One need not have read Dr. Atul Gawande’s recent 9,000-word essay or visited a physicians’ lounge to know that doctors are not fans of the electronic medical record. Physicians yell at least as many words, unfit for print, at computer monitors each day. We live and die by the smallest incremental changes. Every downtime, planned or unplanned, sends us into a tailspin for weeks. But as health systems and physicians aim for the same destination—better care—the two groups need to be aligned constructively, despite their different routes.

The way that health systems and physicians interact can best be described as complicated. The goals and challenges are largely the same. And though sometimes the approach is congruent, most times it is about as a similar as a Ming vase and a CBGB t-shirt (both, at least, artifacts of collapsed dynasties). To promote alignment, health systems must engage providers early and often. For this approach to work, engaged but informal subject matter experts are often better than formal leaders with little direct knowledge about the process.

We used this as a guideline as we recently went through a major overhaul of our electronic medical record, which had aged over a decade more like a stale pancake than a fine wine. This project touched nearly every record in some way. We updated security profiles, changed workflows, replaced paper billing, and set up new ways to manage external provider orders. Of course, there were anxieties, but early provider dramatically calmed the environment.

We structured our steering committee to include physician representatives who regularly use the EMR. The committee included our system Chief Medical Officer and invited the acute care Chief Medical Officer, as well as the trauma and primary care medical directors, both of whom practice regularly. I participated as a clinical/IT “translator.” For additional touch points, we created a physician-specific subcommittee to work through more granular details. As the project progressed, early and frequent user acceptance training included regular users. We scheduled these meetings at times that made sense for providers—at lunch, before their OR time, or after the close of the clinic. There was a little bit of fear and a few concerns, of course, but we were able to address these in real time, long before go-live. And for items that bordered on the unreasonable, we could escalate long in advance to respected physician leaders.

The way that health systems and physicians interact can best be described as complicated.

Correspondingly, communication occurred at nearly every meeting that a provider might attend. IT staff, physician leaders, and I made frequent appearances at medical executive committees and department meetings. At a point, the communication might have become more irritating than the anticipation of coming changes, with posted signage in physician lounges and dictation rooms. And when we finally did go live, we had senior leaders rounding from pre-dawn until long after dark, ensuring that providers knew who to go to and could see that their issues were being addressed.

To paraphrase Dr. Gawande’s Chief Clinical Officer, Gregg Meyer: the EMR is not for the doctors; it’s for the patients. This is absolutely true. But it is the clinicians who use it every day. For meaningful improvements to the EMR, physicians need to be at the table. A small collection of physicians will be sitting there before you ask them. But the rest should not be ignored. Health systems need to reach out to the providers not already there.

How does a health system help them do that? It is our obligation to ask more of ourselves when we ask more of physicians and to challenge some of the standard assumptions about what is possible. We are rightly working to streamline care, reduce waste, and lower cost. We should also work to reduce documentation, put meaningful in a meaningful format at clinicians’ fingertips, and improve the stale pancake. These are multi-year efforts that can only start when we support our doctors in guiding our transformation.

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By Will Conaway, CIO/VP, Prime Healthcare

Leaders in healthcare IT are part of the problem. There, I said it. Any of my colleagues can tell you one of my best-known phrases is “Define the Problem.” Recently, I have noticed that many of the discussions about IT challenges in healthcare have revolved around end users. But are end users the problem or a symptom of a more systemic issue? Loosely put, the dialogs incorporate the concept of the Three A’s: Adoptability, Adaptability, and “Adept-ability.” How, where, and when to address these Three A’s in healthcare IT continues to spotlight a glaringly obvious flaw: our leadership may have vast knowledge of both healthcare and IT. Business operations and strategy? Not so much. And therein lies the problem. Using our Three A’s as a mantra, let’s examine some hotspots in healthcare IT and what can be done to address them.

ADOPTABILITY

With the advent of the ACA came the golden age of the EHR system. Although overwhelming at first, healthcare IT leadership rallied to implement systems to meet new requirements and regulations. It’s been several years now since the implementation boon; one would assume that the initial learning curve and adoption of these gargantuan systems would be well into the steady state. Many recent studies present quite the contrary evidence. A recent survey at the Mayo Clinic gaged physician satisfaction with their EHRs. It revealed that only 36 percent of the 6,375 physicians interviewed were satisfied with their own use of the system. More alarming is that in my conversations with physicians from around the world many tell me that they are extremely frustrated with technology in their daily practice. For many providers, technology has removed much of the personal interaction from practicing medicine.  They are experiencing “IT fatigue” and express that even one more system change might be too much to take. This should not be ignored by IT leadership and addressing IT fatigue needs to be incorporated into the core practices of healthcare IT professionals. It is crucial that healthcare technology leaders begin to employ more psychology of leadership with an emphasis on teaching our staff to better interact with all people in every department. Learning and leadership development for healthcare technology executives is crucial for healthcare organizations to gain and maintain a competitive advantage.  Developmental initiatives will require congruence with corporate strategies if organizational leaders are to address future industry challenges, opportunities, and restraints.  These developmental initiatives will require focusing on an organization’s basic issues and what makes good business sense.

ADAPTIBLITY

Business leaders around the globe have learned adapting to new environments and new circumstances needs to become second nature. Somewhere along the line, some healthcare IT leaders seem to have missed the message. Statements like “IT doesn’t need to do strategy” can lead to IT being left out of vital conversations with the rest of leadership in a healthcare organization. With new technologies and new technological challenges continually appearing, IT leaders need to employee business acumen beyond their IT comfort zone.  In order for technology leaders to have their rightful place at the table with other departments’ senior leaders, we need to continually seek out greater understanding of the business needs of the organization and of healthcare as an industry.

ADEPT-ABILITY

Advanced technology alone will not provide the products and services that the future of healthcare will demand.  The expectation that technology will resolve bad processes, bad procedures, or poorly performing employees is flawed. The future healthcare workplace will change, work processes will change, skill level requirements will change, and technical demands will be different. Building a technical program of the future requires a new paradigm.  The new concepts will offer new challenges for leaders and redefine managerial and leadership responsibilities.  At the same time, this new paradigm will provide information technology professionals with the opportunity to develop new processes, new practices, and to establish competencies by focusing on organizational strategies and industry necessities.

The new concepts will offer new challenges for leaders and redefine managerial and leadership responsibilities.

…AND A BONUS “A”…

AROUND, as in “still be around tomorrow.”  Future successful healthcare IT departments will have the capacity to regenerate and reinvent themselves often.  They will foster ideas and have the capacity to implement and utilize those ideas.  Healthcare technology leaders have an obligation to all stakeholders to prepare for the opportunities and realities of the future.  What an opportunity this offers healthcare information technology professionals to assume their rightful place in the development of their healthcare organization’s future.

The post Healthcare IT Needs to Get Out of ITs Own Way; Business as (Un)usual appeared first on HealthTech Magazines.

By Luis Saldaña, MD, MBA, FACEP, Chief Medical Informatics Officer, Texas Health Resources

We live in a world of big data, and voice recognition and understanding. It seems physicians are increasingly challenged by volumes of data while simultaneously being tasked with data creation and entry requirements to support billing, performance, and quality measurement. The old dogma has been, “If you didn’t document it, you didn’t do it.” This information burden has contributed to the crisis of physician burnout, and organizations are challenged with engaging with consumers in ways that meaningfully engage and empower them. A new paradigm needs to be created wherein if you did it, you don’t need to document it. And, how do we turn this volume of data into a stream of knowledge and insights to benefit our patients as well as meaningfully supporting the need for ongoing performance improvement?

Addressing physicians’ information needs is critical to support the coming world of value-based care. And how physicians are measured in this world needs to be increasingly transparent to them.

How can we start to relieve these burdens while actually delivering better outcomes and more value?  We need to start charting the course for this vision and get beyond the real burdens of interoperability that impede free, yet secure data flows for patients and physicians.

Patients are just learning how to use data around their own health and are getting more and more access to data that was generated in their own encounters

As we reflect on how to design to achieve this future state, I believe we might lean on two key frameworks:

1. The 5 CDS Rights Framework – the right information, to the right people, in the right format, through the right channel and at the right place in the workflow (Osheroff, etal).
2. User experience principles.

This model can provide us with a good design framework to guide this work.  In addition, this framework could also be married to user-centered design and be more empathetic towards the target of the data.

within the needs to integrate with target end-user workflows in mind. We need to streamline the effort needed to generate reports or run user queries. Strong thought and consideration needs to be given to facilitating data sharing toward support clinical decision making and removing existing barriers inherent to the current state of non-interoperability. The data also needs to freely follow the patient as they move throughout the complex maze of healthcare.

And as we design these systems, we need to start to learn how we can design patient-specific data flows, in both the process of data generation (to include patient-reported health outcomes) and then the process of converting this data into insights that might contribute in a way that supports the consumer taking more control of their own health outcomes. Such an approach could engage and empower patients in their own care, but only if it is done in a way that supports and enhances patient autonomy and might start to free them from traditional paradigms of medical decision making.

Patients are just learning how to use data around their own health and are getting more and more access to data that was generated in their own encounters. And now, they are even generating data that might contribute to improving their health outcomes. The call-to-action is to frame a new paradigm that actively includes and engages all stakeholders in conversation and design workflows in contrast to the current siloed processes, which are largely vendor driven. This is an opportunity and a call for organizations to take the lead towards new, more collaborative and social strategies that will carry us further towards this future state that will address some of the current challenges in and can empower patients and physicians to help to deliver better health outcomes for the communities we serve.

The post The EHR and Data: Making it work for Physicians and Patients appeared first on HealthTech Magazines.