Many physicians have chosen an electronic health record
(EHR) and are now unhappy with their choice.
Multiple issues can lead to that situation. First, doctors
might not have purchased the right product, for a variety of reasons. For
example, they might have outside influences who tell them to use a particular
product. Second, physicians might not be completely engaged in the selection of
the product. And third, in some cases, doctors buy the right product but they
are just not using it effectively.
To figure out which of those situations might be affecting
you, go back and look at how you made the decision and how engaged you were in
making that decision. In some cases, doctors literally have said to their
staff, “Go find an EHR product for me and I will use it.” Or, when looking at a
product, they don’t invest the time in understanding it or they don’t make site
visits to see how they can use the product successfully.
The bottom line is, physicians who are making the decision
about which EHR to buy have to realize how profoundly the decision will affect
all aspects of the practice. Even in a multiphysician practice, you must ask:
Are we going to use this system? Are we willing to put in the time and effort
and adjust to adopting this tool into the style of how we practice medicine? If
you can’t answer those questions in a positive way, you are putting a lot of
risk on the table regarding your EHR.
When looking to adopt an EHR, you must make decisions about
redesigning how your practice is going to operate.
Changing the Whole Practice Workflow
As a national EHR consultant and author, I tell people that
they have to take the whole practice apart and put it back together again, no
matter how big or how small the practice is, because everything they do right
now is tethered to that paper record. If that tether no longer exists, they
have to figure out how they will operate in their environment without this
piece of paper.
For example, clinicians may be used to this type of system:
if the chart is in the door this way, it means that the patient needs to see a
doctor. If it’s in the door that way, a nurse is supposed to go in. If a paper
record doesn’t exist, how will I know which it is? I have been flipping through
this chart for years, I know all the visual cues, and now I have to sit there
and flip around in this computer system.
In many cases, I have to redesign the system from a workflow
perspective. I also have to consider how doctors interact with patients so that
they get the information they need and put it into the EHR. That’s a lot of
change that somebody has to engage in; it’s not such an easy thing.
Lack of training is another reason why physicians may
dislike the EHR. The reality is that the practice must become independent from
the vendor. Nobody has enough money in their pockets to pay the vendor to be
there for months. The vendors come in, train everybody on the EHR, and then
pull their people. You may not be willing — or have the resources — to pay for
them to stay.
Even if you have those resources, you will come to a point
where they will leave your practice, go back home, and you will be left to run
the system yourselves.
Who Needs to Know What?
From a training perspective, you need to assign a couple of
your practice employees to become in-house experts on the various aspects of
using EHRs, which includes understanding the clinical content as well as the
work in your environment. You have to protect that to make sure that you use
the system on a consistent basis.
When doctors become disillusioned with the EHR, it could be
because they don’t know how to use it correctly, or in some cases they are not
maintaining it correctly. If they are not sitting down on a daily basis and
saying, “Have I done all the work? Have I documented all the information I need
into my EHR?” then the EHR will become problematic. They will almost be
undermining the efficacy and the accuracy of the EHR records.
If that is the problem, in order to fix it, the practice has
to invest the time up front for the doctors and the staff to become
knowledgeable and comfortable enough with the EHR so that they can get in front
of a patient and use it.
In some cases, vendors say to the doctors, “Here is your
EHR, here are a few hours of training; go treat a patient.” Then we are
surprised when the doctor’s focus becomes the EHR. They are not looking at the
patient. Or they will turn their backs on patients so they can document
something on a workstation in the corner of the room. All of these things
undermine the connection with the patient.
Not Enjoyable for the Doctor
It’s not a pleasant experience for the doctor either,
because the doctor thinks, “I’ve become a data-entry clerk.” If staff put in
enough effort up front to become knowledgeable about how the EHR works so that
they can integrate it into their style of interacting with patients, it’s going
to be a very good experience.
If I go in and give them a very short training timeframe,
they won’t be familiar or comfortable with it, and when I make them use it when
they see every single patient, it’s not going to be a very pleasant experience.
You have to glide into using the EHR. Make it a positive experience throughout
the implementation process. Make sure that you are monitoring it so you can
measure your success. You don’t want to turn around and say, “We were not
successful because we made all of these mistakes.” Before setting up very
specific mechanisms and asking everyone else to jump in, verify that the
mechanisms will work in your practice.
Maybe the EHR Is Just Plain Wrong
The other factor that can subvert the success of the EHR is
that the doctor didn’t pick the right product. Or, in some cases, over time the
product or the practice has changed and the EHR is no longer a good fit.
Suppose you had bought an EHR geared toward your specialty
practice, and now you want to branch out to become a multispecialty practice.
Maybe the product isn’t right for that. Or perhaps the practice started out as
a 2- or 3-doctor practice and now has become a 10-doctor practice. Ten-doctor
practices have different EHR issues and problems than smaller practices.
Another scenario is a vendor who becomes nonresponsive. You
might have started out with a vendor because it dealt with your area of
medicine, but now all of its business is in primary care, which is not your
area. All of the toys that are coming out in the EHR are geared toward primary
care, but you are trying to deal with surgery scheduling. You can grow away
from the product or the product can grow away from you. You will have to make a
move to something that is more appropriate for your situation.
If you hate the EHR, even though the EHR is competent and
effective but you just don’t use it correctly, consider assessing why it isn’t
working for you. Do you need to go back and redesign the system? Do you need to
adjust how you use it so that you can be more successful? After you go through
that exercise, you might have to go through a retraining process for your
staff. Once you have done that retraining, you are reimplementing the EHR.
Be forewarned that some of that reimplementation might mean
going back and fixing a patient’s medical record going forward. Suppose, for
example, that EHR users are entering medications as notes instead of putting
them into the medications module. Everybody says, “We are doing drug
utilization review; can we get our meaningful use points to collect our money?”
You have to go back and say, “Wait a second — the product works; we are just
not using it correctly.”
That’s very different from being in a situation in which the
product itself is bad or is really inappropriate for you. At some point a
doctor may cry “Uncle!” and say, “This is not the right system for us.” You
have to soul-search and make sure that the product that you are buying is going
to solve the problem, and make sure it’s not about your practice.
Money and Effort Will Kick In
Switching to another product requires a different effort,
including cost issues. It is also extremely difficult to take information from
one EHR and move it to another environment. Different systems have very
different structures. Some are textual, with long text fragments that make up
the medical record. Some of them have small labeled fields. If you are a
cardiologist and you are taking the patient’s medical history, in some systems
you will be checking off boxes, whereas in other systems you will be dictating
notes through Dragon or a similar product, using voice recognition. Those are
very different products, and to move from one to the other and back again is
very challenging.
The features of some systems are very different. For
example, consider a scanned image. If you scan in an ER report from the
hospital or a patient’s previous medical record, some EHRs track whether the
doctor looked at this document. Some EHRs don’t track this. When you are trying
to convert from one to another, how are you going to bring that information
over correctly, and where are you going to enter it? There are many examples of
trying to map out where information should be entered.
Sometimes an EHR fails because the vendor is failing, and
that means that the product isn’t working for you anymore. You might have lots
of workarounds. In some cases, you end up with many pieces of paper that you
are using to document and the system is scanning them in. Sometimes the vendor
is abandoning the product and moving to a different product and therefore has
stopped maintaining and fixing your system. They are no longer investing their
money in it. We have vendors who have said, “We sold a product that we put in
your office, and now we want to sell you a service out of the Cloud.” They make
it impossible for you to continue to use that product in your office. These are
things that can happen and you are subject to them.
Another situation that I have seen is when the EHR is no
longer being actively sold. The manufacturer says, “No new practices are implementing
this system.” That is a very serious problem strategically. Therefore,
practices need to keep an eye on what’s going on with the product. Is it moving
forward? Are there signs that this product is no longer a viable option to
maintain your records?
Remember that the punchline to all of this is that it’s the
practice that is responsible for maintaining patients’ records, not the EHR
vendor, and HIPAA security is the responsibility of the practice, not the
vendor.
Source: emrindustry
No comments:
Post a Comment