A straightforward piece of news from TEKsystems Healthcare Services, a provider of workforce planning, human capital management and IT services to the healthcare industry, showing the following results a joint survey with HIMSS Analytics regarding health organizations’ readiness pertaining to the implementation of electronic health record (EHR) systems.
According to TEKsystems, the survey shows insights into the status of EHR implementations, the challenges healthcare organizations face and areas of improvement; TEKsystems and HIMSS Analytics surveyed 300 single and multi-hospital organizations and health professionals throughout the United States. Key findings include:
Current State of EHR Implementations
Nearly 39 percent of hospitals have surpassed Stage 4 of the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM).
Currently less than half (43 percent) of integrated delivery systems or single hospital systems have completed their EHR implementation.
Achieving end user adoption
Nearly two-thirds of healthcare professionals (64 percent) believe achieving adoption is a roadblock to a successful EHR implementation.
“Achieving meaningful use and truly improving the quality of patient care can only happen if end users fully adopt a new EHR system in an acceptable timeframe. Organizations expect their people to adapt quickly, yet many do not plan for end user training until late in the effort,” says , TEKsystems vice president of healthcare services. “Upfront training strategy development would allow for the identification of key competencies and performance indicators. As organizations transition from implementation to day-to-day operations, any deficiencies in the ability to meet the targets can be pinpointed to either a specific user group, department or globally as indicated by analytics and aligning remediation accordingly. Developing an effective adoption strategy is a critical step that needs to be detailed earlier in the process and carried throughout the life of the initiative. That includes finding the appropriate resources necessary for building, integrating and conducting the training.”
Bringing in the right people and skills
Sixty-six percent of respondents cite the challenge of finding the right workers with the right skills for the implementation. More than half struggle with finding the right people to build a training program (57 percent) or lead the classroom discussions (53 percent).
“The supply of HIT talent is not keeping pace with the demand – from clinical trainers, builders and consultants to project and program managers. Finding the necessary resources can be a daunting task for many organizations, but one that is essential to achieving a successful EHR implementation,” continues Kriete. “That includes finding the right principal trainers and scaling to meet the overall training and adoption needs.
Conducting an impactful training experience for the end users
According to more than three-quarters of healthcare professionals, results of poor EHR training implementation include: rework (85 percent), lack of applicability to real-world scenarios (84 percent), low levels of user adoption (84 percent), long learning curves (82%) and inability to leverage the system for meaningful use (77 percent).
“The importance of effective training cannot be overlooked. To avoid these outcomes, organizations must proactively build a customized training program that is led by educators with clinical and technical EHR experience. The training cannot simply be ‘off-the-shelf.’ It should align with the overall organizational goals, workflows, technical requirements and end-user job roles” states Kriete. “One method for ensuring a training program is effective and builds confidence within an organization is to engage end users, those using the system on a day-to-day basis, in the development of the curriculum.”
“In addition to leveraging end users in this process, efforts should be taken to combine synchronous and asynchronous learning methods to foster a learning environment that meets the needs of the adult learner and their hectic schedules and a learning environment that is not bound by space or time” says Von Baker, TEKsystems healthcare practice director.
Including end users in the process
Overall, less than half of clinical end-user stakeholders are deemed completely engaged in the program; even the trainers for the new system are not fully engaged, with only 59 percent reporting their trainers are completely engaged in the process.
“This study shows the majority of executives and decision makers are engaged in the implementation process, but unfortunately, this is not the case with end users. Giving end users the opportunity to provide feedback during the development of and during the training boosts their sense of ownership and increases their confidence in the system post-implementation,” comments Baker.
Continuing to support end users after go-live
More than 50 percent of healthcare organizations anticipate end users will need more than six months to adapt to the new system.
“The work does not stop once the implementation is complete. Providing post go-live support is critical to ensure the end users fully adopt the system. Best practice is to create performance support tools for end users to have ready access to how-to reference guides when the needs arise – self service. The right blend of performance support tools depends on the organizations culture, internal drivers (i.e. varied workflows, varied specialties, and geographically dispersed facilities), and available technology. Underestimating the amount and degree of post go-live support can cause a decrease in productivity and performance and increase end-user frustration,” concludes Baker.
About TEKsystems Healthcare Services
TEKsystems Healthcare Services is dedicated to providing workforce planning, human capital management and IT services to the healthcare industry. Utilizing its suite of services, including EHR Implementation Support, ICD-10 Support and Data Services for BI, Reporting and Data Warehousing, they help healthcare organizations accomplish critical initiatives related to meaningful use, compliance, analytics, network transformation and revenue cycle management.
EHR structured data begins to make a play for importance as health IT moves into Stage 2 and we begin to require useful and useable information. It’s not a new topic, but one, much like ICD-10 I suppose, that has had many a practice leader hoping to push off until later.
Unfortunately for many, the days of structured data are upon us. Hoping that the data you dumped into your system when you implemented won’t be a problem for you in the future may now begin to start causing you some nightmares.
For many practices, as they begin to look at their data and hope to find a treasure trove included, they may be surprised to find much of the information worthless, as least when trying to compare to health information as a whole.
Why? Well, according to Computerworld, there’s just not enough EHR structured data. For example, pieces of data like problem lists, medications and allergies are inconsistent between the varying EHRs and the codes are often different between the different products.
Perhaps most importantly, though, is during the initial set up of the EHR. Practices looking to get their systems up and running, they often simply dump data in and move on to the next step of the training process. This, according to Computerworld, means a lack of protocols, standards or proper charting of the data.
As we’re now finally beginning to see is that the data that goes into the EHR must come out in a standardized and useful way so that it can be reported through meaningful use and exchanged through HIEs and electronic health records.
From Computerworld, “EHR structured data is required to aggregate, report and transmit the collection of data at the point of care, it is often perceived by physicians to inhibit their ability to practice medicine and document in a fashion they feel is most effective.”
Again, the lack of proper protocols and creating a culture of success can sink a practice in the long term. Simply dumping the data and letting providers practice as they see fit is a lot like public companies with their eyes on short term, end of the quarter returns rather than trying to build a successful foundation to create a stronger organization even if it means a slower, more steady return on their investment.
In fact, a case might be made that suggests that the loss of productivity physicians face when first learning their EHRs could be related to their use of structured data. Creating a process for them to follow from the beginning will pay huge dividends in the long run. In the near term, though, there will be a minor fall off in productivity.
There are some solutions for streamlining your data structuring process:
Create a committee to police standards to maintain clinical information in your EHR and HIE
Educate physician on the importance of capturing structured data, but allow the some ability to customize how they capture notes, for example
Spread the workload for capturing structured data among your staff and allow physicians the ability to focus on providing care and maximizing their productivity
Prepare your technology solutions for extraction, and utilizing, structured data. An EHR along may not be the only solution you need to get the data you need. Plan ahead and remember that one size fits all rarely does.
Follow these, and perhaps few of your own, and the value of your data will be worth a whole lot more for your organization in the long term than any unstructured attempt you make.
One Texas physician leads a global healthcare mission from Moscow, supporting thousands of poor and underserved Russians, while maintaining a full-time practice in Midland, Texas.
Part 1 of a two-part series.
For more than 10 years, Dr. David DeShan has been traveling between Midland, Texas, and Moscow, Russia. DeShan is a physician and a missionary — serving patients at Midland Women’s Clinic in Texas and providing needed prescriptions, exams or treatment to hundreds of indigenous Russians.
The contrasts between the two worlds in which DeShan lives are stark. Here in the United States, he’s connected to his patients through electronic health records and secure web-based practice portals that allow him to communicate, share records and provide consultative services. Likewise, his patients can connect with him through any web-enabled device from anywhere in the world where there’s an Internet connection. His practice, which is building a new state-of-the art clinic, provides 21st century medical care.
In Russia, he is the president of Agape Unlimited, an international Christian medical mission program. Through Agape he visits people that are often secluded in very remote villages far removed from first-world creature comforts. Sometimes, as part of his medical mission work, he travels days into the lost wilderness of one of the world’s most vast and remote regions.
Four to five times a year he ventures outside of Midland, Texas, for up to four weeks on each trip. The majority of his travels are to Moscow where he oversees the nonprofit and its network of clinics. His involvement with Agape includes both the oversight of the organization in addition to traveling to the countryside to administer medical care. Despite being half way across the world he is able to effectively take care of his patients and colleagues in Texas.
In 2002, when Dr. Deshan first started his missionary work in Russia, he was completely detached from his practice in Texas. Needing to reach his patients, he eventually secured a satellite phone. Today, with the help of his EHR, he is fully connected irrespective of his location. Dr. Deshan has access to patient charts and tracks their progress remotely. Occasionally, he will use the information from the EHR and Skype his clients if a face-to-face conversation is warranted. Either way, when he returns to his patients in Texas, he never misses a step.
“None of what I’m now able to do through the ministry and the practice would have been possible without our EHR,” Dr. DeShan said recently. “I run the ministry over there, provide medical education over there, conduct outreach in Siberia and bring doctors here to the U.S. to train. The EHR really allows me to stay connected, in a fashion not available just a few years ago. It’s nice to have the opportunity to live in two worlds at the same time, and the EHR technology really makes it possible.”
Empowering an impassioned dream
Being a full-time physician and president of Agape is highly demanding and Dr. Deshan works up to 90 hours a week.
He has been on 14 expeditions into central Siberia and has made another 16 trips to Russia working in Moscow for a total of 30 trips since 2002. Outside of the expeditions to the countryside he does not practice medicine in Russia. “My role with our organization is to administer, encourage and enable our Russia staff to do the work and to invite others to join us,” DeShan said. “I have also been spending more time in medical education working with the medical schools and hospitals in Russia.”
Healthcare is different there than in the United States, as would be expected. The system is more socialized and less open compared to the U.S. Technology is also limited and use of such tools like EHRs are minimal. In fact, DeShan says there are just a few EHR-like systems in place in Moscow at elite practices.
Each workday, he logs in remotely to his EHR, reviews the pap smears, lab work and patient calls that need his response. His nurse highlights any abnormal mammograms and scans them into the system for his review, and he reviews the physician assistant encounters with his patients. The only things remaining when he gets back home is to go through the mail and review the bone density exams and normal mammograms, usually taking about 30 minutes.
“The EHR is truly what enables me to work in Russia yet still stay caught up. Since I can do this from Russia, it greatly reduces the burden on my partners and most of my patients really don’t miss me while I am gone because everything is still answered in a very timely fashion,” DeShan said.
From Midland to Moscow
DeShan said he’s always been drawn to serving his faith through medicine.
“I’ve always been very interested in Christian outreach, and I see medicine as a tool to this end. I wanted to find an organization for Christian doctors and I went to Russia once and kind of got hooked. I just felt like I was supposed to do more. It called to me,” he said.
He leads a handful of international volunteers from Germany, Canada and the U.S. and a staff of 10 in Russia working on the ministry and 40 working at Agape’s clinic. About 50 serve on expeditions each year. Despite resources, these folks see more than 365,000 patients a year at the group’s clinical network throughout Moscow and provide more than 2,000 pairs of eyeglasses to people throughout the country. Outside Moscow, more than 70,000 consultations have been given since DeShan became involved with the mission.
Though Russia is considered a first-world country, more than 75 percent of its rural residents don’t have plumbing. Without running water, medical infrastructure is not just impossible, it is a wishful hope.
“There’s a tremendous need for care, especially in rural areas out there, for medicine, and things like glasses,” he said.
What is Agape Unlimited?
Agape goes where no others go, taking action to improve the health of people who may have never seen a physician. This takes the organization to remote areas in Siberia and beyond, as well as to Moscow, meeting the needs of the medically underserved in the capital city, DeShan said.
Since 1993, Agape has been providing medicine, medical consultations and assistance to those who have little or no access to medical care in Russia. Agape sends teams to areas where the need for medical help is urgent , focusing on both the most remote and isolated people in the Arctic and Siberia, as well as the poor and overlooked in rural and urban areas,.
Agape’s medical expeditions always work in conjunction with a church within the region; this way the work continues in the community after the medical missionaries leave.
Agape provides everything to its patients for free. There’s no cost for the consultation, for medication or for the glasses received. Because of the care provided for the folks in the rural areas, sometimes this is the only medical treatment they’ll receive for years. Word of mouth spreads and people come for miles. In one instance, a group of patients rode on a reindeer-pulled sleigh for more than 24 hours for a visit with an Agape physician.
For more about Agape Unlimited, visit www.agaperu.org.
For example, video tape and video stores are virtually gone already. Watches, paper maps and newspaper classifieds are on their way out; and perhaps newspapers, too.
Wired phones are hard to find (though my children will probably see a land line in my house because of their benefit in hurricanes and other natural disasters.)
Printed encyclopedias (some of the last were printed this year) and, likewise, encyclopedia salesmen are history. Printed phones books I still get, and use, but they will one day stop coming to the door; CDs, film and fax machines are all but obsolete, though, there are still enterprises trying to make their livings peddling their wares to help organizations send secure faxes.
I don’t consider myself to be old by any means; just part of a transitional generation. I remember paying $1 for a gallon of gasoline and I remember protestors picketing gas stations in Southern California when the prices topped $1.50 a gallon.
I was introduced to the web via dial-up Internet and wondered when its value would be achieved, as it was difficult to imagine a life lived through the web one AOL minute after another.
Now, the Internet is considered one of the most innovative advancements of all time. Healthcare, and nearly every other business sector, will never be what it once was because the technology allows for continuous advancement and the development of tools like EHRs, patient portals, HIEs and mobile devices.
Why all the reminiscing, then, about all of the gadgets that my children will never know?
Simple. My primary care physician uses paper charts. She has no plans to change and is unapologetic about it. Her patients sometimes ask her why and she shrugs it off like it’s not important, an overly hyped issue. One that she’d rather not discuss and one she might wish went away.
The wall of charts behind the reception desk is a symbol of her success. They represent patients she’s treated, conditions faced by the people she cares about, meetings with those of us she’s counseled. Perhaps that wall of record is her trophy case, a testament to her professionalism, outstanding demeanor and nature, and the trust she’s earned with all of us.
She doesn’t want to be forced into any kind of decision that affects her business – that’s how she sees her practice, as a business — even if she’s ultimately penalized because of it.
Though she’s got the paper to sift, she claims to be organized and just as efficient as any machine could make her. The notes enclosed are her own and won’t be shared with anyone. The only incentive for paper these days is the recycle bin.
But, she carries on. For now.
In the end, though, she’ll probably close shop, shred the records and move on to retirement if her decision not to implement an electronic health record means she can’t continue to do what she loves – practice medicine and provide care.
She has that luxury. She’s of a certain age. She remembers things that many of us have never experienced. She grew her business on typewriters, dial telephones and paper records.
And soon, she will become one more thing my children will never know.
In an effort that could revitalize the EHR space (at least the mainstream market), the Veterans Affairs Department’s classic and still heavily used VistA (Veterans Health Information Systems and Technology Architecture) system is getting the open source EHR treatment.
In a move that is revolutionizing other technology sectors — like manufacturing, gaming and the device world and because of the success of such sites as Kickstarter (I know because I represent clients in this space and have seen their success first hand), which is a haven for open source projects, allowing volunteer programmers who are passionate about code and perhaps even passionate about healthcare, is really a pretty swell idea.
From the VA’s perspective, how else could it possibly bring a beleaguered and somewhat bemoaned product like VistA to the modern area after more than 30 years in use? Certainly, the government didn’t seem to have the funds or the necessary experience to overhaul the system by itself.
According to Rick Baker, chief information officer for the VA, even though there is a contract with a firm to make changes to VistA’s code to make it less complex and more readable, the open source community will be involved directly, day to day, with the EHR’s refresh.
The success of involving the open source community in healthcare, and in the development and maintenance of EHRs, is showcased at Oroville Hospital in Northern California, which recently passed on some of the mainstream vendors like McKesson and Meditech for a personalized, customer version of its.
Leaders at the hospital wanted the flexibility to make changes to its EHR system, and they wanted to ensure they received the attention they felt they deserved from their vendor of choice. Ultimately, they wanted total control over the hospital’s electronic health record.
The best solution to the problem for the hospital? Build its own EHR.
In addition to gaining every advantage over the creation and implementation of the home-grown system, Oroville Hospital plans to save a bunch of money by not purchasing a commercial system even though it is building a complete EHR soup to nuts.
The hospital chose to build the system with the help of the same open source folks who are working on the VistA system; the same folks the VA is using to update VistA. Once done, Oroville Hospital’s EHR was even certified for meaningful use and the hospital received more than $5 million in meaningful use incentives.
What all of this seems to suggest is that custom solutions are viable options in a sea of corporate technology offerings. With open source now breaching the professional world of electronic health records, this may only just be beginning of a wave of technology innovation, especially as hospitals and practices seek more efficient solutions and more control of their EHR technology.
Given the time, patience and buy in of leaders, healthcare facilities may be closer to independence than we’re used to in the regulated and oversight-driven world that has become healthcare.
Fee, fees are everywhere, and not all EHRs are similar. But when purchasing an EHR, there’s much more to consider than just the amount of cash you’ll have to spend for the actual system you want. More than the sticker price of the system alone, you have to account for all the other functional pieces — like support, training and licensing — that need to be bolted on.
So, let’s hear it for the Maryland Health Care Commission. The Commission provides some great insight into all of the things you need to consider before making an EHR purchase and some intangibles that, when addressed, may determine your long-term happiness or misery with the tools you decide to implement.
The Commissions’ list is succinctly published by AmericanEHR Partners, which also makes a fine and sincere recommendation to take into account during the pricing of any EHR: “Price of the system alone should not be used as the primary determinant for the system, but rather one single factor to help make the decision.”
Licensing and Subscription Fees
Check to see how licensing and subscriptions work with the vendors you are shopping: Do you pay per clinician or per user, and do you pay more for more “seats” at the table if you need them? Is your payment all inclusive, meaning, are getting a fully integrated EHR with practice management system or are covering for additional features?
The Commission makes an interesting point here: Client server systems are usually licensed based upon a one-time fee with maintenance costs.
I’ll add the following: Hosted, cloud solutions are less expensive than client server to implement; typically fees are paid on a monthly retainer; and they often are less robust systems than on-site server-based counterparts.
Practicing with Your Practice Management System
If purchasing an EHR that includes and PM system, be cautious of paying extra for the practice management capabilities. With continued integration of the systems and requirements brought on by regulation, such as meaningful use, there really should not be any additional fees for the capability.
Vendors may offer a full version and a light version of PM. Make sure the light version can meet your practice’s capabilities if you decide to take that option.
It goes without saying, but make sure that the PM, like the EHR, is meaningful use compliant.
Paying forPatient Portals
According to the Commission, “Vendors may have tiered pricing for portals based upon level of functionality.”
Make sure you have an understanding the portal’s functionality, how it fits with your system and if it’s part of the EHR or an add on. It could go either way, but from experience, you’ll be paying extra for it. Don’t forget to budget for it if you plan to meet meaningful use.
Support, Training and Maintenance
No surprises here, vendor support costs vary significantly based on the level of service you need and when the support can be accessed. You’ll pay more for support at certain times like nights, weekends and holidays.
To budget for training, you have to account for the trainer’s time, travel expenses and the amount of training you want. Plus, there may be a flat fee built in to cover it with additional hours sold in blocks.
The most important thing with training is to clarify how much you’re going to get for the price paid. A word of advice: Log your own hours. Track how much you’ve actually used and compare it to the amount that you’re billed.
Another cautionary tale from the Commission is to be prepared for any training initial fees and should be priced out separately.
Finally, the maintenance. Maintenance fees are generally included as part of your software agreement. If not, proceed with caution and read the agreement carefully.
And, according to the Maryland Health Care Commission, maintenance fees for client-server systems are generally 20 percent of initial licensing and interface fees.
Hopefully, some of the preceding information helps as you price and shop for your EHR. If you have additional tips or insights, please post them in the “comment” section.
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.
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.
If physicians use healthcare technology so much less than practice administrators and others in the average practice with these implemented systems, why do they continue to receive so much of the marketing and pre-sales attention from vendors and others in HIT community?
All healthcare vendors take a similar approach with physicians as they jostle for a lane at the front of the race. They gear their public-facing collateral and educational materials to physicians knowing all the while that they also must woo practice administrators and support staff. Rarely, though, is there any effort put into publicly promoting healthcare technology systems to non-physicians nor is there much effort behind celebrating non-physician care givers and administrators as the industry’s leading users of HIT.
It should come as no surprise that non-physician practice employees, such as RNs and PAs, use the systems like electronic health records, much more than their physician counterparts, on average. But, for whatever reason, HIT messaging is all about the physician and continues to be tailored to these mascots and figureheads within practices and healthcare settings.
EHR Watch’s editor, Jeff Rowe, recently published a blog post about the amount of time physicians use healthcare technology as opposed to their in-practice colleagues like RNs and PAs.
In his succinct summation PAs and RNs spend more time online for professional purposes than physicians; during consultations, PAs and RNs leverage mobile applications more at the point of care than physicians; and, in his words, “PAs and RNs use pharma or biotech websites more frequently than physicians and are more interested in using pharma features on electronic health record systems (EHRs).”
If physicians spend most of their time seeing patients and administering care, there’s nothing shocking about this data. It’s a good thing; they need to be seeing patients, not playing around on their computers.
However, this information should validate what everyone in healthcare already knows: Physicians are not the only ones using healthcare technology, and more can be done to include healthcare’s other care providers (and leaders) in the conversation about the technology and how it affects business and patient care outcomes.
The data Rowe provides also should encourage practices to continue including non-physician team members in the selection process of new technology if they are not already doing so because, clearly, though physicians are experts in providing care, they are not always the experts in using a practice’s technology solutions.