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How To Create Satisfied EMR Users

Posted on September 3, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

These days, we’re deluged with statistics on medical practices determined to show their EMR the door — but I’d like to believe that it’s possible for doctors and EMRs to have a happy marriage.

A few months ago, on question-and-answer site called Quora.com, a health IT expert named Mark Olschesky posted a nice list of factors which he believes are critical to a successful EMR/practice relationship. I thought they were worth sharing:

Doctors, clinic staff and administrators agree on business metrics and functions they want to improve with the EMR.

Some examples proposed by Olschesky:

· Right now I need to do manual chart reviews for research and I have to hire 3 staff to help me with this. I’d like to build forms so that I can do this automatically.
· It takes us 7 days to send follow-up communication to referring doctors. Can we speed this up to one day?
· I’d like to prove that I do a comprehensive visit so I can bill the proper amount of money for a visit.
· We would like to know every child that has a difficult airway and fire a warning every time we access their chart in the hospital so that everyone knows they need to prepare for a tricky intubation. This can save lives. 
· I do the same thing 50 times a day and I don’t want to do that anymore. Can you standardize the way that I do x thing 50 times a day?

The tech contact person needs to meet with clinicians regularly and get their feedback on what they want. 

Rather than simply coding up new features or tools, the  IT person needs to have clinicians check out the tools they are building before they go live with them in the system, he says. Some practices are loathe to take the time it takes to slowly and carefully build out, but they should grit their teeth and do it anyway. “It pays out at a major multiplier,”  Olschesky notes.

Practice leaders need to be absolutely clear about which organization-wide decisions are being made and how that plays out in how the system will be configured.

Rather than simply unveiling the system at go-live time, there should be an easy channel for clinicians to submit feedback and share what changes they think will be helpful to them, Olschesky says. Otherwise, groups may end up with doctors who are needlessly unhappy. While some unpleasant or unpopular features may still be necessary, due, say to regulatory requirements, none of these features should come as a surprise to users.

Practices should make sure that *plenty* of training opportunities are offered. 

Everyone in the practice should get enough training, specialized to their function, and everyone should be able to practice before the software is turned on. And everyone in the practice should give the system a test run with simulated  patients before go-live, he advises. Why? Well, aside from the obvious need to be oriented, there’s no such thing as a no-brainer EMR, he says. “This might make some UI/UX people cringe, but I’m going to say it: We can’t design an EMR solution that is totally obvious and requires no training and no practice,” he argues.

Getting the core EMR workflow to a level that’s comfortable to physicians is obviously of tremendous importance. But it’s not just a matter of getting physicians to a point where they can function. Practices will never be able to leverage the EMR to take care to the next level if they’re struggling to cope with the basics — and that’d be a real shame.

EMR Costs Outweigh Benefits, Physicians Say

Posted on August 21, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Nobody likes paying for something that’s expensive but not that valuable. But that’s the position many physicians feel they’re in when they buy an EMR, FierceHealthIT reports.

A new study by athenahealth concludes that while physicians do feel EMRs deliver benefits, the expense they have to take on outweigh the benefits EMRs deliver. The EMR vendor surveyed 1,200 physicians, 70 percent specialists and 30 percent primary care doctors to learn more about their attitudes toward EMRs, FHIT said.

The study wasn’t all bad news for EMR use. Thirty-eight percent of doctors had a “somewhat favorable” opinion, and 31 percent had a “very favorable” opinion of EMRs. That being said, 51 percent of responding physicians said that the financial benefits of EMRs don’t outweigh the cost, athenahealth found.

The study found that physicians were more familiar with EMRs than they were when athenahealth did its 2012 Physician Sentiment Index. But doctors’ willingness to buy an EMR  has actually fallen, probably because those who haven’t done it at this late date are particularly resistant. Meanwhile, one thing that hasn’t changed since last year is that doctors don’t think EMRs are made with their practice needs in mind.

Sadly, these results aren’t much of a surprise. While some doctors are adapting to their EMR installation, they’re still struggling with clunky interfaces and questionable vendor support.  Some practices have spent years waiting for their pre-EMR productivity to come back, and have found that it just isn’t happening.

But here and there there are some signs that vendors are “getting it.” For example, I really liked a story John wrote about how EMR vendor Elation requires programmers to shadow a physician as part of the hiring process. To my mind, this kind of thinking is far more likely to bear fruit than the existing system, which puts programmers at a considerable remove from their product’s end users.

The truth is, we’re never going to reach the point where all physicians are EMR boosters, but it’d be nice if we at least reached a point where most saw EMRs as being worth the (big) pricetag.

Cutting Down On EMR Implementation Struggles

Posted on August 14, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

In blogs like this one, we spend a lot of time talking about the frustrations doctors face when adapting to use of an EMR. But what if there were ways EMR implementations could be less painful for doctors (and their staff)? According to Dike Drummond, MD, there’s three major ways to minimize the pain and improve the process of putting an EMR in place in a medical practice.

* Change your attitude

According to Drummond, doctors often start out hating EMR technology and resisting the idea it could ever be helpful. “We treat the computer and the programs as if they rose from the very fires of hell to torment us,” Drummond notes. As a result, physicians fail to embrace the technology and never learn how to use it well, leading to more unhappiness, he suggests.

Instead of being angry and frustrated, set yourself a goal of becoming a power user, Drummond advises his colleagues. Take all vendor training twice, and have your nurse and receptionist do so too; customize your EMR to offer the most personalized and elegant experience possible, including automating any repeat keystrokes; and sit and watch over the shoulder of well-versed colleagues to see what existing power users do. “Just one tip from a power user colleague can make a huge difference in each patient encounter,” he says.

* Don’t force paper and EMR to compete

Too often, medical practices overlay new documentation requirements for their EMR on top of their paper chart patient flow process, and results are usually pretty ugly, Drummond warns. Doing so “sets up a Death Match between your old flow systems and your new EHR,” he says.

The better strategy is find ways to integrate the two processes, he  suggests. It’s much better to find ways to alter the way you see patients so the EMR documentation gets built into your patient flow.  Refusing to accept this makes no sense, he argues.

Leverage your team

Doctors are used to being the one who steps out in front and leads the team, but in this case, it’s important for doctors to dig in and take advantage of the insights their team can offer.  Doctors should get everyone’s ideas on how to refine workflow through powerful brainstorming sessions.

To further the process, Drummond recommends doctors ask open-ended questions such as the following:

~  What do you see me doing that I can stop – or  you can do better?
~  What ideas do you have on how we can do things differently to make documentation easier?
~  How can we share the charting activities more effectively?

Drummond’s points are well-taken, but I’d go even further. Doctors don’t need to just adapt to an EMR and tailor it to their needs, they have to embrace digital tools — from smartphones and tablets to patient portals and e-mail — if they’re going to survive the next wave of medical practice.  But for starters, it certainly makes sense to stop hating on EMRs and learn how to make them work as a supportive tool. The advent of EMRs is inevitable, so why fight?

US Lags Behind On Physician EMR Use

Posted on February 20, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

US doctors are far behind most of their counterparts in Europe and Australia when it comes to EMR adoption, according to a new study by The Commonwealth Fund.

To get a sense of EMR adoption internationally, the Fund surveyed almost 9,800 primary care physicians representing 11 countries.  The results: the U.S. still  has a ways to go to catch up with peers in other developed nations.

True, U.S. doctors’ uptake of health IT has gone up dramatically, from 46 percent using an EMR in 2009 to 69 percent in 2012, the study found.

That being said, doctors in such countries as the Netherlands, Norway, New Zealand, the U.K., Australia and Sweden all reported EMR usage rates above 88 percent in 2012.  The country with the lowest adoption rate was Switzerland, which trailed all countries in the survey with a 41 percent EMR uptake rate by physicians in 2012.

As for sophisticated usage of EMRs, defined by the Fund as using at least two electronic functions such as order entry management, generating patient information, generating panel information or clinical decision support, the U.S. didn’t make it onto the list of power users. Only the U.K., Australia and the Netherlands had more than 50 percent of doctors who did so.

Despite the gap in usage between other nations and the U.S., I thought the nearly 70 percent rate of primary care usage was a very positive sign.  I don’t know if this jump is 100 percent attributable to Meaningful Use — I believe PCPs see the writing on the wall and will go with EMRs to manage medical home functions regardless — but either way, it’s a sign that changes major and permanent have happened among the primary care flock.

Still, what really matters isn’t just how many PCPs have bought an EMR. What I’d like to know is how many of those 70 percent are tackling Meaningful Use requirements effectively, and how many are still stymied. If I find that data you can be sure I’ll share it here!

Consumers Hungry For Online Health Data Access

Posted on September 24, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

We may be at a major tipping point, folks. It seems that consumers are becoming eager to interact with both their doctors and their health data online, after years of fear and disinterest.  In fact, it seems that doctors  may be lagging behind.

A new survey from Optum Institute, a part of health insurer UnitedHealth’s Optum division, took a look at attitudes across several major stakeholder groups, including 1,000 physicians, 2,870 U.S. adults and 400 U.S. executives.

Optum found that three out of four patients were interested in accessing their health records online through EMRs, and more th an 60 percent wanted to connect with doctors via e-mail or other Internet vehicles.

And that’s not all. According a summary of the study in MedCityNews:

  • 76 percent of patients are willing to go online to view test results
  • 65 percent want appointment reminders via email
  • 62 percent of patients want to communicate online with their primary care physician

Meanwhile, physicians don’t seem to be keeping up. Only 40 percent of physicians said they had the ability to allow patient EMR access or communicate securely via the Internet.

Why such a gap? Apparently, many of the doctors Optum surveyed have only basic EMRs in place which don’t support patient data access or communication.  For example, only 46 percent of physicians’ EMRs offer patient-specific information to help them make decisions and manage their health.

It’s hard to tell from a survey like this whether patients merely like the idea of greater connectivity, or are ready to insist that their doctors get on board.  So I wouldn’t go out on a limb at this point and suggest that doctors will lose patients if they don’t get their EMRs souped up quickly.

This does suggest, however, that when physicians make patient data access easier and begin to communicate online, they’ll certainly make some new fans.

One ED Doctor’s View on EHR: A “Certified Nightmare”

Posted on February 10, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

I’ve written more posts than most about doctors and the EMRs they love to hate. But too often, observers like myself are forced to share stats from research organizations or (potentially suspect) ratings by groups like KLAS that poll doctors. Not only are stats a bit sterile, they gloss over some of the idiosyncratic issues doctors face when they take on an EMR.

This time, I had the pleasure of a heart to heart with an ED physician. I got more out of our brief conversation than I have in months of writing up survey “results” from interested parties.

The physician, a left-coaster who works with a large non-profit chain, spent a bit of his time telling me about his experiences with his EHR, which is installed in hospitals where he works.

His conclusion:  his EHR deserves the “Certified Nightmare” nickname it’s won among the medical staff.  From what he says, the EHR installation he’s dealing is way too hard to use.  To him, the user interface imposes a nasty “click burden” that slows him down needlessly.

Before you leap to the conclusion that he’s a Luddite, know that our friendly ED doc is completely paperless at home and that this EHR isn’t his first EHR.  He’s actually pretty fluent with technical stuff.

So I have to believe him when he says that the EMRs he’s looked at are clumsy as heck. “The height of EMR design seems to be Microsoft Outlook 2003,” he says. I wish he was wrong!

When Physicians Own Practice, EMR Implementation Feels Tougher

Posted on January 30, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Here’s an EMR adoption study which interested me largely because it runs counter to what I would have predicted.  The study, which surveyed physicians pre- and post- EMR implementation, found that doctors who owned a stake in their practice found their rollout to be tougher than physicians who didn’t have a stake.

I don’t know about you, but I would have assumed that the folks with more control — the owners — would have found it easier than those who have to adapt to the decisions others make.  But it seems that physician-owners simply feel the pain of change more acutely.

To conduct the study, which was published last week in the Journal of the American Medical Informatics Association,  researchers surveyed 156 physicians working with the Massachusetts eHealth Collaborative.  The surveys included a pre-implementation questionnaire  in 2005 and a post-implementation questionnaire in 2009.

Thirty-five percent of doctors who responded reported that implementation was very difficult, 54 percent said it was somewhat difficult and 12 percent not difficult. Those numbers square pretty well with what I’ve seen elsewhere. The twist here was that 38 percent of physicians with full or partial ownership stakes in their practices voted “very difficult,” versus 27 percent of non-owners. That surprised me. After all, aren’t most of the complaints coming from doctors who try to use the new systems?

According to Marshall Fleurant, MD, one of the study’s authors, the owners “probably experienced more underlying challenges associated with EHR implementation and workflow transformation” given their broader operational responsibilities.

While this study is interesting, it’s hardly the last word. Teasing out just which factors predict how doctors will react to EMR implementation, much less what it takes to support them, is still a new science.  But it never hurts to bear in mind that physicians making critical management decisions get support, too.