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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.

EHR Requires You to Reconsider Your Workflow

Posted on November 19, 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.

Despite many EHR vendors best efforts to tell you otherwise, an EHR requires every organization to reconsider their workflow. Sure, many of them can be customized to match your unique clinical needs, but the reality is that implementing an EHR requires change. All of us resist change to different degrees, but I have yet to see an EHR implementation that didn’t require change.

What many people don’t like to admit is that sometimes change can be great. As humans, we seem to focus too much on the down side to change and have a hard time recognizing when things are better too. A change in workflow in your office thanks to an EHR might be the best thing that can happen to you and your organization.

One problem I’ve seen with many EHRs is that they do a one off EHR implementation and then stop there. While the EHR implementation is an important one time event, a quality EHR implementation requires you to reconsider your workflow and how you use your EHR on an ongoing basis. Sometimes this means implementing new features that came through an upgrade to an EHR. Other times, your organization is just in a new place where it’s ready to accept a change that it wasn’t ready to accept before. This ongoing evaluation of your current EHR processes and workflow will provide an opportunity for your organization to see what they can do better. We’re all so busy, it’s amazing how valuable sitting down and talking about improvement can be.

I recently was talking with someone who’d been the EHR expert for her organization. However, her organization had just decided to switch EHR software vendors. Before the switch, she was regularly visited by her colleagues to ask her questions about the EHR software. With the new EHR, she wasn’t getting those calls anymore (might say something good about the new EHR or bad about the old EHR). She then confided in me that she was a little concerned about what this would mean for her career. She’d kind of moved up in the organization on the back of her EHR expertise and now she was afraid she wouldn’t be needed in that capacity.

While this was a somewhat unique position, I assured her that there would still be plenty of need for her, but that she’d have to approach it in a little different manner. Instead of being the EHR configuration guru, she should becoming the EHR optimization guru. This would mean that instead of fighting fires, her new task would be to understand the various EHR updates that came out and then communicate how those updates were going to impact the organization.

Last night I had dinner with an EHR vendor who told me that they thought that users generally only used about 50% of the features of their EHR. That other 50% of EHR features presents an opportunity for every organization to get more value out of their EHR software. Whether you tap into these and newly added EHR features through regular EHR workflow assessments, an in house EHR expert who’s constantly evaluating things, or hiring an outside EHR consultant, every organization needs to find a way to regularly evaluate and optimize their EHR workflow.

The EHR Has Clothes … At Least Some of Them

Posted on July 10, 2012 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 really falling in love with some of the content that the Health Affairs blog has been putting out there lately. A recent post titled “The EHR Has No Clothes” was no exception. In this incredibly thoughtful post by Barry Saver, he’s not afraid to start a discussion about points that many are afraid to talk about. I like that a lot. Although, I think the post also represents a couple ongoing trends I see in EHR perceptions.

Common EHR Problem 1 – I can’t tell you how many times I ask a doctor how they like their EHR and then they provide me some small facet of the EHR which annoys them. In Barry’s case it’s “Most screens do not show age, date of birth, or medical record number.” While we could delve into the particular feature that Barry mentions, that’s really not the point. The point is that far too often I see users of EMR systems fixating on one particular issue and ignoring the dozens of other items that are better than the paper world. It’s the proverbial throwing out the baby with the bath water.

No doubt I have a little Pollyanna in me. Although, I should be clear that I’m not suggesting that EHR problems shouldn’t be addressed. Please do hold EHR vendors accountable if their software needs changes. I am saying that I see far too many doctors and clinics that get so fixated on one problem that they ignore all the other good things that are possible. There are deal breaking EHR features and their are EHR annoyances that can be fixed. Make sure you know which one you are really dealing with when you see it.

As an interesting sidebar, this same fixation often happens in the EHR selection process. Although, in this case the person selecting the EHR often fixates on some particular feature (valuable or not). For example, they’ll say that they really love the login screen or background color. It’s amazing what little things can have such an influence on our decision making when they shouldn’t matter at all.

Common EHR Problem 2 – I’ll call this problem the mature feature problem. It turns out it’s a fallacy to assume that a mature EHR (ie. one that’s been around for a long time) has had time to fix all the problems. Here’s a short paragraph from the above linked post:

Approving 12 months of refills when I receive an electronic refill request typically takes a combination of 14 mouse movements, clicks, and keystrokes – as opposed to four if it were implemented efficiently. The list of items needlessly making it more difficult to provide efficient and effective care would cover many pages. These might seem like issues that could be present in version 1 of a system and then promptly fixed, but we currently have version 5.6.

I’ll save the discussion of mouse clicks and keystrokes for another post since it’s an important one. Instead, let’s focus on the idea that a mature EHR will have worked out all the issues with certain features. While this can definitely be true in the early development of EHR software, the opposite often comes into play as EHR software matures.

When an EHR begins its development life cycle it’s usually only saddled with a very specific task. In fact, you don’t have time to build all the features so you often have to make it really simple because of time constraints. Assuming this meets your workflow, it’s a great thing and you enjoy a wonderfully simple interface. Over time, features continue to be added to the interface. Plus, they have to start supporting all 50+ medical specialties that all have their own specific needs. Quickly, the beautiful EHR interface gets bloated to the point that it can do everything imaginable, but it does nothing really well.

Certainly, the best EHR software vendors know this and battle against it. Although, it really takes a battle to overcome this challenge.

What I find even more ironic is that Barry suggests Vista as the solution to his issues with EHR. At least he admits to never having used it other than the demo client on the web. Certainly Vista has its place in the EHR world and I love that it’s open source and benefiting from that innovation. Although, I think it’s crazy to think that a small doctor’s office is going to implement Vista. I’d love to see Barry do a write up after he adopts Vista.

Does the EHR have no clothes?
I think many EHR companies do have clothes on. I think the real problem is that we need to just stop shopping at the high end stores by the nude beach.

Top 12 Electronic Medical Record Software Features

Posted on August 17, 2009 I Written By

I just looked at a website of an EMR consultant who posted this blog entry on his Top 10 Electronic Medical Record Software Features for every Physician. This is what he came up with. Take a look.
1) A fully Integrated EMR Software System as opposed to interfaced systems
2) Integration of EMR Software with ePrescription to receive bonus payments
3) Electronic Medical Record Software that supports PQRI Automation
4) Electronic Medical Software with adaptive learning
5) Secure Portability and access to your electronic medical records even without an internet connection
6) Integrated patient portal – Keeping more in-touch with your patients
7) Electronic Medical Record Software that does not box you into rigid templates
8) Document and Image Management
9) Integrated with voice recognition and handwriting recognition
10) Meets all regulatory and compliance requirements (http://www.revenuexl.com/)

My Top Twelve list would go like this:

First of all the EMR has to be: Easy to Use, Simple to Learn, Affordable and it has to make Providers more productive. Without this functionality, none of the other stuff matters!
1. Can document a progress note quickly and efficiently
2. Can ePrescribe
3. Can access medical record information quickly using document management system (lab results, test reports, consultation and hospital reports)
4. Can track Health Maintenance, Chronic Problem Information and Orders
5. Can generate reports for Quality Improvement and Incentive Programs
6. Can connect to other systems via CCD or CCR
7. Allows flexible documentation via typing, dictating, writing and scanning, and drop down menus, templates and pick lists
8. Patient Portal would be nice
9. Interfaces with Scheduling, Billing and Messaging quickly and seamlessly
10. Keeps Patient Medical History Information Stored and Accessible (Allergies, Medications, Past Medical History, Past Surgical History, Habits, Family History and Social History)
11. Quick and Simple ICD-9 and CPT Coding Support
12. Quick and Effective E&M Coding Support

What do you think? Did I miss anything? Is my list better or worse than the list from the EMR Consultant?