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Long Standing EHR Issues That Remain Unaddressed

Posted on June 17, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Dr. Jayne has presented a pretty great voice of reason in her blog posts about the realities of being a doctor in the meaningful use era. In a recent post she offered this comment which I’ve heard from many doctors:

And while we as physicians are having to cope with arduous workflows as a result of the regulations, there are advancements that would really benefit us that remain unaddressed.

I realize that EHR vendors have to prioritize requests from users. Plus, they have to deal with massive government regulation which has made it hard to prioritize user requests over government regulations. However, I know from the end user standpoint Dr. Jayne’s comment about the advancements that could be made in an EHR that still haven’t been added creates a really awful feeling.

Dr. Jayne also added this sad observation:

We’re forced to gather loads of information that could be put to good use but isn’t. For example, we collect information on race, ethnicity, religious preference, language preference, sexual orientation, and more. In many cases, it’s not used to further clinical care. It would have been great to have a prompt to ask about religious fasting the other night when I was treating a patient with profound dehydration. Although it occurred to me to ask, it didn’t occur to my patient care technician or to the resident I was supervising.

The optimistic side of me says that comments like this are a very good thing. 5-10 years ago, doctors wouldn’t have even thought to request this kind of feature. All they wanted to do was automate the paper charts. So, it’s progress that now we’re talking about ways we can incorporate the data in an EHR at the point of care in a much more effective way.

Now if EHR vendors can just be given the flexibility to work on these challenging problems instead of a list of prescriptive goverment regulations which just add to the burden of doctors as opposed to creating magical experiences.

Are You Cheating Yourself and Your Patients When Meeting Regulations Like Meaningful Use?

Posted on February 11, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I spend a lot of time counseling clients that, although they may be able to check the box for attestation, they’re cheating themselves and their patients out of the improvements that systems were intended to drive.

The above quote was from a post by Dr. Jayne on HIStalk. Her comment really struck me on a number of levels. The first is that I know so many organizations that met the rule of the law when it came to meaningful use, but definitely didn’t meet the spirit of the law.

Dr. Jayne is so right that many organizations that just slapped an EHR in there in order to get the EHR incentive money cheated themselves and their patients out of benefits that could have been achieved. I realize the economic realities associated with waiting, but I think we’re going to suffer some long term consequences from all the rushed implementations that jimmy rigged things to meet the letter of the law as opposed to using the meaningful use regulations to improve the care they provide.

However, I’d take Dr. Jayne’s analysis one step further. It’s worth considering if doctors chasing the EHR incentive money and showing meaningful use are cheating themselves and their patients. Those fans of meaningful use will probably think I’m just being negative. Most doctors will likely think it’s a very good question.

The reality I’ve seen is that the happiest doctors I know chose to shun meaningful use and some of them are now laughing at their physician friends that are busy clicking meaningful use check boxes. Ok, most of them aren’t evil enough to laugh. However, in their heads they’re thinking how grateful they are that they chose not to pursue meaningful use. It’s not hard to make an argument for why not doing meaningful use is in the best interest of your patient.

My takeaway from the experience of the meaningful use “gold rush” was to slow down and think rationally. Mistakes happen when you make irrational choices. Taking the time to make a well thought out business decision is key when evaluating any software implementation and government program. Even a software implementation with $36 billion of government incentive money attached to it.

When an EHR Pilot Makes Sense

Posted on May 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been a real fan lately of Dr. Jayne’s in the trenches commentary on the EHR implementations she’s apart of as CMIO. In her latest post she offered some really valuable insight into the integration of a physician group her health system purchased. The physician group wanted a bunch of custom content and Dr. Jayne’s team had convinced them of half of their recommendations and then she offers this insight:

At this point and given their resistance, I can get on board with half. It’s certainly more than none. Through discussion of their actual needs and observing their workflow, we’ve even identified a handful of customizations that we’re going to advocate that our vendor incorporate into the product out of the box. Ultimately, what allowed us to get the agreement we achieved was the idea they will be piloting the changes for a couple of months after the upgrade and then we’ll revisit them.

We added the pilot approach when we sensed they were stuck in analysis paralysis. The reluctance of the identified physician champions to make decisions was palpable. They feared backlash from their colleagues and claimed to be unable to reach consensus.

I had a somewhat similar situation happen to me on my first EHR implementation. The clinic had real fears about the transition to EHR. However, they needed to replace some old bubble scanning sheets which were no longer supported on this really old system. So, instead of going all in with a full EHR implementation, we did a partial EHR implementation as a kind of “pilot” for the clinic.

What resulted from this was really amazing. A week or so into the partial EHR implementation, the providers started asking us why we weren’t using the rest of the EHR features. In fact, some of them started using the other features before we even asked or trained them on it. I still remember walking into the director’s office and saying, “They’re asking me why we aren’t using all of the EHR features.” We quickly corrected that and implemented the full EHR a few weeks later.

You should never underestimate the value of jealousy. If you let a few people play with the shiny new toy, the others will be jealous. Of course, you better make sure that the shiny new toy works as proposed. Plus, don’t get sick with Pilotitis either.

Dr. Jayne also offered this powerful insight which says a lot about her as a leader in her institution:

I’ve been through this enough times to know what kinds of darts their colleagues might start throwing, so I was happy to offer myself as a virtual human shield. If using the larger health system as the scapegoat for required change is what it takes to move them ahead, so be it.

There are a lot of ways to deal with the “darts” of colleagues. Although, the best answer to the problem is having a real leader with a vision and understanding of where you want to take your EHR. Having a great leader at the helm of an EHR implementation has been the key difference between the good and bad EHR implementations I’ve seen.