- As EHR adoption becomes nearly ubiquitous across all hospital specialties, many providers are also becoming increasingly frustrated with the technology. Well-informed EHR optimization decisions throughout the many phases of implementation can help healthcare organizations avoid future problems with provider EHR dissatisfaction, administrative burden, and usability.
While some large enterprise vendors such as Epic and Cerner inspire confidence in most healthcare organizations by nature of their popularity, a botched implementation and poor EHR tech support can lead to a problematic system.
Continuous EHR-related problems can contribute to rising levels of physician dissatisfaction and negatively affect clinician productivity. Making smart EHR optimization decisions before, during, and after implementation can help to reduce frustrations long-term.
Involve all hospital staff — not just leadership — in the EHR selection process
Making the right decision during the EHR selection process can have long-term financial implications that extend far beyond the initial cost of an EHR contract.
A recent JAMIA study found that certain EHR vendors — specifically, Epic, Cerner, and MEDITECH — are associated with higher performance in meaningful use. Given evidence that some EHR systems outperform others in meeting federal reporting requirements, healthcare organizations that select certain systems may be more likely than others to earn incentives.
While earning federal incentives can boost hospital income, many other factors come into play when determining which system is the best fit for a specific practice during EHR selection. Ensuring a high level of user satisfaction is particularly important in avoiding physician burnout.
Engaging all physicians and hospital staff in the EHR selection process (e.g., product demonstrations, site visits) can help to improve provider satisfaction.
When hospital officials at Meritus Health began their own extensive EHR selection process in August of 2017, they made sure to weigh opinions from all staff members before deciding between three potential candidates.
“We had each of the three vendors come in and spend a week doing detailed demos for our team here at Meritus,” said EHR Project Director Joan Hall. “We had very detailed scoring sheets at every demo that we’ve had everybody fill out. We then scored each of the vendors and compared them to each other.”
After considering staff member feedback, Meritus officials completed several focused site visits at hospitals similar to their own. Hospital staff scored each site visit and gave each vendor a final ranking based on all accumulated feedback, as well as the total cost of ownership.
Ultimately, Meritus decided on an Epic EHR, with end-user satisfaction playing a key role in making this determination.
“From a provider standpoint, they looked at what the workflow looked like within the actual computer system and software,” said Chief Transformation Officer Carrie Adams. “They also looked at the availability of information following patient discharge, the ability to look at labs and progress notes, and the ability to follow up easily and quickly.”
Involving all hospital staff in the EHR selection process can provide insight into which system best meets the specific needs of providers in terms of EHR design and functionality, ultimately leading to EHR usability.
Focus on simplicity during EHR implementation
While health IT companies must shoulder part of the blame for complaints about poor EHR usability, there are steps healthcare organizations can take to improve usability during implementation.
At the 2017 ONC Annual Meeting, ONC Chief Medical Officer Andy Gettinger lead a panel of healthcare experts in a discussion about how stakeholders can work together to yield the usability improvements providers have wanted to see for years.
Gettinger opened the discussion by relating EHR usability to a three-legged stool.
“The first leg is what our developer colleagues do when they develop software,” he said. “The second leg is how institutions implement the software. And the third leg is the responsibility we have as users of the software to understand how it works.”
Healthcare organizations can therefore improve usability themselves without waiting on new innovations from health IT developers.
University of Vermont Health Network Interim Chief Nursing Informatics Officer Rebecca Freeman suggested avoiding excessive system customization choices during implementation. Overly-customized systems can muddle and confuse users, she said.
A recent report from Pew Charitable Trusts backs Freeman’s advice. Researchers stated organizations could potentially make changes to a software that are not approved by health IT certification programs.
“These customizations — which may be requested by a health care facility or staff — may not have undergone rigorous testing by the care team or the product developer to detect potential safety concerns,” the research team wrote.
Researchers also advised that healthcare organizations choose the simplest possible EHR design and layout.
“Important design principles include knowing what users need for a simple interface, removing complexity, using simple and clear terminology, emphasizing key elements, and using color effectively to draw users to important areas,” advised report authors.
Cluttered or confusing EHR interfaces can pose a patient safety threat, they stated. Healthcare organizations should ensure providers can find patient information as quickly and easily as possible to avoid EHR use-related errors.
Prioritize EHR tech support during and after implementation
Finally, hospitals and physician practices should ensure adequate EHR system tech support is available to providers during and after implementation.
According to a 2017 Black Book survey, eighty-five percent of surveyed nurses, physicians, and hospital leadership reported that subpar EHR system tech support continually hinders patient care delivery.
Though most healthcare organizations understand the impact of EHR selection and implementation decisions on care delivery, EHR tech support generally ranks low on the priority list for hospital leadership. Survey findings indicated most providers feel their health system’s tech support is lackluster.
While EHR design customization may cause problems, customized EHR tech support can increase the chances of organizational success.
“Customized levels of support to match the client’s organizational needs align clinical collaboration and innovation in ways that clients expect and appear to result in better and faster issue resolutions,” said Black Book Managing Partner Doug Brown.
According to researchers, Cerner was the only health IT company that offered comprehensive, full, four-level technical support with established clients in the second and third quarter of the 2017 fiscal year.
During its Epic EHR launch, Vanderbilt University Medical Center (VUMC) spent millions on “elbow support,” team members wearing gold vests that were on-hand throughout the first month of the system go-live.
“We are spending millions in 'at the elbow support,’” said Health IT Senior Vice President Kevin Johnson. “It has nothing to do with Epic. It has everything to do with changing the engine in mid-flight. We are spending, really, a small amount on the actual software.”
VUMC’s investment in hands-on training and tech support demonstrates the importance of maintaining close ties with a health IT company long after the implementation is completed.
Investing time and resources in EHR optimization during selection, implementation, and beyond can help to avoid the ongoing clinical, financial, and administrative problems that accompany unsatisfactory EHR systems.