tremendous increase in the adoption of electronic health record (EHR) systems
by physicians has been witnessed in the past few years, mainly because of incentive
payments introduced by the HITECH Act.
HITECH, between 10 and 20% of American physicians had an EHR system. A
considerable growth from 2009 to 2013 was documented by The Office of the
National Coordinator for Health IT in their December 2014 brief, noting that
approximately 80% of eligible physicians were using or planning on
using an EHR system.
The data brief stated that 59% of eligible physicians have already adopted EHRs
capable of achieving Meaningful Use, 12% have adopted other EHRs that are not
necessarily capable, and 10% have plans to adopt EHRs.
About 19% of all eligible physicians are not committed to an EHR system. Of
those, 3% plan to retire, 11% are uncertain what they are going to do, and 5% are
willing to absorb penalties rather than invest in EHRs.
This represents a good first step toward realizing
some of the many potential benefits that patients, payers, health providers,
and the national health system as a whole can attain. However, EHR adoption is
still facing challenges such as physician satisfaction and added value from the
Are Physicians Satisfied with Their EHR Systems?
To some extent we can say that physician
satisfaction has been achieved. Practices have become more proficient in using
EHRs than they were a few years ago, and EHRs have had an overall positive
impact on reducing medical errors. However, Health IT is believed to have
decreased the total amount of time that physicians spend with patients, and EHRs
have largely been seen as difficult to use and comprehend. Interestingly, the
United States was the only country in the study with a majority of respondents
making this statement. Initially, EHR involved time-consuming data entry and user
interfaces that did not match clinical workflow, these are not new concerns.
Although technology and methodologies have improved significantly, the stubborn
challenges still remain.
Time Management and the
It can be
said that the most valuable assets of a physician are medical knowledge and the
time available to use that knowledge to help patients. With time being such a
scarce resource, it is logical to hire more staff to offset some of the
additional work. A few strategies have been implemented to alleviate issues of
time scarcity, but with varying degrees of success. A few of the more common
More Intuitive Systems:
the “holy grail” of physician system design. This will help achieve a
productive market advantage. There continue to be big differences among
specialties, age groups, medical school attended, and the many other unique differences
and preferences of each individual.
Pace of the System and Its Acceptance:
systems may not be as fast as others. Doing things electronically is vastly different
than doing them manually (e.g., writing a prescription). There will also be
downstream savings and benefits by doing things electronically, such as fewer
calls trying to decipher the scripts, and potential patient safety improvements.
This requires influencing physicians to see the “whole picture” rather than
focusing only on the frustrating extra moments spent entering information on each
Every school has a unique way of teaching the diagnostic thought process to
medical students. This includes developing thought patterns for the types of questions
to ask a patient, the sequence in which to ask them, the routine and sequence
for examining the patient, a decision tree approach to diagnose a problem, and
an approach for documenting data in the patient record. These thought patterns get
thoroughly embedded in the medical students’ psyche. The thought process
becomes habitual, governing physician behavior and workflow throughout their
career. There is great inherent value in this: it establishes a clear comfort
zone on how to do things, creates a mental checklist that provides consistency
and thoroughness of care, and serves as an intuitive quality control mechanism.
In the paper world, providers follow their well-engrained and seamless process
to 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 are
meticulously organized to their liking. It is second nature for them to process
and turn this data into information, followed by recording it into the patient
record and orders.
Change Is Hard.
something you have done extremely well in a new and different manner is even
The challenge is not avoiding change—because change is unavoidable. Instead,
the challenge becomes how to create reasonable expectations and minimize the
level of disruption. Dealing with thought process disruption from an EHR is a
subtle, yet important consideration you will have to make when acquiring and
implementing an EHR system.
some practical tips on how to approach this with your medical staff:
• Create awareness of the potential problem of thought disruption. In my
experience helping scores of physician practices with EHRs, no one has ever
introduced the issue of thought disruption. Informative conversation with them
on this can help.
the expectation that while today’s EHRs are making good progress in system
usability 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 new
system may be, especially how it may take longer to complete
all the patient documentation.
Importance of Workflow
important consideration to make when acquiring and implementing an EHR system
is how to manage the workflow and process changes. Physician workflow will change,
failure to recognize this results in much unnecessary frustration and
inefficiency. The first and foremost consideration in addressing workflow is to
establish a thoughtful and objective process for selecting an EHR system. If nobody
in your organization has experience doing this, consider using outside
assistance from industry consultants or Regional Extension Centers (RECs) in
your area. Note that RECs are federally subsidized organizations chartered to
serve as a resource to assist providers in EHR implementation and healthcare IT
needs. Recognize and develop reasonable expectations. Answer questions such as:
– Why do you want an EHR system?
only reason is to get Meaningful Use incentives or avoid penalties, you will
probably not be happy with the results and may want to consider whether it
makes more economic sense to not get an EHR system.
are the most important things you want out of a system?
what is really important to the physicians and practice.
– What types of benefits do you expect to achieve?
reasonable goals for both quantifiable and intangible benefits.
– How will you deal with temporary or permanent inefficiencies that medical
staff will need to endure such as taking more time to treat and document care
for each patient visit?