I’ve seen a lot of articles lately about physicians who are unhappy with their EHRs because they feel they’re being forced to collect too much meaningless data and to do “too many clicks.” I read most of them to see if I can pick up any pearls that will help my physicians and also to prepare counter-arguments for when my colleagues email me links to those articles.
I’ve used quite a few different systems and each has its own little annoyances. Physicians always seem to think the grass is going to be greener on the other side of the fence. If I had a dollar for every time I’ve heard someone say, “It would be so much better if we just had System X,” I could retire much sooner than currently planned.
I know I have a fair number readers who are CMIOs, medical directors, CMOs, or EHR champions. There are quite a few physician leaders I know who are new to the EHR game and haven’t quite figured out all their responses yet, so I wanted to share some of mine. These should also be helpful to anyone who has to work with physicians, train them, or manage physician practices. Vendors might want to take note as well and incorporate some of these elements into their implementation and optimization strategies.
When physicians complain about entry of discrete data, I like to ask them specifically what data fields they are referencing. Our organization has a pretty liberal policy about using free text or voice recognition to enter data in certain parts of the chart. For example, users can enter the patient’s History of Present Illness (why they are seeking care and how their condition has progressed) in a non-discrete way. No drop downs, no picklists, no checkboxes, if that’s how they want it. When you dig deeper, many of the fields they are complaining about are those that are required for Meaningful Use, quality initiatives, or important things like drug-allergy checking. They are often fields that do not specifically require physician entry.
We created a matrix of required data and documented which staff members could be authorized to enter the data after appropriate training. It also includes directions on where and when it should be done in the flow of the patient visit. For example, the patient’s pharmacy and HIPAA contact preferences can be entered by the front desk check-in staff. Neither data element requires clinical training or expertise, just access to the right screens. If a physician has to enter the pharmacy name (and it’s not because the patient changed his or her mind at the last minute regarding where the prescription should be sent) this is a systems and workflow failure, not a “terrible EHR.”
The matrix also explains specifically why each data element must be collected, what our organization plans to do with it, and how it benefits patient care. This has been a helpful reminder for many of our physicians as well as new information for those …read more