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.
First steps
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.
The Olympics always inspire me. They are one of most fantastic human events to witness, including the obvious sportsmanship; athletes overcoming obstacles; the sheer passion displayed by those competing in the field; the pain and joy of the athletes; shots of their family’s responses to the competition; and the personal stories and exposition about overcoming the odds.
Despite the haul of medals taken by the likes of swimmers Michael Phelps and Missy Franklin, the U.S. women’s gold in gymnastics and Serena Williams in tennis, other Olympic contributors will leave London without any hardware, but perhaps having just as much impact.
Healthcare technology continues to invade nearly every aspect of life, and the Olympics are not immune. One of the most notable appearances of HIT in the games has been by GE Healthcare. Actually, from my recollection, GE has been the only game in town during the greatest human competition on the planet.
What GE has done so well during the games is connect its products with consumers. Through a series of informative commercials, those of us on the sidelines have been able to learn how GE’s systems help keep the games clean, how they help identify and localize athletes’ injuries and potentially help treat injuries more quickly, and finally, how the systems actually help us in our lives anywhere we may be.
For example, we are also able to see how GE’s healthcare technology is being used to change lives, as is the case of its commercial about the technology serving an East London hospital’s pediatrics unit.
The stories featured in GE’s commercials are compelling for a couple of reasons, primarily because GE is the only technology vendor talking about how its products change the lives of real patients, but also because GE is taking the healthcare technology conversation to people who never would have otherwise engaged or thought about technology in healthcare without the commercials.
Consumers are not often engaged in conversations about the benefits of the machines and software they encounter during trips to the hospital or while meeting an iPad screen in their physician’s office.
Most patients have no idea what the letters “EHR” stand for. Those of us in healthcare technology seem to forget that; we pollute our own well, if you will. We get so enamored with the industry, its terms, its regulations and its advancements that we forget there is a whole world out there, that we eventually must try to sell to, that doesn’t know the first thing about technology or its purpose in healthcare.
Prior to my joining the EHR vendor space, I only knew things like, “That big tube thingy take pictures of my insides,” and “The jumping green line on the electronic graph means my heart works …”
But, those of us in the HIT community like to talk technology, and if we can’t find someone in the real world to listen, we talk to ourselves, which brings me back to GE.
If for no other reason than to educate consumers of the importance of healthcare technology and how it can impact something as mainstream as the Olympics, the company at least brought the conversation to the public and met consumers in their world rather than simply ignoring it like so many others, and that’s admirable.
Another day, another EHR survey, and once again it’s about the security of information contained in electronic health records.
Apparently, according to this latest survey, more needs to be done to educate patient consumers of the value of the healthcare technology they encounter in their physician’s offices even though more than 50 percent of respondents said they feel EHRs are better than paper charts. Specifically, in this survey patients feel their personal information contained in the EHR is vulnerable to security breaches or hackers.
The data captured in this survey is not surprising, nor is it anything new. In fact, the following statement came from an April 2011 survey I administered for a major healthcare software vendor and announced to the press:
“While both physicians and patients believe that EHR will help improve the quality of healthcare, both groups have concerns about privacy and the security of EHR.” – April 26, 2011.
Though many people think the burden of educating the public about the benefit of EHRs should be placed on physicians, I disagree with this stance.
Physicians, frankly, are consumers of EHRs, just as patients are. It’s an unfair burden to put a group of consumers in the position of advocates for products they pay to use. In what other commercial industry do the manufacturers and retailers of products leave the education of the product to consumer? Correct me if I’m wrong, but I can’t think of any.
The burden of educating consumers about the value and importance of EHRs should fall to the EHR vendors. After all, the vendors are the experts of their products’ capabilities, not the physicians. Automatically electing physicians into this role is unfair.
When I represented an EHR vendor, we brought our message to physicians and patients. Get patients to realize the value of EHRs and you drive them to persuade their physicians to adopt the systems. Our stance meant we held ourselves responsible for educating the market about our EHRs’ capabilities. We didn’t feel that it was right to put our physician clients in the position of becoming product advocates unless they wanted to be. Advocating our products was our job.
As patients become more familiar with EHRs, they will fear them less, just as happened with online banking and shopping. Familiarity and comfort with these systems have changed and so have consumers’ perception of them; the same will ultimately happen for EHRs.