance, Finance, Other

If This Kept Going, What Would Break First?

• What is the single recurring documentation or workflow problem you worry will cause a major safety, quality, or financial incident if unchanged?
• Can you describe a recent example where documentation or charge capture failures led to an adverse outcome, revenue loss, or operational disruption? Tell us what happened and why it mattered.
• How often do clinicians report spending more time documenting than delivering care on this unit? Options: Almost every shift, Several times a week, Weekly, Monthly, Rarely
• Which workflows create the largest downstream problems when they fail (select up to three)? Options: Order set usage, Discharge summaries, Charge capture/billing, Nurse handoffs, Care plan assignments, Alert management, Other
• What hard metrics do you already track that feel most impacted—time per encounter, missed charges %, order set adherence, readmission, etc. List values if available.
• How do clinicians describe these problems in their own words—frustration points, workarounds, or phrases you hear repeatedly?

Are We Sure Automation Won’t Make It Worse?

• If we handed your team an automation that saved time but introduced even a small billing or safety regression, what would your tolerance be? Options: Zero tolerance — must be perfect, Very low — minor acceptable if reversible, Moderate — balanced against benefits, High — willing to iterate, Unsure
• Have you run automations or rules in your EHR before? Tell us about one that succeeded and one that failed—what made the difference?
• Which of the following risks worry you most about adding automation to the EHR (select top two)? Options: Patient safety regressions, Incorrect billing/overbilling, Clinician workflow disruption, EHR upgrade breakages, Loss of clinician trust, Data privacy/security
• What rollback or fail-safe controls must exist for you to feel comfortable running a pilot (e.g., kill-switch, staged enablement, manual review)? Options: Immediate disable button, Staged rollout per clinician, Audit logs and alerts, Manual approval step for billing changes, Daily monitoring report, Other
• How do your compliance/legal teams want to evaluate billing or safety risk during a pilot (certifications, test cases, audit frequency)?
• If clinicians are skeptical, what will convince them to try automation—peer endorsement, small pilots, measurable time savings, or something else? Options: Peer champions, Data from similar hospitals, Short controlled pilot, Demo in their workflow, Training + on-shift support, Other

What Would 'Good' Actually Look Like — In Numbers and Feelings

• If this pilot is an undeniable win at 90 days, what three measurable things changed (specific KPIs and target values)?
• Which KPI should be the primary success signal for the pilot? Options: Minutes saved per encounter, Charge recovery %, Order set adherence %, Clinician satisfaction score, Reduction in documentation variability, Other
• What numerical target would make you comfortable calling the pilot a success for the primary KPI? Options: >12 minutes saved/encounter, 6–12 minutes saved, 3–6 minutes saved, Charge recovery 3–5%, Charge recovery >5%, Other
• Beyond metrics, what qualitative signals would tell you clinicians feel this simplifies work rather than adding a layer?
• Who needs to sign off that the pilot met 'good'—clinical lead, IT, revenue cycle, patient safety, or others? Options: Clinical lead/unit manager, CMIO/CNO, IT Director, Revenue Cycle, Patient Safety/Quality, Legal/Compliance
• Which data sources will be used to validate these KPIs (EHR logs, time-motion studies, billing data, clinician surveys)? Options: EHR audit logs, Charge capture reports, Time-motion observation, Clinician survey, Patient outcome metrics, Other

How Work Really Gets Done Here — The Hidden Details

• Walk us through a typical patient interaction from admission through discharge for this unit—where are the manual handoffs and repetitive clicks?
• Which EHR configuration constraints limit how automation can operate (locked order sets, custom schemas, lack of APIs, local scripting policies)? Options: Locked/order-set lifecycle managed centrally, Limited API access, Custom templates heavily used, No scripting allowed, Frequent EHR upgrades, Other
• Who currently owns content like order sets, discharge templates, and charge master mappings on your side? Options: Clinical informatics, Nursing informatics, Revenue cycle, Unit leadership, Central IT, Other
• What common failure modes do you observe when staff workaround the EHR (lost orders, missed charges, incomplete notes)? Give an example and frequency estimate.
• Do you have access to a non-production EHR environment where we can test integrations and workflows? If yes, describe level of access. Options: Full test environment with realistic data, Limited sandbox, Only read-only access, No test environment available
• Who on your team will be available for day-to-day configuration decisions during the 6–8 week setup window?

Where Would We Start, and What Would Day 1 of Pilot Look Like?

• Which single unit or workflow do you believe is the best place to run a first pilot and why?
• Which modules or capabilities should be in scope for the pilot (pick all that apply)? Options: Order set automation, Charge capture optimization, Discharge summary automation, Nurse handoff templates, Alert management, Other
• What boundaries must we honor for the pilot—patient types, hours of operation, clinician groups, or other constraints?
• Who will be the local pilot owner, super-users/champions, and the escalation contacts?
• What training and go-live support do clinicians expect (on-shift superuser, short micro-training, recorded modules, or just-in-time help)? Options: On-shift superuser support, Short in-person sessions, Recorded micro-training, In-EHR prompts/tour, Blended approach
• What would an immediate rollback look like operationally if we detected a safety or billing regression during pilot?

Ready to Commit—or Still Figuring Out the Fine Print?

• What commercial or procurement constraints could delay a pilot (budget window, contracting team, purchase orders, etc.) and what is your target procurement timeline? Options: Budget available now, Budget next quarter, Requires new approval, Procurement >3 months, Undecided
• Who are the stakeholders that must review legal/security documents, and do you have standard data use agreement templates we should align to? Options: Security/Infosec, Legal, Privacy Officer, Vendor Management, Other
• What level of transparency and reporting cadence would make you comfortable during pilot (daily, weekly, KPI dashboard access)? Options: Daily during go-live, Weekly executive brief, Real-time dashboard, Bi-weekly review, Other
• Are there budgeted pilot funds or a cost-neutral expectation (we absorb pilot cost, shared cost, hospital funds)? Options: Budgeted by unit, Central IT/innovation funds, Vendor covers pilot, Shared cost, No current funding
• What would make you say 'yes' to a pilot in a single meeting—what three conditions must be true?
• What date or timeframe would you consider an acceptable earliest start for a pilot given your internal approvals and EHR schedule? Options: Immediately, Within 30 days, 30–60 days, 60–90 days, 3+ months

Walk me through a shift — the real, messy version

• Start simple: describe a typical clinician shift on the unit we’d pilot — who does what, and in what order?
• Which tasks currently eat the most clinician time (documentation, order entry, reconciliation, charge capture, handoffs)? Rank the top three. Options: Documentation (notes), Order entry, Medication reconciliation, Charge capture, Nursing handoff summaries, Other
• How many clicks or distinct screens does a clinician typically traverse to complete a single common workflow (e.g., discharge or procedure documentation)? Options: 1–3 screens, 4–6 screens, 7–10 screens, More than 10, I don’t know / need audit
• Tell us about the last time a workflow took far longer than expected — what happened and what did it cost the team (time, frustration, delayed discharge, missed charge)?
• Which unit-level variations exist for the same clinical task (e.g., different nursing templates, physician preferences, or local order sets)? Options: No variation — standardized, Minor variations, Moderate variations, Significant variations across staff, Unknown

What’s stealing time and morale — candidly

• If you had to name one thing keeping clinicians late or burned out today, what would it be—and why does it persist?
• How often do clinicians tell you documentation is the primary source of burnout versus workload or staffing issues? Options: Almost always, Often, Sometimes, Rarely, Never
• Which documentation tasks provoke the strongest clinician resistance or fear of error (free-text notes, order sets, billing prompts)? Options: Progress notes, Discharge summaries, Order set selection, Charge capture, Nursing documentation, Other
• Share a specific story where automation or a template made things worse—what did clinicians react to and how did leadership respond?
• How do clinicians currently signal that a workflow is broken or fraudulent (safety/billing concern)? Options: Email chain, Ticketing system, Peer escalation, Safety huddle, We don’t have a reliable path, Other

Where the EHR is a bridge — or a bottleneck

• When has your EHR configuration directly prevented you from automating a unit workflow? Give a recent example.
• Which EHR and deployment model are you on (vendor + cloud/on‑prem), and are you on a managed hosting or customer‑managed instance? Options: Epic (Cloud), Epic (On‑Prem), Cerner/Oracle, Meditech, Allscripts, Other
• What is your current release cadence and how often do upgrade windows change workflows or break integrations? Options: Quarterly, Biannual, Annual, Irregular/On demand, We don’t know
• Are there local customizations (builds, custom flowsheets, bespoke order sets) we must support? List the ones critical to unit workflows.
• What integration methods are available for third‑party automation in your environment? Options: Native APIs (FHIR, SOAP), Interface engines (HL7 v2), Database reads, No supported integrations, Other
• Who administrates the EHR configurations and how much lead time do they require for changes (days, weeks, months)? Options: Days, 1–2 weeks, 3–6 weeks, Months, Varies by request

When revenue quietly leaks — let’s find the holes

• How confident are you that all billable services performed on the unit are captured in the record today? Options: Very confident, Somewhat confident, Unsure, Not confident at all
• Estimate recent financial leakage: what percent of potential charges do you suspect are missed in the unit(s) under consideration? Options: <1%, 1–2%, 3–5%, 6–10%, >10%, Don’t know
• Which scenarios tend to produce missed charges (emergent procedures, consults, nursing‑initiated services, handwritten orders)? Options: Emergent procedures, Consults not closed, Nurse‑initiated billables, Manual paper orders, Order set mismatches, Other
• Describe how charge reconciliation currently works and who is accountable for catching omissions.
• What billing or compliance controls (audits, CDI reviews, chargeback processes) are in place that automation must respect?

When automation fails — what breaks first and who notices?

• Imagine an automated workflow introduced a subtle error that affected care or billing — how would that typically surface, and how long before someone noticed?
• Which failure modes worry you most: silent incorrect suggestions, dropped orders, duplicate charges, or clinician override fatigue? Options: Incorrect suggestions (safety), Dropped orders (care impact), Duplicate charges (billing), Override fatigue, Data sync delays, Other
• What monitoring, alerting, or rollback controls do you require before accepting automation in a pilot? Options: Real‑time alerts, Daily reconciliation reports, Automatic rollback on errors, Manual sign‑off gates, Audit logs only, Other
• Have you experienced any safety or billing incidents linked to past integrations or automation? If yes, what was the root cause and outcome? Options: Yes — safety incident, Yes — billing incident, Yes — both, No, Prefer to discuss offline
• Who on your team would own incident triage, root‑cause investigation, and communication to clinicians if an automation error occurred?

Who moves the needle — and who slows it down

• Which stakeholders must sign off before we can run a pilot (clinical leads, IT, Revenue Cycle, Compliance, Nursing)? Options: CMIO/Clinical informatics, CNO/Nursing leadership, IT/Application team, Revenue cycle/coding, Compliance, Facility leadership, Other
• Which stakeholder group typically requests the longest proof of safety or ROI before approving new automation? Options: Clinical leadership, IT/security, Revenue cycle, Compliance/legal, Finance, Other
• Who are the operational owners who will configure and maintain unit‑level rules after pilot? Names/roles and typical availability.
• How do change control and governance meetings operate today for EHR changes—frequency, decision thresholds, and emergency paths? Options: Weekly CAB, Biweekly, Monthly, Ad hoc, No formal process
• What escalation path is required for clinician concerns during a pilot (on‑shift superuser, 24/7 helpdesk, clinical governance)? Options: On‑shift superuser, 24/7 helpdesk, Clinical governance team, Email/ticketing only, Other

If we could measure one thing tomorrow — what would change

• Which measurable signals would prove a pilot is succeeding for you (time saved per encounter, charge recovery %, reduction in documentation variability, clinician satisfaction)? Select top two. Options: Minutes saved per encounter, Charge recovery %, Variability reduction, Clinician satisfaction score, Error/rework reduction, Other
• Do you have baseline data for those signals today? If yes, where does it live and how fresh is it? Options: Yes — readily available, Yes — requires effort to extract, Partial/fragmented, No baseline data
• What cadence and format do you prefer for pilot reporting (daily dashboards, weekly summaries, clinical huddles)? Options: Daily dashboards, Weekly summaries, Biweekly meetings, Monthly report, Ad hoc on request
• What minimal delta in a KPI would make you comfortable advancing from pilot to phased rollout (e.g., 5 minutes saved, 3% charge recovery)?

Small tests, clear boundaries — what would make a pilot safe and convincing

• If we ran a pilot next quarter, which single unit or clinician cohort would provide the clearest signal and why?
• What hard constraints must the pilot respect (scope of orders, patient population, hours of operation, blackout dates)?
• What rollback control do you need to feel safe (manual disable, automatic fail‑safe, staged ramp‑down)? Options: Manual disable by superuser, Automatic fail‑safe on error, Staged ramp‑down, Audit + approval to revert, Other
• Who needs to be trained before pilot go‑live and what format works best (in‑person briefings, recorded micro‑training, superuser shadowing)? Options: In‑person training, Recorded micro‑modules, Superuser shadowing, Job‑aids/cheat sheets, Combination
• What would constitute an unacceptable outcome during the pilot that would force immediate stop? (safety incident, >X% billing variance, clinician refusal)

People will decide this — are they ready emotionally?

• How do frontline clinicians typically react to new automation: curiosity, skepticism, passive resistance, or active pushback? Options: Curiosity/open, Skeptical but willing, Passive resistance, Active pushback, Varies widely
• What fears are most common among clinicians about automation (loss of control, added documentation, billing errors, job security)? Options: Loss of control, Added documentation, Billing/safety errors, Job security worries, Other
• Who are the natural early adopters and who are the known blockers on the unit? Name roles and influence.
• What success stories or past wins can we cite to build momentum—are there local pilots or neighboring units with relevant results? Options: Yes — local wins, Yes — peer health system wins, No clear examples, Unsure
• What ongoing support would make clinicians feel respected during change (regular check‑ins, rapid feedback loops, visible leadership endorsement)? Options: Regular check‑ins, Rapid feedback resolution, Visible leadership support, Incentives/recognition, Other

Quick Orientation — Who's in the Room?

• Who are the core stakeholders for this pilot (list sponsor, clinical lead, informatics lead, IT lead with names & roles)?
• Which of these best describes the primary trigger for this project? Options: Clinician burnout documented, Missed billable procedures / charge leakage, Quality variation / inconsistent order sets, EHR upgrade or migration, Operational efficiency initiative, Other
• What's your ideal timeline from 'we start build' to pilot go-live? Options: 4–8 weeks, 8–12 weeks, One quarter (3 months), 2–3 quarters, Unsure / TBD
• Which three outcomes are highest priority for the pilot? Select up to three. Options: Minutes saved per encounter, Charge recovery percentage, Reduction in documentation variability, Clinician satisfaction improvement, Zero safety regressions, Operational handoff reliability, Other
• Who will make the final go / no-go decision for pilot readiness (name & role)? Options: CMIO, CNO, VP Clinical Operations, IT Director, Revenue Cycle Lead, Multi-stakeholder committee, Other

If We Flip the Switch Tomorrow, What Breaks?

• What single failure or unintended consequence keeps you up at night when you think about automation touching the EHR?
• Have you had a safety or billing incident caused by an integration or automation in the last 24 months? Options: Yes, No, Possibly / under review, Unsure
• If yes or possibly, briefly describe the incident, its operational impact, and how it was resolved.
• Which domains would you classify as highest risk if automation behavior changed unexpectedly? (select all that apply) Options: Medication orders, Charge capture / billing codes, Critical alerts / allergy checks, Order set logic, Discharge summaries, Nurse handoffs, Other
• Do you require predefined rollback controls or automatic fail-safes before we build? Select all that apply. Options: Immediate rollback script, Feature-flag / kill-switch, Manual disable by IT with checklist, Read-only or monitoring mode, Staggered rollout per unit, Other
• How much downtime or manual effort is acceptable during a rollback window for the pilot? Options: None — must be seamless, Under 1 hour, 1–4 hours, Over 4 hours, Depends on unit / impact

Is Your EHR Ready for Us — or Will It Fight Back?

• What EHR version(s), major modules, or local customizations do you run that you believe will complicate integration?
• Which EHR vendor(s) will we integrate with for the pilot? (select all that apply) Options: Epic, Cerner / Oracle, Meditech, Allscripts, Athenahealth, Custom / In-house, Multiple vendors
• Do you expose FHIR or other APIs for the specific workflows we plan to automate? Options: Yes — broad API access, Partial — limited endpoints relevant to some workflows, No — APIs not available, Unsure / need to check
• Are there non-standard builds, local code, or third-party integrations in the pilot unit that we should map up front? Options: Yes — several customizations, Some minor local tweaks, No — largely standard build, Unsure
• Who controls EHR upgrade scheduling and how frequently are minor/major upgrades applied? Options: Vendor-managed schedule (regular cadence), In-house team schedules (quarterly/annual), Ad-hoc per patch, Frequent/continuous updates, Unsure

Where Will We Build, Test, and Break Things Safely?

• Which environment would you never allow an external build to touch, and why?
• Which environments are available for our work? (select all that apply) Options: Production, Non-prod / Sandbox, Test, Staging, Training / Simulation, Other
• Can we obtain service accounts and API credentials for non-prod environments through your standard provisioning process? Options: Yes — automated process, Yes — manual approval required, No — only prod access granted, Unsure / depends on workflow
• How often are non-prod environments refreshed with production data (or sanitized extracts)? Options: Daily, Weekly, Monthly, Rarely, Never / not applicable, Unsure
• Are there data masking or synthetic data requirements for non-prod use? If so, please summarize constraints. Options: Strict PHI masking required, Partial masking sufficient, Synthetic data preferred, No masking required, Unsure

Can We See the Data We Need — and Can We Trust It?

• If we depended on a single data feed to detect billable events, how likely would it be accurate enough to trust without routine manual checks? Options: Very likely, Somewhat likely, Unlikely, Very unlikely, Unsure
• Which specific data feeds will we need to access for the pilot? (select all that apply) Options: Clinical notes (free text), Structured orders, Charge transaction logs, MAR / medication administration, Problem lists / diagnoses, Patient demographics, ADT events (admit/discharge/transfer), Custom database tables
• Do you have named owners for each feed who can validate schema, quality, and latency? Options: Yes — clearly mapped, Partially mapped, No — owners not assigned, Unsure
• How do you currently detect and alert on data feed integrity or latency issues? Options: Automated monitoring & alerts, Periodic manual checks, Ad hoc when issues reported, No monitoring in place, Unsure
• If there are known data quality issues (duplicates, missing timestamps, free-text variability), please describe examples, frequency, and impact.

How Will We Know It Worked — and Nobody Got Hurt?

• What would constitute an unacceptable safety or billing regression after the pilot that would trigger an immediate rollback?
• Which KPIs will you hold the pilot accountable to? (select all that apply) Options: Minutes saved per encounter, Charge recovery percentage, Documentation completeness / compliance, Clinician satisfaction (survey), Order accuracy / error rate, Reduction in care variability, Number of safety events
• For each KPI you selected, what are the target thresholds or acceptance criteria we should aim for during pilot evaluation?
• Who will own acceptance testing and formal sign-off at the end of the pilot? Options: Clinical Lead (CMIO/CNO), IT Lead / Architecture, Revenue Cycle Lead, Joint steering committee, Other
• Do you require shadow mode or dual-chart verification for an initial period to validate automation outputs? Options: Yes — mandatory, Recommended but optional, No — ready for live, Unsure

Who Owns What When Something Goes Wrong?

• If an automation causes a billing discrepancy, who has the authority to pause or disable the feature within 30 minutes?
• What are your escalation tiers and on-call contacts for production incidents? (list roles and responsibilities) Options: Tier 1 - Unit / Service Desk, Tier 2 - IT Integration Team, Tier 3 - EHR Vendor / External Partner, Clinical Safety / Patient Safety Committee, Revenue Cycle / Billing Leadership
• Do you have an on-call rotation that can respond to pilot issues outside business hours? Options: Yes — 24/7 on-call, Yes — extended hours only, No — business hours only, Unsure
• What change control, CAB, or emergency change processes must we follow to promote changes from test to production for this pilot? Options: Formal CAB approval required, Emergency change process available, Standard RFC with scheduled window, No CAB for pilot (informal agreement), Other
• What rollback verification steps and acceptance checks do you require after a rollback is performed?

What Does a Smooth Pilot Day Look Like?

• What single moment during go-live most worries your clinicians — and what is the underlying reason?
• Which clinician groups need training before launch? (select all that apply) Options: Attending physicians, Residents / trainees, Nurses / RNs, Allied health (PT/OT/RT), Charge capture / billing staff, Unit clerks / secretaries, Other
• Which training formats have the best uptake in your organization? (select all that apply) Options: Live classroom sessions, Bedside super-user support, Recorded micro-videos, Quick reference one-pagers, Simulation / role-play, EHR-integrated tip cards
• How many super-users or champions can you commit per unit to support go-live? Options: None, 1–2, 3–5, >5, Unsure
• What communication channels should we use for urgent clinician issues during pilot (select preferred)? Options: Dedicated Slack / Teams channel, Pager / phone escalation, EHR inbox / In-basket, On-floor super-user, Email (non-urgent), Other

What Would Make You Say 'Let's Scale'?

• If we meet KPI targets but clinician sentiment lags, would you still expand — and why or why not?
• What minimum KPI results (by metric and threshold) would justify phased expansion beyond the pilot?
• What governance body will be required to approve scaling? (select all that apply) Options: Executive steering committee, Clinical governance committee, Revenue cycle leadership, IT architecture board, Patient safety committee, Other
• What timeline would you expect for phased expansion after a successful pilot? Options: Immediate (within 1 month), Within one quarter, Within 6 months, 6–12 months, Unsure
• What monitoring, SLA, or ongoing reporting requirements must be in place before you will approve expansion?

Next Steps — Locking Down Readiness

• What single commitment (resource, date, or decision) do you need to give us today to call your environment 'deployment-ready'?
• Which artifacts do you need from us to proceed? (select all that apply) Options: Integration architecture diagram, Detailed test plan & scripts, Runbook / rollback procedures, Training materials & quick cards, Data mapping spreadsheets, Security & privacy attestation, Other
• What date or milestone would you like to target for build start? Options: Within 2 weeks, 2–4 weeks, 1–2 months, More than 2 months, Unsure
• Who specifically needs to sign off before we begin the build (please list names and roles)?
• Are there any procurement, legal, or budgetary approvals pending that could block kickoff? If yes, please specify which. Options: Procurement approval, Legal / BAA, Budget allocation, No pending approvals, Unsure

Quick Intro: Who's in the Room?

• Tell us who’s joining from your side for this discovery (names + roles) and how you’d like us to address them.
• Which of these best describes the primary decision sponsor for automation initiatives right now? Options: CMIO, CNO, VP of Clinical Operations, Director of Clinical Informatics, Chief Nursing Informatics Officer, Revenue Cycle Lead, Other
• Which clinical unit or service line should we focus on for the initial conversation? Options: Emergency Department, Inpatient Medicine, Surgery/OR, ICU, Observation/Short Stay, Labor & Delivery, Outpatient/Clinic, Other
• Quick technical snapshot: what EHR vendor and major version are you on (and any local modules that matter)? Options: Epic – <2018 builds, Epic – 2018–2021 builds, Epic – 2022+, Cerner Millennium, Meditech, Allscripts, Other / Custom (please specify)
• How soon do you expect to decide on running a pilot if the proposal matches your needs? Options: Immediately (0–4 weeks), Short term (1–3 months), Quarterly (3–6 months), Longer (6+ months), Unsure

If Nothing Changes, What Keeps Getting Worse?

• When you look at clinician workload and outcomes today—what is one thing you’d say is actively getting worse because of current documentation or workflows?
• How often do documentation burdens appear in your clinician burnout or engagement surveys? Options: Top 1 issue, Top 2–3 issues, Occasionally mentioned, Not reflected in surveys, We don't have recent survey data
• What concrete downstream impacts have you observed from poor documentation or missed charge capture (clinical risk, revenue loss, compliance findings)? Give examples and the estimated scale where possible.
• Which of these outcomes would you say is most urgent to stop deteriorating? Options: Clinician time with patients, Charge capture / revenue recovery, Clinical safety / adverse events, Care variability / quality metrics, Staff turnover / engagement
• How long have you been tolerating the current level of burden—weeks, months, years? Options: <6 months, 6–12 months, 1–3 years, 3+ years, We can’t remember a time it wasn’t an issue

Where Do Workflows Break Down, Day-to-Day?

• If I asked a frontline nurse or physician what part of their EHR workflow makes them sigh the most, what would they say—and why do you think that is?
• Which specific workflows do you suspect are most error-prone or time-consuming (select all that apply)? Options: Order sets / ordering, Discharge documentation, Nurse handoffs, Charge capture / procedure coding, Care plan assignments, Alert or inbox management, Other
• Tell us about a recent example where a workflow failure created visible harm, delay, or lost revenue—what happened and what was the root cause as you saw it?
• How standardized are those workflows across units—do some units follow local habits that differ substantially from system standards? Options: Highly standardized, Mostly standardized with exceptions, Significant variation by unit, Highly variable and informal
• When a workflow breaks, who typically notices first and how is it escalated? (roles, channels, expected response times)

What Would ‘Less Burden’ Look and Feel Like?

• If automation reduced documentation time per encounter, what is the minimum minutes-saved figure that would be meaningful to you? Options: <5 minutes, 5–10 minutes, 11–20 minutes, 20+ minutes, Not sure / need baseline data
• Beyond minutes, what measurable signal would prove to your clinical leaders that the change is working (choose up to three)? Options: Reduced variability in order use, Improved charge capture %, Fewer safety incidents, Higher clinician satisfaction scores, Faster throughput / LOS reduction, Reduced documentation time per patient
• How would you define clinician acceptance for a pilot—what % of clinicians using an automated suggestion or flow would feel like success? Options: >75%, 50–75%, 25–50%, <25%, Unsure
• Describe the sight-lines you need to feel confident during pilot (dashboards, audit trails, weekly metric reviews, clinician quotes)—what matters most?
• If we delivered the time-savings you want but introduced a small, visible change in clinician workflow, what would you expect the immediate reaction to be? Options: Enthusiastic adoption, Curiosity then adoption, Pushback needing training, Strong resistance requiring rollback

What Risks Keep You Up at Night?

• If automation accidentally introduced a billing or safety regression, how would that change your willingness to continue or expand the project? Options: Immediate pause & rollback, Pause to investigate then proceed, Tolerate minor issues with fixes, Proceed regardless—we’ll manage
• What are your top three non-negotiable risk controls we must include before any pilot (examples: explicit rollback, dual-charting, manual signoff gates)?
• How do EHR upgrades or local customizations typically affect integrations here—have past upgrades ever broken automation or caused reversion to manual work? Options: Often, Occasionally, Rarely, Never, Not sure
• Which compliance or billing stakeholders need to sign off on changes that affect charge capture or documentation templates? Options: Revenue Cycle / Coding, Compliance Office, Clinical Documentation Improvement, Chief Medical Officer, Legal, Other
• What error tolerance would be acceptable for automated suggestions during pilot (%)—and who sets that threshold? Options: 0% (no errors), <1%, 1–3%, 3–5%, >5%, Unsure

Who Holds the Keys — Decision & Deployment Map

• If we were to map a decision tree for this project, who are the must-have approvers and who are optional influencers?
• Which team will own EHR configuration and access during build and testing? Options: In-house EHR build team, Third-party implementation partner, Shared responsibility (IT + vendor), We don't have a clear owner yet
• What internal resource constraints should we factor into the timeline (available FTEs for testing, training, build windows)?
• Who will be the single point of contact for day-to-day coordination during pilot? Options: Clinical informatics lead, IT project manager, Nurse manager, Revenue cycle lead, Other
• How do you prefer decisions be made during pilot—consensus, escalation to sponsor, or a steering committee model? Options: Consensus with clinical sign-off, Escalation to sponsor (CMIO/CNO), Steering committee majority, Other

Pilot Design: Success, Scope, and Exit Lanes

• If a pilot only gave you one clear yes/no answer, what question would you most want answered at its end?
• Which boundaries make sense for your pilot (pick the best fit): single unit, unit + cross-cover teams, multi-site, or use-case specific? Options: Single unit, Unit + cross-cover, Multi-site same unit type, Single use-case across units, Other
• Which modules or capabilities must be in scope for the pilot to be meaningful (select up to three)? Options: Order set automation, Charge capture suggestions, Smart discharge summaries, Nurse handoff automation, Alert/inbox triage, Other
• What are the objective acceptance criteria for pilot success—list specific metrics and target values (e.g., minutes saved per encounter = X; charge recovery = Y%).
• What would be a clear, pre-agreed rollback trigger that would immediately stop the pilot? Options: Any safety incident, Revenue impact > X%, Clinician satisfaction drop > Y points, Technical instability > Z hours, Other (specify)
• How long should the pilot run before making a go/no-go decision? Options: 2 weeks, 1 month, 1 quarter (3 months), Other / custom

Voices of Clinicians: How Do We Earn Trust?

• What would you say is the single biggest reason clinicians might distrust automation in your system?
• Who are the natural early adopters we should recruit as clinician champions (roles, units), and who are likely skeptics?
• Which engagement tactics have worked previously to accelerate clinician adoption (select all that apply)? Options: Shadowing and co-design sessions, Peer champions/ambassadors, Short on-shift training, In-system prompts & contextual help, Incentives or recognition, Other
• How do clinicians prefer to give feedback—real-time in-system flag, weekly debrief, anonymous survey, or direct meetings? Options: In-system flagging, Weekly debrief sessions, Anonymous survey, Direct clinician leader meetings, Other
• If a clinician raised a concern during pilot, what is the fastest path to resolution you expect? Options: Immediate removal of change + investigation, Triage to vendor + daily follow-up, Weekly review with clinician rep, Logged and tracked through change control