- EHR implementation projects are notoriously stressful for hospital management and staff as providers, administrators, IT staff, and leadership adjust to changes in daily operations.
Without sufficient EHR training and communication between hospital management and staff, healthcare organizations may be susceptible to internal quarreling and financial trouble as a result of snags with billing or EHR workarounds.
Achieving high levels of clinician engagement early in the EHR implementation process can help to reduce slowdowns, boost physician satisfaction with EHR technology, and improve clinical efficiency with new health IT tools.
The following are three strategies to achieving high rates of clinician buy-in during the early stages of the EHR implementation process:
Gather clinician feedback during EHR selection
Before committing to a large capital investment, healthcare organization leadership needs assurance a new EHR system’s functionality, design, and level of usability will meet the specific needs of its patients, providers, and environment.
Executives at Virtua Health System gained insight into which EHR system best aligned with their organizational needs by inviting over 1,500 staff members to attend 80 product demonstrations for competing systems.
Staff members were told to score EHR systems from different vendors based on their performance against certain key metrics.
“We looked at two solutions: Epic and Cerner,” Virtua Senior Vice President and Chief Information Officer (CIO) Tom Gordon told EHRIntelligence.com. “We had a week-long process where we conducted 40 demos apiece — 40 Cerner demos and 40 Epic demos.”
Clinicians ultimately scored Epic higher than Cerner against almost every criterion. Executives also learned during the week of product demonstrations that a top priority among physicians was a system that simplified health data exchange.
“You didn’t want to have to fax your information anymore,” said Virtua Medical Director of Informatics and primary care physician James Gamble, MD. “You didn’t want to have to switch over from one EHR to another to look up information. That was really the thing that drove the clinicians.”
Virtua leadership took the advice of clinicians and chose to implement an Epic EHR system after thoroughly reviewing staff input. According to Virtua leaders, putting users at the center of the EHR selection process helped to sustain high levels of clinician engagement after the go-live and improve provider satisfaction with the new system.
“To just go out and switch an EHR just for the sake of switching is a disaster waiting to happen,” said Gordon. “You need to clearly define what you need to accomplish. We knew we wanted to better align with healthcare reform, increase communication and care coordination, and integrate to best tell the patient’s story.”
Once a healthcare organization has decided on a new system, executives need to make sure providers know how to effectively and efficiently use the technology.
Require Mandatory EHR Training
Inadequate EHR training can cause problems with patient care delivery, billing processes, and EHR use for months after go-live.
Requiring thorough EHR training for all health system staff can help to sidestep these issues and shorten the adjustment period that inevitably accompanies new changes to clinical operations.
Streamlining these changes was a top priority when Pennsylvania-based Uniontown Hospital adopted new health IT tools to optimize its existing Cerner EHR system.
Uniontown Clinical Informatics Integration Analyst Jennifer Abrahams told EHRintelligence.com the hospital required all clinicians to attend three-hour training sessions prior to going live with new tools to ensure all staff had a common understanding of new technology.
“This required attendance had a huge impact on the success and adoption of Dynamic Documentation,” said Abraham. “Also, during the training session we made sure every doctor got the same message. The expectations were common at each session.”
An IT team monitored these training sessions to gauge how well clinicians were taking to the tools.
“That was important for us,” Uniontown Health Information Management Director Karen Keniston said. “There was someone from the team at all of the education sessions, so we could see who was getting it and who wasn’t, and identify anyone who may need extra help.”
Two Cerner representatives and several members of the IT project team attended each three-hour training session. The team conducted each training session according to a standardized script to ensure every physician received the same training.
“We had bullet points that we made sure to hit,” said Abrahams, “And between points we interjected. Every single training session included the same pieces of information about how to use Dragon and Dynamic Documentation.”
The team made sure to offer three sessions per day for two weeks so that physicians with different schedules could attend at least one session.
“There were evening sessions, early mornings, sessions in the middle of the day,” said Keniston.
In addition to offering plenty of sessions to fit different physician schedules, Uniontown also made efforts to allow each clinician to get hands-on experience with new tools.
“Each person had their own computer and their own dictation microphone,” said Keniston. “You need to actually do it to be able to learn it.”
The team kept class sizes under 15 physicians per session to ensure each physician had access to at-elbow support from Cerner executives and members of the Uniontown IT team.
This level of standardized EHR use training helped to reduce clinical inefficiencies before any problems could affect patient care delivery.
While standardizing training sessions can help to limit confusion with new technologies, a degree of customization can boost EHR usability.
Specialize clinical workflows to suit different care settings
One pain point that often hinders provider satisfaction with EHR technology is poor EHR usability.
In 2017, a group of healthcare CEOs identified problems with EHR usability as a top contributor to rising rates of physician burnout.
To reduce potential problems with EHR usability, healthcare organizations can invite clinicians to provide input on the design of clinical workflows and EHR interfaces.
This feedback can give EHR vendors and health system leadership an idea of which clinical information clinicians would like to see prominently displayed on the EHR interface, and which information can be concealed.
Reducing cluttered data in clinical workflows and physician EHR notes can help to improve clinical productivity.
A November 2017 JABFM study found showing less data in physician EHR notes and highlighting abnormal clinical information with colored text and bold font helped clinicians to more quickly locate relevant information for streamlined clinical efficiency.
University of Illinois Chicago Assistant Professor of Biomedical and Health Information Sciences Andrew Boyd, MD, told EHRIntelligence.com specializing the EHR interface can save clinicians a significant amount of time per day by cutting down on time spent searching out necessary clinical data.
“If you can figure out a design interface for a hospital where they only need to spend five minutes looking up the data on a patient instead of 15, you’re saving them time that they can spend with the patient,” said Boyd.
According to Boyd, healthcare organizations and vendors can work together to design EHR models specific to unique disease states, hospitals, or care settings. These specific EHR interfaces display high-value information to clinicians in the same way a web browser predicts which website a user is most likely to use based on user history.
“We’re not concealing — we’re highlighting the important information,” emphasized Boyd. “If a user wants to pursue other information, they would be able to pursue it.”
The IT team at Uniontown Hospital involved clinicians across specialties in EHR interface design to ensure clinical workflows displayed only the most relevant information to users.
“We divided physicians into four specialty groups, and we brought in physician champions for each specialty,” said Abraham. “These physician champions were the drivers. They were the voice of that group of doctors. They gave us input and designed their own systems. We very much took the approach that this was their system, and we’re just helping them build it.”
With the help of these physician champions, the Uniontown IT team created four specialized clinical workflows.
“We had workflows for inpatient medicine, surgery, cardiology, and pediatrics,” explained Abraham. “We had physician champions from each of those areas help to build their workflows to that specialty.”
“Whenever the physician logged in — say the physician was a surgeon. They would have their specific labs,” she continued. “The workflow is specific to what each department needs.”
This level of specialization informed by user feedback can help to promote widespread user adoption and improve common challenges with EHR usability.
By involving clinicians in each aspect of the early EHR implementation process, healthcare organization leaders can avoid conflict, slowdowns, and clinical efficiencies associated with troublesome EHR launches.