Want a Quality EHR? Ask Doctors What They Want.

Transcription

1 Want a Quality EHR? Ask Doctors What They Want. Sponsored Material

2 It is difficult to imagine a company creating a product without asking consumers what they want or need. However, that is exactly what often happens in healthcare. Specifically, many electronic health record (EHR) systems are designed and healthcare organizations buy these systems without consulting the end users. Physicians often are left out of the conversation. According to a HealthLeaders Intelligence survey of healthcare executives in June, about one out of four organizations involved physicians in every step of the clinical system purchase. Less than half consulted a physician advisory board or used beta testing before implementation. However, perceptions of physician involvement varied. More than one-third of executives indicated physicians were highly involved throughout the process, compared with only 7% of physician leaders. Likewise, 17% of physician leaders said physicians had no role in the selection of an EHR, compared with 4% of executives. An American College of Physicians (ACP) survey in March found that EHR user satisfaction among physicians actually fell between 2010 and Dissatisfaction is increasing regardless of practice type or EHR system, said Michael Barr, MD, who leads ACP s medical practice, professionalism, and quality division. These findings highlight the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability to help reduce inefficient workflows, improve error rates and patient care, and for practices to recognize the importance of training at all states of EHR adoption. Physicians key to Stage 2 Meaningful Use Frank Newlands, MD, chief medical officer for HMS and its parent company HealthTech, said he was not surprised by those results. Frank Newlands, MD Chief Medical Officer HMS / HealthTech Physician Involvement I How involved are physicians in selecting clinical technologies and systems at your facility? 52% 28% 12% 8% Highly involved throughout Involved at various stages, Minimally involved No role in selection process, including selection, but not throughout at various stages implementation, and rollout the process Base = HMS I Sponsored Material

3 Physician Participation in Clinical Technologies and Systems I Which clinical technologies and systems do physicians participate in selecting? EHRs 73% CPOE 51% Clinical decision support 48% Mobile access to clinical technologies 40% Analytics, business intelligence, and dashboards 19% Other 11% Base = 151 I Multi-response Doctors were not necessarily tasked with using EHRs until Meaningful Use. However, Stage 2 has a lot of EHR metrics that are doctor-dependent. As they begin using these systems more, they are more dissatisfied with what they are presented with. More of these EHRs are being designed without subject experts input regarding features, functionalities, workflow, user experience, and look, he said. Meaningful Use served an important purpose by motivating vendors and hospitals to create and acquire systems, Newlands said. However, EHRs often are built around Meaningful Use guidelines and government incentive deadlines rather than physicians needs. In that way, Meaningful Use was counterproductive in the development of efficient EHR systems, and many vendors are now realizing the magnitude of the problem created by a lack of initial physician input, he explained. Because of the urgency with Meaningful Use, EHRs that are not fully thought out are being deployed. They have been developed primarily for revenue cycle management and pharmaceuticals. Many are not up to par clinically. Frank Newlands, HealthTech chief medical officer Because of the urgency with Meaningful Use, EHRs that are not fully thought out are being deployed. They have been developed primarily for revenue cycle management and pharmaceuticals. Many are not up to par clinically. It becomes evident after the launch and 3 HMS I Sponsored Material

4 end users get a hold of it. When these systems try to qualify for Meaningful Use they are going to cost providers and health systems incentive dollars, not to mention revenue lost due to inefficient work flows, he said. According to Newlands, obtaining physician input on EHRs is a twofold problem: organizations fail to seek it out, and physicians are too busy to press their case. Doctors have valuable input to give, but they don t have time, he said. They are trying to deal with issues such as coding, compliance, Medicare, insurance, and liability. They don t have any more bandwidth to offer themselves up to contribute to that. Physicians realize they need to get involved with administration, especially when it affects their livelihood and day-to-day workflow. They were slow to figure that out. So IT departments made decisions for them. Regardless, Newlands said companies need to make the effort. [Executives] need to ask. Most don t ask. Doctors feel like they re shut out of the process. You need to create an executive physician role to act as a liaison with the opportunity to make decisions that affect doctors. Executives would be surprised. Doctors really enjoy getting involved and having their voices heard, he said. Use a physician advisory board Ongoing physician input is built into HMS EHR system, Newlands said. Its 12-member physician advisory board (PAB) meets in Nashville every two to three months for a full day to consider customer requests for upgrades. The board includes physicians who are not HMS customers and others who do not use EHRs. HMS upgrades its software about three times a year, he said, adding that the board s job is to vet the upgrade requests. We are not going to appease one doctor and affect everyone else adversely. We do what s best for the industry. There is a need for standardization. If we meet the daily needs of a physician [with the upgrades], then we ve done our job, Newlands said. The board has helped us streamline our road map. When we get in a room, we get 95% unanimity on Methods to Involve Physicians I What methods are used in your organization to involve physicians in selecting clinical technologies and systems? Ad-hoc consultation during selection, implementation, and rollout 72% Participation in project committees 67% Beta testing prior to rollout 41% Standing physician advisory board 40% No involvement 7% Base = 151 I Multi-response 4 HMS I Sponsored Material

5 how [the software] should work, feel, and function. The board understands how our world works. The clinical vetting prior to release has been absolutely invaluable, he added. Newlands said he has been bombarded with questions about the successful HMS advisory board process. People act like it s the greatest thing since sliced bread. It s such as simple idea. If you re gonna build something, ask users how it should work. You need a group like this throughout the healthcare decisionmaking process, but especially for EHR, he said. According to Newlands, once physicians are on board with EHR functionality, the next frontier is data exchange interoperability between EHRs. Without it, he said, physicians are not working with the whole story when making treatment decisions. Make the EHR mirror how physicians think Peter Marzano, a Melbourne, Fla., internal medicine physician and PAB member, said he is impressed by the physician vetting of HMS software. It s unique. We sit at a table with the IT guys. They ask, What do you think? and we might say, This doesn t work because... It is not adversarial as with some other IT firms. Marzano, who is employed by a regional health organization, said the hospital did not seek much physician input when the original EHR system was installed several years ago. There was a massive learning curve, he said. The software was not intuitive. The first time I used it, it took me nine hours to complete a four-hour shift in the [Physicians] are trained to think a certain way, and you need to make the system logical for the way physicians are trained. Peter Marzano, internal medicine physician emergency department. [Physicians] are trained to think a certain way, and you need to make the system logical for the way physicians are trained. Those who vet their systems with clinicians will rise to the top. If you can t make the product work for us, it will come back to bite [the organization]. Randy Lee, a Hamilton, Texas, family physician and PAB member, agreed. A lot of hospital administrators buy a system that fits their budget and don t let the doctors become involved. They have problems with implementation and efficiency of use, and eventually have to abandon the system because the doctors don t buy in, he said. It is very imperative that EHR companies embrace the end user. HMS has programmers who get it. They have enough clinical judgment from listening to doctors to understand how things need to flow and how a doctor s mind works. You can see at a glance the patient s status without having to look behind a lot of closed doors. If you need more information, it s just one easy click away, he added. Lee pointed out that EHRs have to satisfy government reporting requirements for Meaningful Use as well as satisfy the needs of the end user, which are not necessarily related. HMS is a paradigm shift toward satisfying both, he said. Ultimately, you have more efficient care and better patient safety with its use. n 5 HMS I Sponsored Material