Common Missteps in Physician EHR Deployment
Despite the fact that Electronic Health Records have existed in some form or another for the last 15 to 20 years, surprisingly, we find that when on-boarding new clients, many are behind the times in terms of how they work; what they do, and, most importantly from a physician's perspective, how they facilitate delivery of healthcare.And, oddly, this is likely a perspective that many physicians agree on.
In a 2015 Physicians Practice Technology Survey, only 53 percent of 1,181 respondents said they had a fully implemented EHR system. And, despite seeing an improvement in documentation (66%), 68% said they did not see a measurable return on their investment in EHR. Respondents said one of their top information technology problems was "a drop in productivity due to our EHR," indicating a significant disconnect between the intent of EHR and its reality.
If you are wondering what EHR trip-ups other physicians are struggling with, consulting pods at Endeavor Health have concluded the following to be the most prevalent when working with new clients:
Inadequate training on EHR systems for both physicians and clinical staff can be a significant source of frustration. Yet there are many other demands for a physician's time and money. It is a paradox that devils many practices: If a practice doesn't go "off line" and dedicate enough time to initial training on the EHR, implementation and subsequent productivity will suffer. But few practices can afford to take a full week or more away from patient care.
Endeavor Health counsels new physician clients to avoid learning a new system while they are seeing patients. We realize EHRs have learning curves and, for some they may be steep. If you do not ascend the curve in a productive learning environment, you will be paying for it with wasted time and frustration.
With our entire network of physician clients, Endeavor Health incorporates technology use in order to have true success with understanding and efficiently using the EHR so as to enable our physicians to commit time each week to relearning [the system]. We recommend practices’ carve out one to three hours each week for a single physician or staff member to learn the functionality of the practice's EHR. That person becomes a liaison or a de facto liaison to the Endeavor consulting pod and can also be a person who can educate and provide ongoing education for the physicians and the office staff.
• Training should be timely, and repeated for both new staff and current users.
• Training should focus on specific tasks that staff/providers will use daily.
• Identify a practice "super-user" who will be a clinic resource/trainer/ IT support person.
Endeavor Health supports a client network of 64 physician practices many of which often struggle with spending too much time on documenting the patient encounter in the EHR. We encourage physicians, PA’s and NP’s to chart on the computer when the patient is in the exam room. All too often, this proves to be a cumbersome task. It can be very difficult for physicians follow this protocol when they are trying to talk and listen to the patient. But, with the recent requirement of medical doctors to move to electronic charting and the impending 2018 conversion for dentists, this will soon not be left up to choice!
Completing the patient note while the patient is present in the exam room is a necessary component of providing a summary of care for the patient to bring home — a meaningful use requirement. So, physicians who are not ace typists, being required to enter the patient note during the encounter can slow down their day and reduce overall productivity.
Another productivity drag? Physicians commonly fail to make use of time-saving EHR features like shortcuts, templates, built-in coding, and voice recognition software to dictate the patient note. And, when visiting other clinics, the doctor often sees them using out-of-the-box templates provided by random vendors, which slows down physician work flows. Engaging the right management firm will better enable your practice to understand your practice's work flows and how they are affected by the EHR. Additionally, the right firm can work with your practice to create customized templates that will speed up documenting the patient encounter.
Many EHRs have the ability, with time and effort - and that's the problem - to make some modification to these templates. But most physicians find those barriers too high, in terms of time and effort. Endeavor Health consulting pods will correctly configure the EHR during implementation so that things like an incorrectly set up dictionary does not create a negative affect for years to come!
• Integrate the EHR into clinical work flows, and revisit work flows after implementation.
• Develop templates/customization that work for the specific practice.
• Ask the vendor for system enhancements to facilitate improved work flows, where possible.
INADEQUATE TECH SUPPORT
Many practices have vendor-provided tech support onsite for the first week of EHR implementation, and after that they are essentially on their own. Obviously that can be a huge detriment to a practice. Endeavor Health administrators provides tech support with a return visit within 90 days after the initial implementation, for one or two days, to answer questions that have cropped up at the practice.
Communicating with the our clients on a regular basis is crucial to the successful rollout of EHR! We suggest that the appointed EHR "super-user" be our liaison to the practice. This person should not only be communicating back to the our pod(s) what they need and what's working, but they should be communicating back to the office what updates are coming out for the software.
Large health systems typically have their own onsite tech support, which is a definite plus for busy practices. But that doesn't always mean your practice can get the personal attention it deserves. Endeavor consulting pods also act as an EHR optimization team. The goal here is to make that system work better for you. Our consultants have EHR exhaustive experience and approach their work from a "lean-thinking" perspective.
• Build in adequate tech support in the initial vendor contract, with a return visit within 90 days.
• Develop a practice work group (physicians and staff) that will initiate and support EHR implementation/use.
• Task the EHR super-user to act as a vendor liaison.
SOAP NOTE SLOWDOWN
According to a member survey of the American College of Physicians, most of whom were experienced EHR users, 89% of respondents said they experienced slower data management; 63.9% said the SOAP (subjective, objective, assessment, and plan) note documentation took longer; 33.9% said it took longer to review medical data; and 32.2% said it took longer to read another clinician's note using EHRs.
If your EHR finds you on the low end of the learning curve #weshouldtalk