Office EHRs and "The Greatest American Hero"
The Power's Unlocked with the Right Instruction Manual
Imagine you come into the possession of an alien suit – a suit of amazing power. But, there’s one catch - you lost the instruction manual. How do you begin to harness these powers? I know you are thinking, “How could I possibly relate Office EHRs and The Greatest American Hero?”
Recently ABC announced a reboot of the memorable 1980’s sitcom, “The Greatest American Hero” (Created by Stephen J. Cannell for ABC Television, 1981-83. The new series casts Hannah Simone (New Girl) in the lead role.). For the sake of those who have never seen this classic, here’s the premise of the original series:
High school teacher Ralph Hinckley (played by William Katt) encounters aliens while on field trip. The aliens give Ralph a super suit that empowers the selected wearer with extraordinary powers. Unfortunately Ralph abruptly loses the instruction manual.
Ralph teams up with veteran FBI Agent Bill Maxwell (A by-the-book character played by Robert Culp). Together they try to save the world with secret missions. All the while, Ralph is stumbling to gain control of his suit’s powers – including flight, invulnerability, great strength and invisibility. Ultimate power in the hands of our hero. If only he could master the suit’s powers...*
* I could go on and on about the great chemistry between Katt, Culp and Connie Sellecca (as Ralph’s girlfriend/eventual spouse Pam Davidson). It’s hard to forget the theme song, Believe It or Not (written by Mike Post and Stephen Geyer), sung by Joey Scarbury. It remains stuck in my head as I construct the analogies between Office EHRs and The Greatest American Hero.
We Need Help For Office EHRs... and The Greatest American Hero May Be a Key
Why do we need a new approach to the office electronic health record (EHR)? 60% of physicians report dissatisfaction with their office EHRs. And it’s getting worse. [LINK HERE to read a review of physicians' Growing Dissatisfaction with Office EHRs].
As a health IT consultant and physician, I typically hear my colleagues voice the following complaints about their office EHRs:
- "We need a new EHR!"
- "The notes I get from other doctors are bloated and worthless."
- "I don’t own my EHR, so I can’t fix it."
- "I am spending more time on the computer and less time with my patients."
- "I’m spending every night and weekend finishing my work."
- "I need more training."
Believe it or not (remember the theme song), these all have an element of truth. Yet they represent beliefs that hold many physicians back from overcoming them. Maybe we can tackle these challenges with super suit powers… and unlock the power of the EHR for every physician office.
Making the Connection Between Office EHRs and The Greatest American Hero...
"We need a new EHR!" – Flight & Super Strength
What we really need is more physician productivity. We need them to more efficiently fly through their day – not pulled down by redundant work. Super Strength comes as the office staff leverages the EHR as a team. There is no redundant workflow. Everyone works at the “top” of his or her license and skills.
Many fall into the trap thinking that a new EHR or a “code upgrade” will solve the issue. It is very expensive to change your EHR. Instead it makes sense for offices to take the time to learn how to:
- Leverage the EHR for program requirements (like Medicare Quality Payment Program) and opportunities.
- Set up automated reminders for disease management, preventive maintenance, and population health.
- Use clinical decision support (CDS) rules to manage repetitive tasks and delegation to staff members.
"The notes I get from other doctors are bloated and worthless" – Telepathy
No one wants to read bloated notes. Notes should quickly communicate “the story of the patient.” We need to communicate with less words, and more content and context. We don’t have the power of telepathy to help us discern exactly what we need to know during each visit. But much of the EHR physician documentation today seems to actually impede the seamless transfer of information from author to reader.
Many physicians are using templates to regurgitate minutia into their notes - to the point that it is often difficult to ascertain what is actually going on with the patient. Even within their own practices, physicians are spending too much time each follow-up visit trying to recall the important patient history.
This “note bloat” phenomenon can be solved. Physicians can be coached to use their encounter notes to tell the “story of the patient.” Two objectives are critical:
- Using staff and auto-documentation in a way that no one is ever re-entering information already in the record, and
- Including narrative details in each note that will capture the essence of the visit and serve as both a reminder and time-saver at follow-up.
"I don’t own my EHR, so I can’t fix it." – Use your sidekick
You probably don’t own an ultrasound or a reference lab. Yet, you quickly figure out how to get these tools to work for you. Articulate your expectations to the “owners” and get them aligned with your needs. Ralph couldn’t be successful without the encouragement and skills of Bill Maxwell, his trusty sidekick.
If you don’t own your EHR, then figure out what you and your staff need. Then dialogue with the people that can help achieve your goals (I like to call these “the EHR Fixers”.). Find your “EHR Fixer” sidekick. Put on the super suit, set your expectations, and work with a person who knows what your EHR can do. Let him or her help you become more productive with your EHR. Define a problem to solve, and let them join you in finding a better way.
"I am spending more time on the computer and less time with my patients." – Invulnerability
I observe too many physicians suffering from the arrows of inefficiency, the wounds of frustration and the risk of burn-out. We all are vulnerable to work bleeding over into our personal and family time. You can don the suit of invulnerability, and minimize these problems.
It is discouraging to personally observe so many physicians who don’t understand how to best leverage the EHR inside and outside of the exam room. Ensure that it doesn’t dilute the patient experience – and that it isn’t distracting from safe, effective care. Make sure it adds value to patient care…
Physicians can do learn to do that today. There are several success factors, as one learns how to:
- Review the chart to set the stage prior to walking into the exam room.
- Make the patient (not the EHR) the focus in the exam room.
- Leverage the time documenting in the EHR as valuable physician-patient “face time”.
- Document with an intentional goal to facilitate the next visit (whether by you, or an associate) in both content and structure of your notes.
- Finish notes real-time and avoid cognitive waste - it takes twice as much, or more, to document the visit later, through recall, at the end of day.
"I’m spending every night and weekend finishing my work." – Use all your powers
I see too many physicians who transitioned to the EHR, yet tried to hang on to their old workflows. Why have a super suit if you aren’t going to wear it and use it? Many physicians and staff learn to master office EHRs. And The Greatest American Hero approach can help others unlock the potential.
Many do not have a framework for keeping up with office notes throughout their day. They didn’t do it when they dictated either, so the EHR just magnifies the problem. They don’t realize the cost to their day as their staff interrupts them with questions that would be unnecessary if the records were all up to date.
Many physicians miss opportunities to delegate tasks to staff. Incorporating patient reported outcomes and staff documentation into notes can prevent redundant physician efforts. Clinical decision support algorithms (CDS rules) can often redirect work such as routine refill requests, population management and follow up “recall” appointments.
The EHR should also be an important (but not only) source of documentation for MIPS reporting and future APM (Advanced Payment Model) incentives.
"I need more training." – Make Your Own Instruction Manual
Most EHR training during implementation is done around features and functions of the EMR. This is the most we can expect from EHR vendors and non-physician trainers. It’s a good thing if you lost their instruction manual! You need a new one. End your dissatisfaction with office EHRs. And The Greatest American Hero analogy can help.
The physician and staff working together can determine the best way to leverage their EHR to improve office productivity for everyone. There is not a “one size fits all solution.”
Physicians benefit first by determining what they need the EMR to do, how they want their workflow to occur, and how best to accomplish that in their typical day. Physicians should first ask WHY the EHR must become an important office asset, HOW the EHR will help them achieve their personal goals, and only then, WHAT they need to know to be successful. Training is never the starting point of successful EHR use. If the physician knows the WHY, the right training will be prescriptive - not generic.
The bottom line between Office EHRs and The Greatest American Hero – OWN the instruction manual for you and your staff!
It is time for a paradigm shift from physician EHR dissatisfaction to a renewed focus on three areas of EHR Return on Investment:
- Money, and
- Peace of Mind.
EHRs are critical to meet the needs of 21st century care and reimbursement models. There are better ways to use Office EHRs. And The Greatest American Hero can help. Physicians and their office staff can leverage their EHRs, to:
- Improve personal and staff productivity,
- Create Practice Improvement Activities under Medicare’s merit-based incentive payment system (MIPS),
- Better align to patient-centered medical homes (PCMH) and other shared-services models,
- Adopt new alternative payment models (APMs),
- Increase patient and physician satisfaction,
- Improve chronic care management,
- Promote better health of specific populations, and
- Get the most out of their EHR investment.
This is not just about EMR training. It begins with “change leadership” principles. It moves to influencing beliefs, so that physicians and their staff can best understand how to reframe their EHR as a valuable asset in both word and action. The journey needs to lead them through the process of awareness, self-assessment, adoption, and action on specific ideas… that they can apply to their own unique situations.
The answer is not to have physicians struggle like Ralph Hinckley - trying to unlock the EHR powers through trial and error. Physicians need not wait for the EHR vendors to figure it out. They need to abandon the delusion (held by some vendors and users) that the next EHR upgrade will solve the problem… or that EHRs will go away.
It's time to reconsider office EHRs and The Greatest American Hero. Be sure to leverage the 12 principles of Office EHR Optimization.
Believe it or not, it’s time to put on the super suit, and unlock the EHR powers for every physician office.