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Listen to the Local Tribal Medicine of a Practice During an EMR Implementation

Posted on August 16, 2011 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.

At the recent Health Tech Next Generation conference that I attended, I heard someone refer to the “local tribal medicine” practices that are found in a practice.

I found the description incredibly intriguing and descriptive. It’s an incredibly apt description of many of the practices and norms that exist in a medical practice. Each practice has created what becomes an almost tribal mentality when it comes to people’s passion for existing workflows and processes. [It’s worth clarifying that it’s tribal as far as people’s passion for doing the workflow. Not because the practices and workflows themselves are tribal.]

I guess this is a natural thing that happens not only in medical practices, but throughout life. We grow accustom to certain processes and practices and so they start to feel really comfortable. Changing them can throw people for a loop even if you exhibit incredible care in the process.

I was recently asked by a reader whether I thought it was better for EHR vendors to look at changing the current operations to match the EHR workflow or whether it was better for EHR vendors to adapt to the current clinic workflow. Here was my response:

It’s an interesting dynamic. Part of it depends on the type of clinic that you’re dealing with. Sometimes a clinic has such terrible workflows that they need to be fixed before you apply an EMR. Otherwise, it will exacerbate the clinical workflow problems and cause some real pain.

However, I generally think it’s best to try and mimic the current process as much as possible when first implementing an EMR. Point being that you should cause as little disruption as possible. Although, it’s best when there’s some flexibility with this approach. Some things are possible in the electronic world that weren’t possible in the paper world and so there’s no reason to delay implementing those benefits when they’re pretty obvious.

Then, I suggest taking a look at the EHR system and how it’s working about a month (sometimes even a bit sooner) after implementation. At this point the clinic is proficient enough to talk about all the EMR features they were too overwhelmed to implement at the beginning.

Then, 9 months to a year out you can do another review to see what processes would be more efficient or could leverage technology better than you’re doing already. I’ve found that this review is when doctors really start to love their EHR and really start to see the value of using an EHR in their clinic.

In summary, I agree with modeling the current clinical workflow as much as possible to start, unless the practice is a mess. Then, I suggest evaluating those clinical workflows after the clinic has experience using it.

I’d love to hear your thoughts. How do you deal with the local tribal workflow of a practice? Do you want to change them during the EHR implementation or wait to make the changes?

EMR Should Make it Easy to Do the Right Thing and Hard to Do the Wrong Thing

Posted on 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.

There’s a really good article by Paul Cerrato on Information Week which tells the story of how a flawed EHR could threaten a patient. While I can’t say I agree completely that the EHR was the cause of the issue described in the article, I do see how an EHR could have possibly prevented the issue if it had been used right.

The article offers the following conclusion:

They hope that these measures will in fact make it “easy for clinicians to do the right thing and hard for them to do the wrong thing.” Among their suggestions:
— Establish an electronic link between operative notes and the EHR problem lists. Doing so would automatically insert “splenectomy” in the latter.
— Use billing data to identify patients who have had the surgery and let the billing data “talk” to the physician through the EHR system, prompting the physician to add that fact to the problem list.

I don’t think these electronic fixes are enough. The real solution is one that nobody in the healthcare reform camp wants to hear: Short of implanting a microchip in every doctor’s head, the simple truth is each clinician needs to see fewer patients and spend more than the typical eight minutes with each of them. And they need more time to manage all the thousands of tasks they have to perform daily. Obviously, this isn’t going to happen anytime soon. But that doesn’t make it any less true.

Those are some good suggestions. Of course, the first suggestions all focus on getting the right information into the EHR so that the doctors have that information when they’re treating the patient. This is a challenge that is really eternal. I do like some of the things they mention. Some of which are already possible.

The last suggestion is a hard pill for healthcare to swallow. More time with patients, in our current reimbursement model, translates to lower pay.

Electronic Medical Records Lost Using External Hard Drive

Posted on I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

I hate to call anyone stupid, but reading stories like Hospital Reports a Possible Data Loss really steams my Chinese dumplings.  According to the post, a doctor who works at two facilities, including the famous Harvard’s Brigham and Women’s hospital (of NOVA fame) walked out carrying a hard drive with over 600 patients’ personal, private medical records and then “lost” it on a trip to Mexico.  How could anyone commit or sanction such a risky action as walking out of a medical facility while hand-carrying an unprotected copy of so many people’s medical records in electronic form?!  And you gotta love that the records ended up in freakin’ Mexico of all places.  Whoever the legendary doctor was — who remains nameless — couldn’t have done a better job, short of sending the records to Al-Qaeda.  Can you imagine?!  Ugh…

You know what the answer to this is?  It’s quite simple — don’t store records on removable hardware. With the Cloud in place, I dream of the day when it’s mandated by law that health records cannot be stored on portable hardware.  We have so many brilliant companies using the latest SaaS technology that I really scratch my head wondering why this isn’t the default choice for all EMR and EHR systems.  There is little reason that the above disaster should still be allowed to happen in 2011.

Rather interestingly, and yet again, this is another example of data theft of patient records that was NOT electronic theft.  No usernames and passwords were hacked to get at the information.  It’s was just a plain, simple (at least as far as anyone knows) dumb-luck loss.  Another shining and yet pitiful  example of why I believe that records are far safer on the web and in the Cloud than in someone’s portable hard drive or laptop.  Do we really need to start anti-theft pad-locking and chaining hardware in place at medical facilities?

On another note, I’d love to have been the fly on the wall when the doctor was asked what happened that encouraged him or her to walk out with it.  Just how common is it?

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.