When someone says, “It’s just like riding a bike,” they typically mean that once you learn how to do a certain thing, you never forget. There’s something about the task or the ability of your body and mind to remember how to effortlessly accomplish the goal that just brings it back.
The same can be said for breathing; perhaps even driving or swimming.
Okay, point made.
But, remove the training, the time spent rehearsing or the practice attempts (you know, the fall on your head and the scars on your knees) and the whole process begins to make a lot less sense than it would had you put in the time to understand how to accomplish said task.
In fact, in the example of the bike, without the practice many never get to experience the exhilaration of reaching the peak of the hill after fiercely pumping on the pedal and finally zipping like a bullet train down the other side. In that instant of wind-rushing joy, all the hard work on the first half of the hill was worth the effort of being able to experience the second half of the hill.
I can’t imagine life without having learned how to ride a bike, or learning how to disappear into the pages of a favorite book because I knew how to read. Frankly, I can probably say the same thing about a few pieces of technology and software that I have been trained to use or that I have taught myself to use. Had I not learned how to use them properly, life wouldn’t be so rich.
Perhaps electronic health records don’t fall into the category of technology that enriches users’ lives if used properly, but there’s apparently a connection between the level of experience one has when working with the systems and the success they’ll have using them to track health outcomes and build efficient practices if they have received proper training of the systems.
According to AmericanEHR Partners, the results of a study it issued shows that user satisfaction was lower for clinicians that used an EHR but received less training than their counterparts who received more training of the systems.
Essentially, the more training and experience using the systems the more likely users are to get more out of the systems. Likewise, clinicians who received less training of the systems perceived their experiences with systems as less than positive.
According the study, five findings were discovered, none of them all that shocking, but certainly very telling.
AmericanEHR Partners found that the more training a survey respondent had with the EHR, the happier the respondent was. Secondly, three to five days of training on the EHR was typically required to achieve the highest level of satisfaction. Fewer than half of those surveyed said they received at least three days of training. The report’s other findings suggest more training leads to happier users.
In addition, according to the finding, those who had a hand in selecting the EHR were generally happier when using it than those who did not help select it.
So, there are some obvious questions here, which Steve Ferguson of Hello Health asks pointedly in his blog post on the same topic. In summary, Ferguson asks: are doctors not getting sufficient training? Why? Do vendors not offer enough training? Is it too expensive? Is the doctor at fault?
Well said; questions deserving of answers.
In some cases, though, no one is really at fault. Vendors, looking to finalize a sale add the fewest number of training hours to the deal so as not to scare new clients away. Training hours are expensive and typically not a free service provided by the vendor. The number of training hours vendors require their clients to buy have been know to cost vendors some deals. Too many training hours can cause some practice leaders to run.
In some cases, there’s often not a lot of margin in selling the EHR systems. Some vendors have even given them away to lure customers.
For vendors, the EHRs are a lot like gasoline at gas stations. The stations make next to nothing by selling the gas; it’s all the convenience store items you purchase while you’re filling up that keeps them in the cash. Same can be said for movie theaters. Theaters make little profit on the movie tickets; their dough is made selling you candies, popcorn and Cokes.
The point is that practice leaders are often scared by the often high prices of vendor’s training hours. Vendors sell systems so they can lock in lucrative annual maintenance and service agreements. They’ll forgo the training hours to close a deal to get to the monthly or annual client stipends.
Practice leaders are sometimes like moviegoers who buy the ticket, but bring their own sandwiches and sodas from home. They think they can get by on their own or will ask for free assistance from colleagues using similar systems.
In the end, it seems quite a few folks are standing around looking at the bike rather than getting on it and taking it for a spin, even though the practice and the inevitable falls is where the real value is at.
Given the increasing popularity of mobile devices that continue to proliferate all areas of our personal and professional lives, clearly personal devices are going to show up in business settings and will be used to disseminate information with internal and external stakeholders.
Even if not an official piece of technology authorized for use in the workplace, their ease of use and availability make them attractive and affordable tools in the professional setting. Though most personal mobile devices not provided by an employer are allowed by employers because organizational leadership believes they lead to more productive employees who are “always on.”
Healthcare is no different. Mobile devices allow physicians to stay connected to their practices, like employees of all other businesses, and where available (as in, practices with systems that support mobile integration) connected devices allow care to be virtually administered from nearly anywhere. In the very least, notes and patient records can be reviewed while the care giver is out of the office or on call giving said care giver a head start on the case should a call come in.
On the other hand, savvy practices are realizing that some patients understand the value of mobile health. Practices are encouraging their employees to interact with patients using portable devices in the care setting. Patients who value mobile technology consider their providers innovative and ahead of the proverbial curve. Sometimes personal mobile devices may be used to accomplish this goal.
However, there are clearly inherent risks involved with blindly and openly accepting the use of personal devices in the workplace that many small businesses simply choose to ignore or overlook. Not because they feel invincible, but most likely because they just don’t know or understand the risks.
Jerry Irvine, CIO of Prescient Solutions — an IT consultancy — points out in a recent editorial for Firmology.com that the most prevalent security risk of mobile devices is that they will be lost or stolen.
According to Irvine, if a smart phone, for example, is stolen, all of the information on it is available to whoever holds it. In most cases, the personal phones don’t have identity-related security benefits to protect the information meaning all personal and business information can be accessed.
As Neil Versel tells in his recent piece, the devices, at some point will go missing. When they do, most affected organizations have little or no plan to prepare for the possibility that the information will be used maliciously. The obvious risk here, in healthcare, is the exposure of patient’s personal health information, cases we hear lots about when they occur.
Offering advice to businesses without a BYOD policy, Irvine provides a nice succinct list of musts that organizations allowing employees to BYOD must consider. Picking some of the high points here, you can see the complete list at the link above.
First off, Irvine suggests requiring and maintaining complex passwords to access the devices.
Next, create a separate encrypted container for business applications and data and don’t allow the same email application to access both personal and business emails.
Set up a registration and provisioning system for the devices that allows for monitoring, remote application installation, locating and wiping of company data. Irvine says, “Use the system to remotely install all company applications as well as mobile device systems updates, patches and security fixes.”
Also, make sure to install antivirus and malicious application scanning solutions keep the devices clean, and disable its ability to access public Wi-Fi networks. Hackers can pirate networks and surf for information though unprotected devices of unsuspecting users. “Allow only known secure networks to include the user’s home network and the company network,” Irvine says.
Perhaps one of the most important steps is to require that all maintenance, updates and disposal of devices be done by the company or authorized vendors who follow specific security requirements. More information than you’d like to think gets swiped while your device is in the shop and you never know.
Finally, don’t allow enterprise data to exist on a personal device, and educate all users on the secure appropriate use of mobile devices. Once you’ve done so, get them to acknowledge and sign an appropriate usage policy.
These steps may not protect you from every incident, but they do create a foundation for what may be an otherwise unscripted and unregulated program. And, putting these steps in place lets your employees know you encourage an environment where initiative and innovation are accepted, and perhaps even rewarded.
The adoption of electronic health records continues as more physicians and practice leaders either realize the benefit of the technology or chase meaningful use in an effort to secure some cash or to avoid the soon-to-be enforced penalties for those without the systems.
However, adoption of the systems isn’t without its roadblocks nor is it as simple as plugging and playing as some might like us to believe.
In an insightful entry featured on EHR Intelligence, Dr. Kyle Murphy nicely summarizes what he labels as the top 10 reasons EHR adoptions stall, according to interviews and conversations he’s had with other physicians.
Some of the reasons cited are what we might expect. For example, at the top of his list is cost. Few can afford the cash required and the initial investment. Practice leaders know that to do it right, they have to buy the right system, as well the training, support and other required bells and whistles.
Two and three on the list are time and preparation, respectively. Typically, implementing an EHR takes a good deal of time and a great deal of preparation. Without the proper commitment, neither will come out right, which can result in less than desirable outcomes for practices.
According to Murphy, practices fear the downtime that can come with an implementation and they know that any good transformation requires total buy in from everyone at the practice. Perhaps the top concern for physicians, concerns that I’ve heard personally, has to do with the EHR implementation preparation.
Next, at No. 4 on the list, is “rollout strategy.” Ah, the choices: to implement all at once or one piece at a time. To each his or her own, but the decision remains and it’s a hard one for many to make while remaining un-conflicted.
At No. 5, is availability of vendors, or lack there of. More specifically, he recommends taking greater ownership of the process and not giving every crucial part of it to your vendor partner. Like everyone else, they are taxed and their resources spent, especially now as the rush to get in on full meaningful use reimbursements is upon us.
At six and seven are training and communication. Do away with one and you’ll likely do away with the other.
Interoperability comes in at No. 8. The system must work with the practice’s other systems. They’ve got to speak the same language and work together. Easier said than done, but at the heart of it, practice leaders are asking, “Can’t we all just get along?”
Skipping ahead to No. 10, data migration rounds out the list. The system, according to Murphy, must do more than its paper-based predecessor. It has to do more than replicate the past, but help power the future.
Perhaps the most important, and somewhat obvious, hurdle practices face, though, lies at the heart of the practice: its culture.
Culture, at No. 9, truly affects every aspect of the implementation. For example, if the culture of the practice is one that embraces change or technology, there’s a greater likelihood that finding the cash to make the investment will happen. Likewise, preparing for the change and developing a rollout strategy will seem much easier with buy in versus having to fight most of the employees who have their heels buried in the sand in resistance to the change.
Finally, with the right culture in place the practice is much more likely to get the most out of its training, even if it’s only a small amount, because there is more acceptance and will to learn on the practice employee’s part. They are more likely to communicate with all partners – vendors, consultants, even patients – because they want to ensure the greatest, most successful process from start to finish.
When the culture of a practice is one of a winner, the list of hurdles faced during this or any other change is greatly reduced and nearly everything, at that point, can be accomplished.
The adoption and mainstreaming of electronic health records continues to face hurdles, even in the least likely of places: teaching hospitals and residency programs. Apparently, even though medical students are using EHRs at the highest levels ever, only a small portion of those students are actually able to write notes or fully access the systems.
According to new studies published by Teaching and Learning in Medicine, researchers “found that 64 percent of the medical school programs allowed students to use their EHRs, but only two thirds of those allowed the students to write notes in them.”
The irony here seems to be that most, if not all, of the residents entering practice after school will either implement EHRs on their own, if they start their own practices, or will seek practices with the latest technology, including EHRs. Certainly, practices with paper-based systems will find it hard to retain and attract new talent to their practices if they don’t employ technology, such as an electronic health record or mobile devices.
With this in mind, one would think that teaching and residency programs would encourage the use of the systems if for no other reason than to attract the best talent to their programs, let alone to ensure that the doctors entering the commercial sector and serving patients are best equipped to provide the best care in the most efficient manner. Unfortunately, given these new findings, it appears student physicians will be forced to potentially deal with not only learning the ropes of the business world – payroll, insurance, employment laws – but also with how to navigate learning technologies they have rarely seen or worked with.
Regarding the limited use of the EHRs in the hospital setting, authors of the study sum up the reason for lack of participation by the students pretty well — Medicare rules. It seems Medicare doesn’t allow physicians to rely on trainee’s EHR notes in care setting.
Odd, given the fact that the student “trainee” is allowed to save lives in the ER, practice care alongside a staff physician throughout the hospital, is most likely months or so from entering professional practice, but for some reason, said trainee’s notes can’t be relied upon for accuracy and integrity, at least as far as Medicare is concerned.
This, frankly, seems like another example of a flawed system. Training programs should be opening up their systems to students, if not in a live setting then at least in a closed classroom-type environment so that they can get they hands on the systems and be more adept at using them once they move onto professional careers.
Perhaps EHR vendors should partner with hospitals to initiate training programs or create partnerships that allow for classroom-based training sessions where the students can use a system for several weeks or months to see how they work and can benefit the provider. The students are, after all, still students and should be given every opportunity to learn. And, participating vendors could go a long way toward getting their products into the good graces of thousands of new physicians who are entering commercial practice and likely in need of an EHR and other technology solutions.
Those who conceived and brought meaningful use to life can apparently chalk up another victory, according to a new survey conducted by Accenture.
As told by For the Record, patients overwhelming want access not only to their medical records and personal health information through connected devices (mobile or otherwise), but they also want direct electronic access to their physicians.
By “access to their physicians,” I mean they want to interact with their caregivers through web portals and email. Actually, respondents of this survey (88 percent) said they want to receive email appointment reminders from their physicians, while 76 percent of survey takers said they want the option of email consultations directly with their physicians.
Enter the patient portal. Secure, web-based portals that, for most EHR systems, allow patients the opportunity to interact directly with their physicians, view lab results (in certain non-overly sensitive cases), schedule appointments and make payments, among other things. The same patient portals that are required ingredients of meaningful use certified EHR systems.
Despite the arguments over the benefits or lack thereof of meaningful use, the requirement that EHRs contain patient portals so patients and their caregivers can interact with each other seems to be giving the patients exactly what they want.
In the very least, at least according to the results of this survey, patients are more likely to engage with physicians and take greater ownership of their care if they are simply allowed to communicate with their doctors electronically.
And given the seemingly current lack of patient engagement that’s prevalent in our healthcare community, anything that sparks interest in patients should be considered a welcome sign to every healthcare professional. After all, patient engagement will continue to become more popular as consumers take greater ownership of their care as they discover that their healthcare providers are actually easier to access because of electronic health records and patient portals.
Unfortunately, however, the average patient doesn’t know whether his physician offers a practice portal or if the practice uses an EHR as fewer than half of the 1,100 survey participants in the Accenture study didn’t know whether they had access to such systems.
Despite this minor detail, there’s plenty in this survey to celebrate. Specifically, patients clearly want to access their health records electronically and they want to be able to connect with their physicians when they want or need through any connected device wherever they are in the world.
The other good news here, for practice professionals anyway, is that there is plenty of room for and an abundance of opportunity to educate patients about a practice’s internal technology systems. Patients clearly want to know more about the technology their physicians are using in their practices.
If you don’t currently have these systems in place, engaging patients is a great way to find out what they might like to see from you in the future and, if nothing else, the information gathered helps you build and develop your practice and tailor it to your customer’s needs.
In conflicting reports recently released by two separate healthcare publications, the benefits and success of meaningfully using EHRs is debated with one publication citing its success while the other notes EHRs alone do not improve care, though, if certain steps are taken by providers, outcomes could be better.
The conflicting data from each report really comes as no surprise. What is a bit surprising, though, is that each report provides valid and tangible information that seems to support a similar conclusion.
For example, according to Becker’s Spine Review’sarticle featuring the report, “Meaningful Use of Electronic Health Record Systems and Process Quality of Care,” meaningfully using electronic health record improves hospital care quality.
In fact, citing the report again here, “hospitals with primitive or limited IT that upgraded to an EHR system satisfying Stage 1 meaningful use objectives saw a significant improvement in healthcare delivery.”
The study was designed to report whether hospitals that implemented and used EHRs meaningfully actually saw improved healthcare outcomes. Apparently, they did, at least in quality measures for heart attack, heart failure, pneumonia and surgical care infection prevention.
The study’s findings seem to tell a somewhat stunning story, frankly: “Hospitals transitioning to EHR systems to meet the meaningful use Stage 1 requirements saw statistically significant improvements in the outcomes for conditions of heart attack, heart failure and pneumonia. The improvements varied depending on hospital baseline quality performance, with low-quality hospitals seeing the largest improvements in quality.”
So, in other words, healthcare systems implementing EHRs saw the greatest improvement from their previous systems, which I assume is paper.
But wait; let’s not get too far ahead of ourselves. According to The Health Care Blog’s piece “EHR Adoption Alone Does Not Guarantee Quality Care,” adopting a meaningful use EHR system does not automatically improve care. The ability to house the data is important, but it’s obviously just the first step in a long process. Perhaps with some work, desired (but not guaranteed) results may be achieved.
According the authors the THCB piece, to fully engage an EHR in the care process and improve health outcomes, more pre-visit work is needed to understand all of a patient’s potential health needs then care givers must take what’s learned, plant it in the system to better serve the patient in the future. Pretty basic, but true, I assume, since the EHR isn’t going to do it by itself.
The next step, according to the blog, is to encourage practice leaders to sub-categorize patients into groups with like conditions to track their health within the population. This should allow for physicians and practice leaders to see how the health among specific populations of the practice is improving or declining. Again, simple enough, and something easily enough done with virtually any EHR currently on the market.
Other advice offered by the blog’s authors to physicians is to participate in local, national and regional care quality measures and initiatives, and compare best practices and care outcomes with other professionals to continue honing their crafts and learning new initiatives and providing innovate care.
Finally, and most importantly (and I agree with THCB on this one), involve patients in their care. Engage patients from the beginning and draw them into their care plans and they’ll likely engage in their health for life.
So, ultimately, the differing points of view from these two reports seem to support the same argument: meaningfully using an EHR allows for the potential of better healthcare outcomes, but achieving better outcomes doesn’t necessarily come from simply having the system.
Additional work is required to get the most of out of the data that goes into it, even if that means committing more to the actual care process, connecting with peers and colleagues to employ innovation and involving patients to ensure what goes into the EHR is everything it should be: meaningful, useful and helpful.
As in all areas of life, social media also permeates healthcare. As practice leaders, hospitals and facilities, and providers wrestle with strategies for capitalizing on the communication forum, some have found success while others continue to struggle.
For each person that has made the attempt, though, valuable experiences have been gained, some worth sharing.
In the piece, Sevilla offers advice to physicians about the need to engage in regular and ongoing social media activities.
Physicians, he says, must begin to interact with patients and the public through a variety of social channels including blogs for no other reason than because patients are beginning to demand it. Without the outside the office interactions, patients begin to disengage from their physicians and seek alternative sources who are willing to meet them where the live.
Seville offers a few compelling reasons for physicians and their practices to engage socially, including:
Social media allows physicians the opportunity to tell their story – telling your story provides evidence of your experience and helps establish you as a leader in the space. Doing so also helps patient consumers have a reason to “buy in” to your system.
Social media allows you to find a community – by connecting with others, you are able to establish bonds, develop stronger collaboration with peers and bring people together for a unified cause.
Social media allows you to discover your passions outside the practice – social media helps you explore new ventures and avenues for creating relationships and bonds outside of the practice.
Social media leads to free marketing opportunities – social media helps you connect with others, Sevilla said. Those connections mean you are marketing yourself and your practice without having to spend anything but your time.
Social media allows physicians the opportunity to manage their online reputations – conversations are taking place about many of us, physicians or not. If we know what is being said, you can help protect ourselves and your practices.
There are a few things Sevilla fails to mention in the piece, though.
For example, social media is more than about building one’s own brand and developing recognition for one’s own efforts. Engaging in social media is about creating relationships with others; specifically, patients.
As such, when using social media tools in the healthcare setting, you must stay close to your customers. Social media can, and should, be used to generate conversations with the public and build relationships with those you are serving. In doing so, you gain ground in each of the areas Sevilla mentions above.
In addition, physicians and practice leaders may consider using social media as an educational tool for patients. With less than 10 minutes of face time with a physician on average, patients can turn to their social media tools to learn more about a certain procedure, to ask generalized questions or to learn how the practice’s online patient portal, appointment setting or how billing and payment processes work.
Also, consider using your Twitter feed to ask questions of your patients. Conduct informal surveys asking for feedback about visit times, practice hours or services offered. Set up a weekly or monthly lunch-hour Twitter chat where a physician takes generic questions from the public or set aside a week each month to provide health and wellness tips about certain conditions.
The results of these efforts may surprise you. And soon, you’ll discover that conversations on social media are two way rather than one sided. Perhaps you’ll even have your own strategies to share.
In what appears to be an extension of yesterday’s post, today I want to examine some questions posed by Success EHS, which asks, “Should you replace your EHR?”
As you most likely know, most large enterprise ambulatory practices and hospital systems have well-established EHR systems in place. They are clearly recognized as among the early adopters of electronic health records, and, compared to their small counterparts, are also the most likely healthcare facilities to currently be in the market for an alternative EHR.
In the age of meaningful use, in a time where healthcare technology is also known as the electronic health record, the systems are being replaced with great frequency. The why and what fors are pretty simple to figure out if you’re familiar with the technology and the marketplace.
There are several prevailing reasons practices are jumping systems, though. They include (and I’m citing Success EHS here):
• Lack of strong vendor support
• Lagging product development
• Consolidation of disparate solutions
• Systems fail to live up to vendors claims
• EHR hinders efficiency and productivity
Given these hurdles – there may be others, of course – there are several questions practice administration must ask to determine whether it’s time to move.
Some of these questions include (feel free to grab a pen and paper and add to the list):
• Are issues able to be solved through remediation? No? Might be time to hit the road.
• Can the vendor’s technical improvements resolve any issues? If so, you need to ask that fixes be made in a reasonable timeframe. Obviously, telling said vendor that fixes need to be made “ASAP” won’t do; you must be reasonable. Consider negotiating a term of three to six months and get final terms in writing. Anything more than six months and it might be time to pack up and leave.
• Are you partially responsible for the EHR’s issues? If you’re partially or fully at fault for a botched EHR implementation or for poor usage, you owe it to yourself, your staff, your patients and, yes, to your vendor to work out a solution. If you’ve tried every solution and there’s no fix, you may be forced to move on. Some times it’s a matter of agreeing to disagree, let’s just agree on that.
• Do you have an opt-out clause? If so, you may wish to exercise it. If not, you’re going to pay, probably handsomely, to exit stage right.
• Are your current long-term goals going to be met using your current EHR? If not, you need to change your goals or change your system.
• Is your EHR negatively impacting practice efficiency? Success EMS says it best, “An EHR that hampers productivity now will only grow worse as the complexities of health reform initiatives increase in the future.”
If you decide it’s time to implement a new EHR system then it’s time to create an assessment plan. Assessments are designed to answer the “why” of implementing an EHR, and what is working and can be improved by installing one.