EHR Optimization: Making It in the Majors
Health IT often is touted as a miraculous game changer, the star player who will propel a healthcare organization to success by eliminating all workflow inefficiencies. But, the reality is that health IT tools are more like minor leaguers who require grooming to reach their full potential in the big leagues.
Adopting EHRs doesn’t end with implementation. Rather, a plan to bring EHR functionality into the big league should be a component of every healthcare organization’s health IT strategy.
She estimates that 90 percent of her clients did not consider optimization during implementation. “It’s not deliberate. They’re busy. Implementing EHRs is not an easy thing to do. Oftentimes, they get so caught up seeing patients to cover overhead that they don’t consider optimization.” While practices can be forgiven for neglecting optimization, they are likely doing themselves a disservice by failing to review their systems to determine whether they are working.
At one site, Dunn observed a nurse handwriting a copy of a patient’s medication list while entering the prescriptions into an EHR. Not all of the prescriptions were being transmitted electronically to the pharmacy, so the nurse was creating the list to call in a portion of the prescriptions. Although the nurse had informed IT, there was no process in place to solve the problem. These instances are common and cause health IT initiatives to fail because the tools aren’t used correctly.
IT administrators should devote resources to ongoing optimization of their EHRs, develop procedures for addressing the failure of EHR functionalities and ensure that their staff stay trained, says Dunn.
Yackel agrees with Dunn that end-user involvement and institutional procedures to address EHR failures should be part of an optimization strategy, but he suggests that providers shouldn’t rely too heavily on their staff to report problems. “Having users report missing results is a very poor way of problem-shooting your system. It takes a diligent user to notice something that’s missing and, by the time it’s reported, the same error often has occurred hundreds or thousands of times.”
EHRs include tools that allow IT departments to test potential electronic rules against patient databases, and layer monitoring software on top of electronic transactions so systems can self-diagnose errors.
BayCare is seeking to transform its care delivery with health IT through careful planning, Sizemore suggests. Of course, there are trade-offs.
“Productivity does suffer somewhat,” she says. “Initially, it’s because staff are learning the system. It’s a lot easier to continue using a familiar paper system than to navigate a new electronic system,” says Sizemore. “We can make up for productivity hits by using IT in various ways, such as running real-time chart audits to identify patients eligible for evidence-based medicine.”
Even in the long term, Sizemore says nurses will spend more of their time entering data than they do now, but that time becomes valuable patient information that EHRs are intended to hold to improve care, and that’s the point. “Turning information into knowledge that guides how we make patient care better, that’s the exciting part,” Sizemore says.
Adopting EHRs doesn’t end with implementation. Rather, a plan to bring EHR functionality into the big league should be a component of every healthcare organization’s health IT strategy.
Plan ahead for optimization
“This is not a ‘hurry up to go live’ event. It’s just not,” says Cindy Dunn, RN, an independent consultant based in Cocoa Beach, Fla. “Practice management is responsible for evaluating EHRs and optimizing them on an ongoing basis.”She estimates that 90 percent of her clients did not consider optimization during implementation. “It’s not deliberate. They’re busy. Implementing EHRs is not an easy thing to do. Oftentimes, they get so caught up seeing patients to cover overhead that they don’t consider optimization.” While practices can be forgiven for neglecting optimization, they are likely doing themselves a disservice by failing to review their systems to determine whether they are working.
At one site, Dunn observed a nurse handwriting a copy of a patient’s medication list while entering the prescriptions into an EHR. Not all of the prescriptions were being transmitted electronically to the pharmacy, so the nurse was creating the list to call in a portion of the prescriptions. Although the nurse had informed IT, there was no process in place to solve the problem. These instances are common and cause health IT initiatives to fail because the tools aren’t used correctly.
IT administrators should devote resources to ongoing optimization of their EHRs, develop procedures for addressing the failure of EHR functionalities and ensure that their staff stay trained, says Dunn.
End user vs. system improvements
While researching test result delivery errors in the EHR system at the Oregon Health & Science University in Portland, Chief Health Information Officer Thomas R. Yackel, MD, MPH, found that most errors were identified by end users.Yackel agrees with Dunn that end-user involvement and institutional procedures to address EHR failures should be part of an optimization strategy, but he suggests that providers shouldn’t rely too heavily on their staff to report problems. “Having users report missing results is a very poor way of problem-shooting your system. It takes a diligent user to notice something that’s missing and, by the time it’s reported, the same error often has occurred hundreds or thousands of times.”
EHRs include tools that allow IT departments to test potential electronic rules against patient databases, and layer monitoring software on top of electronic transactions so systems can self-diagnose errors.
Managing trade-offs
At BayCare Health System in Clearwater, Fla., a team of clinical informaticists and IT professionals were brought together and “challenged not to replicate current practices, but to find best practices for addressing the organization’s needs,” with EHRs, according to Pat Sizemore, RN, chief nursing officer and vice president of patient services at one of the network’s hospitals, St. Anthony’s Hospital in St. Petersburg, Fla.BayCare is seeking to transform its care delivery with health IT through careful planning, Sizemore suggests. Of course, there are trade-offs.
“Productivity does suffer somewhat,” she says. “Initially, it’s because staff are learning the system. It’s a lot easier to continue using a familiar paper system than to navigate a new electronic system,” says Sizemore. “We can make up for productivity hits by using IT in various ways, such as running real-time chart audits to identify patients eligible for evidence-based medicine.”
Even in the long term, Sizemore says nurses will spend more of their time entering data than they do now, but that time becomes valuable patient information that EHRs are intended to hold to improve care, and that’s the point. “Turning information into knowledge that guides how we make patient care better, that’s the exciting part,” Sizemore says.