Over the past couple of years, we’ve written quite a lot about choosing and implementing an electronic health record, and have also covered how best to use the system once it’s up and running. But many physicians comment that these issues often don’t apply to them, because they are employed by a hospital or health system. As a result, they believe that they have no input into what software is provided or how they use it.
If you are among this group, we would respectfully disagree with the notion that employed docs are powerless to transform their predicament. On the contrary, it is often providers working for a large entity that can have the greatest impact in health IT and effect changes that will significantly improve the lives of physicians and patients alike.
By Dr. Neil Skolnik and Dr. Chris Notte
In this column, we will highlight five ways that any provider, regardless of their employment model, can make a real difference.
1. Identify the Issues
It should come as no surprise that to improve a process, one must understand the issues. Unfortunately, in our experience physicians are often critical of health IT based on principle and not on practice. They perceive a disconnect between the software designers and the end users, and they feel that IT professionals simply don’t understand their needs.
While this notion has some historical validity, doctors’ decisions to shun technology in place of paper will never lead to meaningful advancement. It must be physicians who drive positive change, and in order to do that, they need to use the software so they can see where it needs to be improved. A real understanding of the product is the first step to providing insight into how to make it better, and it will help docs develop a list of "pain areas" that can be targeted for improvement.
2. Know How to Ask for Help
Large employers rely on employee feedback to pave the way to organizational change. Therefore, when issues with the EHRs are identified, they need to be expressed cogently and concisely, not simply as a list of grievances. This will allow the health care system to request support from the software vendor aimed at improving the user experience.
In reality, though, some issues are easier to address than others, and it helps to know the difference in order to set realistic expectations of what can actually be changed.
Major alterations in software design are typically difficult or impossible to implement without a significant software upgrade. These are costly and occur rarely, so it is unusual for a vendor to quickly address these requests. For example, it is highly unlikely that meaningful change will occur in fundamental elements such as the method of documentation or billing code entry.
On the other hand, minor changes in process or work flow can normally be readily addressed. There also might be data points or verbiage that can be altered to better accommodate the needs of the providers or network. Remember that enterprise-level implementations are limited in the amount of individual customization that can occur, but it is uncommon to find a concern that is limited to just one user. As long as physicians are driving the process, most changes will be gladly received.
3. Request Optimization
Once the hard work of the initial rollout is complete, it is incumbent on a hospital or health network to make sure users are given every available tool to increase their efficiency and improve their use of the system. This process, known as optimization, is typically driven by the end users.
All EHRs contain tools to improve the ease of documentation and automate repetitive procedures. Unfortunately, most users are unaware of how to properly use them, because institutionalized training is focused on basic functionality aimed at fundamental usage. Providers are left to discover features on their own and may never go looking in the first place. This means they develop inefficient habits that are hard to break, and miss out on the true advantages of the technology, such as templates and clinical-decision support.
At some point, physicians must demand optimization and higher-level training on ways to improve their work flow. This also benefits the health system through improved efficiency and improved charge capture.
4. Get Involved in Governance
Most – if not all – large-scale IT implementations rely on a core set of key users to drive the priorities of improving the software and infrastructure. This is known as a governance committee, and through this group, all ideas for change and processes for improvement are vetted and discussed.