We recently published the first post of our two-part blog series covering seven keys to successful physician EHR implementation. Created by those who design, build and implement order sets for CPOE, these keys should give a better path for those physicians lagging behind the 2014 adoption deadline. In this post we look at steps 4-7.
4. Early Engagement: Process and Software
“This is how we’ve done it for years”
The Gap: More like a chasm or an abyss…
What do they mean when they say “I refuse to enter orders!” ?
“I would never go back to paper charting again!”
What’s the best approach to close the gap…
Physician participation matters! These ladies and gents who practice medicine didn’t get to where they are without a measure of brilliance, perseverance, and resourcefulness. Many of these seasoned physicians already work with complex technology within the hospital systems. As time goes by, we see that healthcare providers have grown readily accustomed to computers and other electronic gadgets… or more notably, never knew life without these tools in their practice.
Undoubtedly, with this next generation of medical school students, having become so accustomed to the presence of technology, there will be a greater degree of acceptance and increased demand for efficient methods to enter orders and thus accelerate EHR CPOE adoption. Within those ranks will be bright minds of those who practiced programming and software development in their young lives. The future is bright for them as they integrate the art and science of medicine to design professionally accepted applications for healthcare. It may even be vital that training begin with medical schools, promoting the use of electronic health records from the academic to the empirical environments.
Although the process to improve the design of order sets is another white paper in itself, here is an outline for the stages of development. It always included input from the clinicians, including physicians:
Making Power plans powerful!
Once a framework is established and a smaller number of prototype orders sets are designed it’s time to engage end users in some testing, which will help get them acquainted with the software’s look and feel. Over the course of time for this analysis, design, development and testing users will gain confidence and experience with the product and can be early identifying how it flows with or interferes with their work process. This is valuable time for both users and vendors.
5. Mandatory Training and Willing Participants
With the significance of the change that will take place from early EMR use to mastery of the documentation process, training willing participants will be crucial to the success of this transition. Physicians will need support to make the transition with staff and IT professionals available to strengthen the process. Everyone involved from data entry personnel, to nurses, technicians, IT staff, hospital administrators and physicians should have reasonable expectations of the complexity of what will come during the transition. No one will say it’s easy but those who successfully transitioned from paper charting to electronic charting know it's worth the effort. The best is yet to come, when the value of all the data collected someday improves the health of populations across the world.
6. Medical practice protection reassurance
Considering the case remarks also step two of this document, physician must be reassured that their practice of medicine is protected. For physicians there’s a constant threat of litigation, and most pay extraordinary amounts for insurance to protect them from litigation. Technology that doesn’t support their practice or seem complex to use leads them to believe they may be putting their practice at risk. With an EMR entries, the risk feels greater because unlike a paper chart they feel that once something is documented and moves off the screen it isn’t always easy to find the location of those details electronically, leaving doubt about where or what was actually charted, or saved. As a reassurance, Hospital Administrations and Vendor should support good faith efforts to enter data correctly. If the risk of patient care or revenue errors occur, it’s more likely a clinician will discover the problem than be the cause of the problem.
7. Customized attention for future time savings
Often, when a consultant is called in to address the needs of a hospital system prior to implementation of an Electronic Health Record we find that most of the physicians and staff have not been sensitized enough to the idea of a “work flow”. These are more like buzz words: recognized, but not necessarily understood.
Likewise, many technology professionals don’t recognize the culture of the medical community and their lexicon. Every effort should be made by the IT departments and Vendor to work closely with the physician to identify best practices; magnifying the day in the life of a physician and how the work gets done; how departments collaborate with one another to serve the patients. By standardizing as much of the work flow as possible, with close attention to the sequence of events to get work done the burden of Electronic Medical Recordkeeping and the practice of Computerized Physician/Provider Order Entry can be made lighter and increase the momentum of physician acceptance of this technology.
Familiarity and experience with the software will enhance the use of the strengths of the application in conjunction with best medical practices, and with greater efficiency and value physicians will find CPOE adoption streamlined and more valuable to patient and population health
Financial incentives; Support from government, hospital administrations, and vendors; Intuitive technology; Early engagement in process and software; Training; Practice protection; and customized attention to the individual for managing time and patient services are the keys to a successful adoption.