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How To Create Satisfied EMR Users

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.

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.

EMR Costs Outweigh Benefits, Physicians Say

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.

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.

Cutting Down On EMR Implementation Struggles

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?

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.

EMR Value Diminished If Patients Can’t Access Care

A new study from the august Commonwealth Fund has just come out, offering a portrait of primary care practices in ten countries. The study had a lot of interesting data to offer, including news of primary care reforms to meet the needs of aging populations and improve chronic disease care.

One of the key data points drawn from the CF study was that two-thirds of U.S. PCPs reported using EMRs in  2012, up from 46 percent in 2009. That’s obviously a big improvement, though the U.S. still lags behind the U.K.,  New Zealand and Australia in EMR implementations and use of IT generally.

At the same time, it seems that U.S. citizens still face serious financial obstacles in getting primary care. Fifty-nine percent of U.S. physicians surveyed said that their patients often have trouble paying for care. That’s a big contrast with other countries included in the study, including Norway (4 percent), the  U.K. (13 percent) and Switzerland (16 percent). These numbers make sense when you consider that the U.S. is the only country surveyed that doesn’t offer universal health coverage.

Putting aside humanitarian reasons to be troubled by money obstacles to PCP access, there are other issues to consider. To me, the most obvious is the selection bias imposed by financial barriers to care.

Consider one of the big goals a medical home hopes to accomplish, managing chronic conditions effectively across the primary care practice’s population.  PCPs can make great use of an EMR to work on such goals, from issuing reminders to get preventive care to tracking patient progress across different demographics to test the impact of new interventions.

The thing is, the power that is a well-tuned EMR is not at its best if the interventions are mostly aimed at those who fit a certain socio-economic profile.

Admittedly, few small PCPs need to be worried about selection bias from a scientific standpoint, as they’re seldom gunning for the next journal article presentation, but looking at the country as a whole, we’re missing out on the collective learning we can generate with clinical data analytics.  It seems to me that we’re going to have to address this problem directly if we want to leverage EMRs for the greater public good.

November 16, 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.

Consumers Hungry For Online Health Data Access

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.

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.

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

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!

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.

When Physicians Own Practice, EMR Implementation Feels Tougher

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.

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.

The Top Three Things The Mass Media Does To Delay EMR Adoption

Now that the government is pushing EMR use, the mainstream press has begun to report on the issue.

True, some astute editors are beginning to dig in to the problems that matter, such as securing patient data and challenges to getting physicians on board.

But most consumer publications, with their penchant for simplifying and condensing issues, are muddying the waters even further. Here’s some things they’re doing which, I’d argue, are actually slowing down the EMR adoption process:

*  Asking consumers whether they “want” an EMR: Let’s be honest: most consumers have only a vague idea of what an EMR is. You might as well ask them whether they’d like oh, I don’t know, a confoobatron. If they think those confoobatrons are supposed to be the latest thing in medicine, they’ll say sure, I’d want one of those!  In other words, you’re not giving doctors and hospitals real feedback as to how EMRs will foster relationships with their patients. It’s easy for clinicians to write off such responses as bogus and avoid adoption for a while longer.

* Focusing on a few spectacular security breaches: Yes, it’s really unfortunate that hospital staffers stole a peek at some Hollywood celeb’s medical data, or that a stolen laptop stocked with unencrypted data exposed patients at Hospital A to medical ID theft. But in playing up spectacular security breaches, mass media players distract everyone from the real issues. As we all know, most hospitals and doctors have far less glamorous problems to worry about, such as encrypting data, controlling access by role and seeing to it that staff are trained in security policies. But playing up a few disasters — such as stolen laptops or celebrity medical record leaks — makes it sound like security is beyond the reach of your average provider.

* Doing little to examine why physician adoption of EMRs is still low: While you will see the likes of USA Today look at abysmal EMR adoption rates, these stories usually collect a few random interviews with association heads or a random private practitioner and cite a few of their random headaches. These stories don’t dig into the really important issues (such as fear of productivity loss, lack of clinician buy in and techno-phobia) that are stopping the train. While doctors obviously read trade publications like this one, they’re human, and if the USA Today story they skimmed on the train doesn’t address their concerns, it’s easy to stay tuned out on EMRs for a while longer.

OK, maybe I’m being a bit unfair here.  Having been an editor for decades, I know the mass media can’t take the place of blogs like this that focus on serious professional issues. But I still wish that my colleagues in the consumer press would give EMR issues as much serious thought as, say, professional football. Wouldn’t that be refreshing?

June 18, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.