EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Top 5 ways to bring doctors to the EHR optimization table

Top 5 ways to bring doctors to the EHR optimization table | EHR and Health IT Consulting | Scoop.it

While some speak optimistically about the "post-EHR era," electronic health records are still very much a going concern – and will be of great interest to many of the 45,000 or so attendees at the 2017 HIMSS Annual Conference & Exhibition later this month.

There will be education sessions on topics ranging from enabling EHR analytics to resolving usability issues that could impact patient safety to better integrating genomics data into clinical workflows. There's even a half-day User Experience Forum at HIMSS17 –  a major theme of which will be the ways UX can be improved for care teams to create a more transparent, intuitive way of care delivery.

Long story short: For all their ubiquity, EHRs still have a lot of improving to do.

 

As a physician informaticist, I'm fortunate to be invited to many meetings about electronic health record optimization: big meetings, small meetings, fantastic meetings … YUUUGE meetings.

 

But there is always one thing, or rather, person, missing: Inevitably, I'm usually the only doctor in the room … and I haven't seen an actual patient in more than five years!

With only 34 percent of physicians reporting that they are "satisfied" or "very satisfied" with their EHR according to a 2015 survey conducted by the American Medical Association, this is a definite problem. Not only that, but as the AMA's Vice President of Professional Satisfaction Christine Sinsky, MD, and colleagues reported, physicians spend another 1-2 hours on computer and other clerical work during their personal time each day, contributing to the increasing rate of professional burnout.

Nearly every hospital and health system has an EHR in place, and are hard at work optimizing their investment in a system that typically cost millions or even billions to implement. EHR optimization, for those unfamiliar, is the continuous improvement of the primary technical tool that provides care to the patient through the clinician. Healthcare organizations are simply not going to get the results they want if practicing physicians aren't at the table.

 

To a layman reading this, this sounds laughable that they are not at the table. Just having guys and gals like me – "the geek doc," "the techie nurse," or "the ex-clinician turned 'suit'" – is not enough. While we haven't forgotten the years we spent providing care for patients at the bedside, you must include the current bedside providers into the decision-making processes.

I understand this is easier said than done – doctors are among the busiest people on the planet, and most do not show up or speak up if it means leaving their patients or taking a significant productivity hit (code word for "financial"). Many clinicians will remember the days of pharma reps bringing in catered lunches in exchange for some of their time. I think the question you need to ask yourself is: "What is the new drug rep luncheon that we can offer busy physicians in order to get a bit of their time to get feedback, versus make a sales pitch?"

In my 15 years of expertise, most physicians and nurses care about "buttons, clicks and lists," which translates to usability, configurations, and technical workflows that match their real-world workflows. So the next question you should have is "How do we get this level of input without needing them to leave the bedside and join a meeting?" I'm glad you asked. I will put on my technical and organizational 'chef hat' to share with you a few recipes for getting the docs and nurses to the table!

 

Here are the top five ways to bring doctors to the EHR optimization table:

1. Email. I know what you're thinking: Did he really open No. 1 with email? Don't doctors get enough messages already? Keep reading: They do, but in my experience in leading EHR efforts at healthcare organizations across the country, it still works. Be sure to leverage the account they use most—for many docs, this is not their hospital-issued account and may be the Gmail account they check every evening instead. If you're unsure, ask them which address they prefer to communicate about EHR matters, which is their new "black bag." Asynchronous (non-real time) communication allows physicians to respond on their schedule. It might take a while to get a reply, but if you include a clear call to action and it's formatted properly, you'll get it eventually. Which leads me to my next point…

2. Images. As I mentioned above, most of the time when you're seeking physicians' opinions for EHR optimization, it centers on how something looks or feels to them: Which design for a particular screen do they prefer, or which workflow diagram makes more sense for their reality? When you can use images—a screen capture or mockup, a Visio, a chart—you're much more likely to get a response. Try to avoid the tyranny of choice by giving no more than three options per question, and always remind them what the current state looks like alongside the future state options: Physicians are typically visual learners, and they also may not realize what the current state looks like. You'll get a much better response when presenting the status quo and three redesigned options under consideration versus a "Here's the new design for this alert, what do you think?"-type question. Minimum 'free-thinking' allowed: Provide focused and well vetted choices.

3. Screencasts. If a picture is worth a thousand words, how much are short videos worth? Screen recording technology tools such as Camtasia and Snagit are inexpensive and user-friendly ways to showcase and explain EHR changes or proposed changes. Other industries have used this method for years, and it often can replace an in-person meeting. EHR builders and analysts can record themselves actually going through a new screen or workflow in the EHR, as they explain what they are doing and why it was designed this way. Doctors can easily watch the video on any device; the small .mp4 files can be sent via email, and email replies or comments on the video itself (preferably web hosted, but follow the guidelines of your health system and vendor) make it easy and efficient to collect physician feedback. Your technical teams will love it as well.

4. Surveys and polls. I've used tools like Surveymonkey for over a decade to survey physicians across organizations. They can be accessed inside or outside of organization firewalls and can be incredibly effective. For example, you may have an EHR developer or analyst create various options for the physician home screen. By embedding images with clearly written captions in the survey, you can get a clear indicator for which one is preferred. This method also gives you objective feedback, which can often be better than random anecdotal feedback—which is the most common thing heard in meetings with many docs. You can use the survey results as support for critical decisions. I once had a doctor voice concern about the new format of an order set, but when I was able to point out that more than 80 percent of her peers selected it as their top choice, she was more amenable to the decision given that so many of her peers had weighed in favorably, and objectively. I've coined this "evidence based optimization!"

5. Meeting etiquette. If you've tried all of the above, and you just really need an in-person meeting, follow these simple etiquette tips to make doctors more inclined to participate. Depending on the group(s) you're targeting, you may have different optimal meeting times. For example, you'll have the best luck with primary care docs around the lunch hour, but hospital-based docs are usually more available in the early mornings or evenings. No matter when you schedule it, be sure to use the best virtual meeting tools you can afford, so docs have no problem logging on and viewing the deck if they're remote. You can also record the meeting to share with those who couldn't attend. If you can't schedule an exclusive meeting, try to negotiate a bit of time during a meeting already on their calendar, such as a recurring "med exec" (hospital meetings that docs typically attend) or "monthly ambulatory practice management" meeting. Design meetings to cater to "WIIFM" (what's in it for me): Before gathering their input on EHR changes and the like, provide a few tips and tricks that can help streamline their current EHR workflow right now. Once you have the "oohs and ahs," the door will be open for gathering their feedback and their suggestions will be more candid and focused. By continuously showing them the results your EHR optimization efforts are achieving, the more invested they will be in the ongoing process.

Nothing is foolproof, but I'm confident that using a combination of these methods will help you bring doctors to the EHR optimization table at your hospital. The pharma reps may bring the food, but effective EHR optimization efforts using the above methods can engage clinicians and garner candid feedback–and that's a pill that's not hard to swallow.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

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Tailored Physician EHR Use Necessary for Evolving Industry

Tailored Physician EHR Use Necessary for Evolving Industry | EHR and Health IT Consulting | Scoop.it

The healthcare industry is changing every day and new, revolutionary processes are continuing to affect patient care and population health outcomes. Whether it’s through patient-centered medical homes, accountable care organizations (ACOs), EHR adoption, or general improved care coordination, the medical sector is making some significant modifications toward better care. However, physician EHR use and implementation of health IT systems will likely depend upon the needs of each disparate medical facility.


Meaningful use requirements, for instance, will need to be flexible enough to ensure health IT platforms are useful and beneficial for differing healthcare providers. When integrating public comments into theStage 3 Meaningful Use final rules and the Stage 2 Meaningful Use modified rules, the Centers for Medicare & Medicaid Services (CMS) should consider the need for adaptable and flexible requirements that providers could customize to their interests.


The American Hospital Association’s President and CEO Rich Umbdenstock wrote in a brief the importance of removing obstacles and developing federal regulations that meet the needs of the healthcare industry. Both care coordination, reducing costs, and investing in physician EHR use are key objectives throughout the medical care market.


“It’s time for regulators to recognize the changing healthcare landscape and remove obstacles on the road to collaboration,” wrote AHA President Rick Umbdenstock. “Healthcare is changing; hospitals are changing; and regulations that block progress toward meeting patient demands and community expectations must change, too.”

Two areas within the healthcare industry that may need health IT customization are public health reporting and chronic disease management. The Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) along with the National Opinion Research Center (NORC) at the University of Chicago released a report titledPublic Health IT to Support Chronic Disease Control.


In efforts to focus more attention on the triple aim of healthcare, NORC determined that chronic diseases are the major medical cost drivers and most common conditions found among patients across the country. The report went over population health interventions and physician EHR use to exchange data with public health agencies in efforts to curb the further deterioration of chronic conditions.

In particular, physician EHR use can be applied toward addressing case management, social services, behavioral health, and public health services. Incorporating EHR systems will also lead to better collaboration and communication among multiple medical facilities and public health agencies.


“The capacity to collaborate and share data across health care, public health and other partners becomes important in the context of supporting public health core functions,” the report stated. “We see great potential for using electronic data shared between health care providers, governmental public health agencies and other community partners. However, our discussion and earlier research points to important barriers to effective coordination and data sharing to promote population health. These challenges range from the limited mandate for governmental public health agencies in relation to chronic disease, limited public health IT infrastructure and historic lack of coordination between governmental public health agencies and health care providers.”

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