Atremendous increase in the adoption of electronic health record (EHR) systemsby physicians has been witnessed in the past few years, mainly because of incentivepayments introduced by the HITECH Act.
|BeforeHITECH, between 10 and 20% of American physicians had an EHR system. Aconsiderable growth from 2009 to 2013 was documented by The Office of theNational Coordinator for Health IT in their December 2014 brief, noting thatapproximately 80% of eligible physicians were using or planning onusing an EHR system. The data brief stated that 59% of eligible physicians have already adopted EHRscapable of achieving Meaningful Use, 12% have adopted other EHRs that are notnecessarily capable, and 10% have plans to adopt EHRs.
About 19% of all eligible physicians are not committed to an EHR system. Ofthose, 3% plan to retire, 11% are uncertain what they are going to do, and 5% arewilling to absorb penalties rather than invest in EHRs.This represents a good first step toward realizingsome of the many potential benefits that patients, payers, health providers,and the national health system as a whole can attain. However, EHR adoption isstill facing challenges such as physician satisfaction and added value from thesystems. Are Physicians Satisfied with Their EHR Systems?To some extent we can say that physiciansatisfaction has been achieved. Practices have become more proficient in usingEHRs than they were a few years ago, and EHRs have had an overall positiveimpact on reducing medical errors. However, Health IT is believed to havedecreased the total amount of time that physicians spend with patients, and EHRshave largely been seen as difficult to use and comprehend.
Interestingly, theUnited States was the only country in the study with a majority of respondentsmaking this statement. Initially, EHR involved time-consuming data entry and userinterfaces that did not match clinical workflow, these are not new concerns.Although technology and methodologies have improved significantly, the stubbornchallenges still remain.Time Management and theEHRIt can besaid that the most valuable assets of a physician are medical knowledge and thetime available to use that knowledge to help patients. With time being such ascarce resource, it is logical to hire more staff to offset some of theadditional work. A few strategies have been implemented to alleviate issues oftime scarcity, but with varying degrees of success.
A few of the more commonstrategies are:BuildingMore Intuitive Systems:This isthe “holy grail” of physician system design. This will help achieve aproductive market advantage. There continue to be big differences amongspecialties, age groups, medical school attended, and the many other unique differencesand preferences of each individual.Pace of the System and Its Acceptance:Somesystems may not be as fast as others. Doing things electronically is vastly differentthan doing them manually (e.
g., writing a prescription). There will also bedownstream savings and benefits by doing things electronically, such as fewercalls trying to decipher the scripts, and potential patient safety improvements.
This requires influencing physicians to see the “whole picture” rather thanfocusing only on the frustrating extra moments spent entering information on eachpatient.ThoughtProcess DisruptionEvery school has a unique way of teaching the diagnostic thought process tomedical students. This includes developing thought patterns for the types of questionsto ask a patient, the sequence in which to ask them, the routine and sequencefor examining the patient, a decision tree approach to diagnose a problem, andan approach for documenting data in the patient record. These thought patterns getthoroughly embedded in the medical students’ psyche. The thought processbecomes habitual, governing physician behavior and workflow throughout theircareer. There is great inherent value in this: it establishes a clear comfortzone on how to do things, creates a mental checklist that provides consistencyand thoroughness of care, and serves as an intuitive quality control mechanism.In the paper world, providers follow their well-engrained and seamless processto collect disparate data from a variety of sources. They observe the patient,look for any physical signs or manifestations of problems, ask questions,review test results, and browse through thick patient charts that aremeticulously organized to their liking.
It is second nature for them to processand turn this data into information, followed by recording it into the patientrecord and orders.Change Is Hard. Relearningsomething you have done extremely well in a new and different manner is evenharder.
The challenge is not avoiding change—because change is unavoidable. Instead,the challenge becomes how to create reasonable expectations and minimize thelevel of disruption. Dealing with thought process disruption from an EHR is asubtle, yet important consideration you will have to make when acquiring andimplementing an EHR system. Here aresome practical tips on how to approach this with your medical staff:• Create awareness of the potential problem of thought disruption. In myexperience helping scores of physician practices with EHRs, no one has everintroduced the issue of thought disruption. Informative conversation with themon this can help.
• Createthe expectation that while today’s EHRs are making good progress in systemusability and adaptability to workflow, the problem can always be mitigated,but not necessarily eliminated.• Mitigation will require active physician involvement.• Create reasonable expectations of what the overall inefficiencies of the newsystem may be, especially how it may take longer to completeall the patient documentation. TheImportance of WorkflowAnotherimportant consideration to make when acquiring and implementing an EHR systemis how to manage the workflow and process changes. Physician workflow will change,failure to recognize this results in much unnecessary frustration andinefficiency. The first and foremost consideration in addressing workflow is toestablish a thoughtful and objective process for selecting an EHR system. If nobodyin your organization has experience doing this, consider using outsideassistance from industry consultants or Regional Extension Centers (RECs) inyour area.
Note that RECs are federally subsidized organizations chartered toserve as a resource to assist providers in EHR implementation and healthcare ITneeds. Recognize and develop reasonable expectations. Answer questions such as: – Why do you want an EHR system? If theonly reason is to get Meaningful Use incentives or avoid penalties, you willprobably not be happy with the results and may want to consider whether itmakes more economic sense to not get an EHR system.– Whatare the most important things you want out of a system? Definewhat is really important to the physicians and practice.– What types of benefits do you expect to achieve? Setreasonable goals for both quantifiable and intangible benefits.– How will you deal with temporary or permanent inefficiencies that medicalstaff will need to endure such as taking more time to treat and document carefor each patient visit?