In continuing a series based on HealthIT.gov’s “How to Implement an EHR,” now seems like an appropriate time to seek additional insight into how to prioritize your implementation plan and identify critical tasks to perform when putting your system in place.
As the HIT world continues to reel from continuous change – meaningful use stage 2, ICD-10 postponement and mobile health among the biggies – like any commercial market, there’s bound to be some constant ebbs and flows.
Selecting, and changing, an EHR are bound to happen no matter what else is going on in the market. So, though much of the market may be focused on regulation and reform related to EHRs, there are still practices who haven’t yet implemented, and there are practices that are looking to get out of their current solutions.
According to the Office of the National Coordinator (ONC), “Building an EHR implementation plan becomes critical for identifying the right tasks to perform, the order of those tasks and clear communication of tasks to the entire team involved with the change process.”
Implementing an EHR is really about implementing a change management process: new rules, new ways of doing things and new things to learn. That’s an oversimplification, but it essentially hits the mark.
Setting up an implementation plan (the plan should be in place before the implementation begins) first starts with segmenting tasks into three categories, according to ONC:
What new work tasks/process are you going to start doing?
What work tasks/process are you going to stop doing?
What work tasks/process are you going to sustain?
The three categories help determine the future work environment of the practice; how things will work after the change.
Obviously, if you are moving from an existing EHR, you’re probably going to be more familiar with how things will work once the system is in place, with a few exceptions. However, moving from paper to electronic records means there are going to be a great number of changes that, if not accounted for, may cause some initial hurdles along the way.
Your next steps should include:
Mapping your current workflow and analyzing how you get things done
Mapping how the EHR will affect your workflow, and how you hope it will enable you to perform certain tasks or functions like how you plan for them to create more efficiencies and reduce duplicate processes?
Creating a backup plan to address issues that arise during implementation. This is crucial as issues beyond your control will come up and if you’re not prepared for them, they could derail your process and set you back. Think of worst case scenarios and plan for them to happen then hope for the best. No implementation is ever the same as another; each are there own experiences.
Building a project plan to blueprint the transition then appoint a team member to manage the plan.
Identifying data that must be transferred to the EHR either from paper or from the previous EHR (charts are the most obvious example here)
Finally, find out what can be transferred to the new system like patient demographics and schedules.
Once this point has been reached, you can bring other parties into your plan, like consultants and vendors, to get the plan rolling and potentially start the implementation.
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.
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 taking a look around the HealthIT.gov site recently, I once again stumbled upon its series dedicated to offering practices insight into how to implement an EHR. A several part series, topics included cover what to look for when selecting a product, how to conduct training and, ultimately, how to reach meaningful use.
Given that nearly 50 percent of all practices currently have some sort of EHR, the process for setting up and implementing the systems are becoming more well known; however, having a clear plan and getting a little advice goes a long way.
So, without further ado, the following information is valuable and bears repeating, at least in part, even if you heard some of it before.
When starting an EHR implementation, a practice should assess its wants and needs. Keep in mind that no implementation is going to go completely smoothly (or at least as smoothly as imagined) so it helps to have a plan for what to expect and the plan should include room for error. Figure 10 to 15 percent in added time, resources and staff commitment over and above what you originally plan.
During the assessment, there will be some error and a few hurdles to jump. Don’t allow yourself to be told otherwise. If someone tries to tell you differently, that person does not have your best interest in mind.
If it’s a vendor, run. Do not purchase the product from the company because it’s only the beginning of what’s likely to be a long road of misinformation and false expectations. And no one appreciates being snowed, especially when you’re spending money on something.
Asking yourself questions
During the assessment phase, you also need to determine if you are even ready to implement a system, and if not, what more you need to accomplish. Assessments are designed to answer the “why” of implementing an EHR, and what is working and can be improved by installing one.
According to HealthIT.gov, “practice leadership and staff should consider the practice’s clinical goals, needs, financial and technical readiness as they transition.”
The site provides the following questions that practice leaders should consider during the process:
Are administrative processes organized, efficient and well documented?
Are clinical workflows efficient, clearly mapped out and understood by all staff?
Are data collection and reporting processes well established and documented?
Are staff members computer literate and comfortable with information technology?
Does the practice have access to high-speed Internet connectivity?
Does the practice have access to the financial capital required to purchase new or additional hardware?
Are there clinical priorities or needs that should be addressed?
Does the practice have specialty specific requirements?
What will the future look like?
Next up, it’s time to envision the future. Think about what you want to accomplish with an EHR, and write as part of your plan some things like: how are patients going to benefit, how can the care provided be better and how are providers’ lives going to change?
Finally, set some goals. According to HeathIT.gov, “goals and needs should be documented to help guide decision-making throughout the implementation process. And they may need to be re-assessed throughout the EHR implementation to ensure a smooth transition for the practice and all staff.”
Goals guide an EHR implementation, and are set once an assessment has been completed. As in life, goals provide an achievable end to an arduous task; the medal at the end of the race, if you will.
When developing goals for the implementation forgo conclusions like trying to determine what amount of savings will be created or how much of an increase in the number of patients or revenue will come into the practice. For now, these are intangible and often create a sense of failure if not immediately met after the EHR is “turned on.”
Keep the goals more process oriented and related to practice strategy and team building. For example, what goal do you have for the transition team? Do leaders emerge? Do advocates and coaches come to the forefront of the team that you had not expected? What practice visions are realized? Are you now more technologically savvy and able to attract better talent to the organization?
Perhaps you have business goals (other than the aforementioned money goals). Do you have a stronger business-planning process and clearer organization objectives now?
Does healthcare technology actually interfere with patient care? Apparently so, according to a new study commissioned by athenahealth.
“Overburdened” physicians face pressures from continual government “intervention,” “increased use of and frustration with EHRs” and “administrative burdens.”
According to the study, physicians are disenfranchised.
Why? Well, according to athena’s study, there’s too much change. Perhaps that’s a bit of a blunt summation, but it seems to be the picture the study paints.
Nearly half the physicians interviewed for the study said electronic health records were not designed with the physician in mind while nearly two-thirds said the EHRs take away from their ability to engage with patients.
Some of this is obviously subjective opinion. Of course, there’s really no way to measure whether or not patients feel put off by their doctors entering data during the visit. On the contrary, there are plenty of reports to suggest that patients actually appreciate that doctors use an EHR during the visit.
However, from the eye of the beholder (physicians), they’re the ones sitting in the practice day after day getting a feel for the moods of their patients in the exam room once the keyboard comes out.
Sadly, the conclusion they have come to as a collective population is that EHRs are significantly reducing the quality of care patients receive. Again, this is filled with opinion, but if it’s the mood conveyed, that mood is bound to rub off on the patient population and will affect their perception of the technology, too.
These same physicians – more than 80 percent of physicians in the study – also feel the future of the independent practice is not viable, and more than two thirds feel the quality of care will greatly diminish over the next five years because of all these continuous distractions, including technology’s pervasiveness in the practice space.
This is stark “reality” for the profession from the mouths of its professionals.
Interestingly, in a completely unrelated study by recruiting firm Jackson Healthcare, more than a third of private practitioners say they will quit private practice within the next 10 years because of “declining reimbursement, capitation, and unprofitable practice; business complexities and hassles; overhead and cost of doing business too high.”
Where they’ll likely end up is obvious: in a hospital setting or in a hospital-owned practice. Why leave? They said they fear economic factors facing private practice (the first reason given) and they don’t want to practice in the age of reform (second response), which may be quite difficult given the current climate of healthcare.
What does all of this eye-opening information mean?
Well, it doesn’t bode well for those concerned about the ever increasing shortage of healthcare providers.
Perhaps more troublesome, though, is that no matter how much time is spent educating and informing certain segments of the healthcare population, there are always going to be many who remain unconvinced that technology produces practice efficiencies and helps lead to better care outcomes.
Patient engagement will continue to become more popular as consumers take greater ownership of their care and begin to discover that their health information should actually be easier to access because of electronic health records and patient portals. However, patients must have reason to engage for this trend to become less of a trickle and more of a flood.
Healthcare technology is meant to allow more access to, and increase the availability of, patient’s health information. At least that’s one of the desired outcomes of the push (meaningful use and federal incentives) to lure physicians to adapt the systems.
Sterling Lanier, CEO of Tonic Health, succinctly sums up lack of patient engagement in a recent editorial published by For the Record magazine.
In it, he states that healthcare, like government, is filled with vernacular and jargon – HIEs, EHRs, ACOs, HIT, et al. – and the more these terms continue to be used, the less likely patient consumers are going to interact and engage with the healthcare community, and to take ownership of their own care outcomes.
As Lanier notes, and as I have often thought, to bring patients into the conversation, they have to be treated like consumers and they must have a reason to “buy” into the system. In this case, consumers must “buy” the information given to them. If they buy and own it, they’ll want more of it, or so goes the prevailing thought.
But simply speaking in terms the natives will understand isn’t enough. Consumers need to better understand how the technology they encounter at the doctor’s office helps produce better care outcomes. They may need some education and certainly they need some engagement once the systems are in place and being used during the visit.
Though patients will interact with the EHR less frequently than other technology they encounter, such as the patient portal (which they can actually use and interact with on their own), that doesn’t mean the EHR should be ignored during the interaction or treated as a foreign concept. In most cases, let’s remember, healthcare is actually behind many other consumer markets so consumers are actually more versed in the use and capabilities of similar systems outside their doctor’s office. Besides, we’re like children with devices and must test drive things like smart phones, televisions and computers as we learn to use them; we like to get our hands on the technology to try it out to satisfy our child-like need to see with our hands.
Even though patients can’t “touch” their EHRs, we can watch the information we provide our doctors being entered into the system; we can speak with our caregivers as they toggle and tab; and we can engage clinicians as they review our profiles and medical records. As a patient of a doctor with an EHR, I ask questions about the system: what it does, who makes it, why it was chosen and if it layout closely resembles the clinics’ past paper charts. I feel better about the little details and doing so makes me feel as though my doctor is listening to me during the visit.
Asking me these questions engages me more in my healthcare, and more than likely, engages my doctor in my care and outcomes.