Electronic Health Records

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EHR nightmares: Why treating EHRs like paper records fails

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- Through our experiences working side-by-side with providers, we have seen many things and learned many lessons. Here are a couple more stories and lessons we encountered along the way. Let us help you ensure that you can avoid these nightmares.

Read the first part of this series here.

Exhibit C: “Automating” provider workflows

Automating is a funny word — it typically implies the removal of manual intervention in a process. More often than not, we find that it is actually used to describe replicating a manual process in a system. After all, if we ditch the paper process, what will be put in the file cabinet? Don’t we need a paper record for everything?

Unfortunately, this mentality is more prevalent than we like to believe. Healthcare, an industry that has not changed in decades, is making a fast and furious transition to Electronic Health Records, but often failing to do so in a logical and efficient way. We can’t blame clinicians for the rough transition, as their “intuitive, user friendly” system is not always as “friendly” as expected, which was illustrated by a previous example.

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In one particular instance, a clinical consultant walked into a provider office who had recently implemented an EHR. Despite having just gone “paperless,” the consultant was shocked by the overflowing file cabinets cluttering the office. Upon digging into the cause behind the sea of paper, she discovered that since the EHR implementation, the provider had been documenting visits in the EHR, printing and filing every single note (replicating the process on paper as he always had), and then proceeding to scan those files into the system and save them to a folder on the desktop of his unencrypted laptop. When the provider was asked why he was doing this, he simply replied, “I don’t trust the system.”

Provider resistance to change is not uncommon; in this case, consultants were presented with the “Mt. Everest of resistance.” After intensive struggles and a ride on the roller coaster of emotions, consultants were able to instill an acceptable level of trust in the system and the provider eventually stopped keeping what could be interpreted as a “duplicate record.” Several months later, his file cabinets were finally able to close.

Change is hard, and the longer you repeat a process, the harder change becomes. Additionally, technology is scary, especially technology that is less than perfect. Providers need to trust their systems, which typically means abandoning their old ways. Once providers begin to trust their systems, efficiency within practices often begin to improve. Also, out-of-the-box EHRs are not designed to mirror existing workflows but can often be configured to meet the original need more efficiently and integrate better with other workflows. Optimization consultants are available to make your system work for you and are worth their weight in gold when you do the math from a long-term efficiency perspective.




Exhibit D: Servers don’t belong in boiler rooms

Servers don’t belong in boiler rooms — I think we all know where this is going. But hey, who knew? The paper files didn’t need a dedicated cooling solution; what’s so special about these metal towers, colorful wires, and blinking lights? What do they even do?

We all make mistakes when we are first introduced to new concepts and technology. I remember when I started tinkering around with some small home improvement projects and installed a dimmer switch without flipping the breaker (ouch!), or when I mounted my first pair of ski bindings and ended up drilling all the way through the base of the ski into my living room floor (I have since retired as a “home ski tech”). The fact is, everything has a learning curve, and we all learn from our mistakes; some are just more costly (or painful) than others . . .

A client hosting their EHR on-site notified our service desk that they had been struggling with performance over the last few months and this morning they were unable to log into their system or access any of their data. Support teams were unable to resolve the issue remotely, so technicians were sent on site to assess the situation.

To their surprise, they found that the brand new servers had been set up in the boiler room. They were able to feel the heat from outside the door, and upon entering, one of the technicians said, “It resembled walking into my wife’s hot yoga class.”

The production servers had overheated and shut down, and there was no backup in place. Luckily the data was recovered, and after some hardware rearranging, servers were back up and running.

The current physical structures of many physician offices were not designed with technology in mind. Doing it yourself to meet the immediate need of “where do I put the servers?” did not serve him well.  Unfortunately, the provider did not know the implications of storing servers in the boiler room and had to learn the hard way. The outcome could have potentially been much worse, and the provider was very lucky in this situation. Sometimes surrendering and leaving the setup to the experts is well worth the small investment.

EHRs are not perfect — they are still a relatively new technology, and many clinicians are still very much in the adoption phase. We have covered some rather extreme examples of how this transition can be rough, but instances such as these occur daily. There is no single person or company to blame for this; change is just difficult, as is developing a perfect system.

We have gained a great deal of expertise from working with clients and sharing these experiences. Our methodology includes planning at the executive level to assure engaged leadership, as well as rolling up our sleeves and standing side-by-side with our clients to prevent these situations, and helping them work through their unique challenges. The knowledge and experience gained from instances like these is then leveraged to help you and your organization maximize the value of your technological investments and to further your success in the new era of healthcare.

Read the first part of this series here.


Greg Chittim is a Director at Arcadia Healthcare Solutions with responsibilities including the analytics service line and strategic marketing. He has a deliberate focus in health information exchange, Direct Project messaging, clinical quality analytics and reporting, enterprise technology implementations and general strategy and operations. Greg works directly with the Office of the National Coordinator for Health IT (ONC) as a Subject Matter Expert on the Technical Assistance team. Through the ONC, Greg has worked with nearly 30 states on their Direct strategies and tactics, and is the Champion for the nascent Direct Community of Practice.





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