Principle 11 of a 12-part series on Optimizing Office EHRs
Eating the Elephant One Bite at a Time
Time to work your plan...
Work your plan to deal with your EHR Elephant in the Waiting Room - Consider eating it one bite at a time.
There's an elephant in your office. 80% of physicians claim the EHR is their biggest disruption. That means only 20% of physicians claim a great office EHR experience. So why only one out of five? Most physicians I know see themselves as leaders, not laggards. What does it take to work your plan to optimize your office EHR? How do you remove the disruption?
Let's consider how we got here. The Health Information Technology for Economic and Clinical Health (HITECH) Act (part of the American Recovery and Reinvestment Act of 2009) brought about a rapid shift to install EHRs as a response to changing Medicare and Medicaid payment models and incentives. The Meaningful Use requirements of HITECH forced hospitals and physicians to not only implement EHRs, but to achieve new levels of patient engagement. This created a lot of change. And everyone was scrambling to implement an EHR. But implementation is not the end; it is near the beginning of the EHR lifecycle:
Select an EHR >> Prepare the EHR >> Implement the EHR >> Stabilize (Resolve immediate issues) >> Adopt & Optimize >> Realize the Benefits of your EHR.
I have a rule of thumb that I share with organizations that want to maximize their EHR investment. The IT team provides the EHR infrastructure for success, but leadership owns adoption and benefits realization. This is true whether you are part of a hospital, health system or single physician office. Principle 11 focuses on seven leadership steps that will get you over the finish line as you work your plan to optimize your office EHR.
Principle #11: Work Your Plan
Work your plan step #1: Have a Written Plan. You cannot optimize your EHR by accident. You need to write down what you want to achieve, when you want to achieve it and why you want to pay the price to achieve it. A written plan will help you:
- Prioritize your efforts.
- Define what you plan to do.
- Create accountabilities for you and your team.
- Define your timeline and milestones for action.
- Estimate the cost of your efforts.
- Refine your goals and how you will measure your success.
Consider using the Action Plan for each of the prior 10 Principles to start your first draft.
Work your plan step #2: Have Measureable Goals. Someone taught me years ago, "A dream without a goal is a fantasy." I found that statement to be true. Goals should be specific, measureable and have a timeline. "I plan to do THIS, to achieve/improve THAT by THEN!" It is amazing how written goals will keep you focused and improve you probability of success. Include these goals in your written plan.
Work your plan step #3: Have a Timeline. I find many physicians are visual learners. Having a graphic timeline displayed on your office wall will remind you every day of your plan, your goals and your timeline. It creates an unspoken sense of accountability - "I say what I mean, and I mean what I say." These statements define your character as a leader. And a timeline on the wall will help you stay the course despite all the many distractions and obstacles along the way. Whenever I build a new informatics team, I make sure they understand my three rules of success regarding deadlines:
- Never miss a deadline. But know that sometimes you will miss deadlines.
- If you think you may miss a deadline, escalate that knowledge immediately. We may be able to mitigate the problem and still meet our deadline.
- If you miss a deadline, and did not escalate that you might miss the deadline, or fail to mention that you have actually missed a deadline that you did not escalate, then we have a serious trust issue and there will be consequences.
Work your plan step #4: Manage Expectations and Accountabilities. You cannot optimize your EHR alone. You will need your team participating. That includes your IT support, your "EHR fixers", your office staff, and of course, yourself. Make sure everyone in your plan knows their responsibilities, your timeline and your goals. Have them sign off on your written plan. Ensure every person knows how his/her effort contributes to the larger success of your EHR optimization plan.
Work your plan step #5: Run 90-day Dashes. This is a critical point that many don't follow. Break your optimization plan into 90-day cycles with goals and consequences. This helps to create a sense of urgency for each 90-day cycle. Though optimization is an ongoing process, you will achieve more in small, focused efforts. Otherwise you will never gain momentum. Distractions will derail your attempts to improve your EHR processes.
Work your plan step #6: Anticipate and Overcome Obstacles. There will be obstacles as you optimize your EHR. However, you can overcome them if you began with a written plan. Be extremely cautious if your EHR vendor tells you that you need to wait for the next version of code. There is so much you can do on your current level of code, as long as you have the correct resources committed to your success. Do not get caught up with the fantasy that the next level of code fixes everything. It never does.
Work your plan step #7: Celebrate your Successes. If you are following the 90-day dash model, then you should have something to celebrate with your team every three months. Make sure you celebrate. This helps to energize you and your team, and build momentum for the next dash.
Include all seven steps in your written plan, put your timeline up on the wall, and start the process. After four 3-month dashes, you can accomplish much each year to benefit you, your practice and your patients.
Action Plan for Principle #11: Work Your Plan
- Review the prior ten principles and determine what changes you would like to make to your EHR, your EHR workflow, and/or your practice.
- Prioritize those changes.
- For each change, write out:
- A title for each change
- A description for each change
- What your want to achieve (goals) and how that would benefit you and your practice.
- The risk of not attempting those goals.
- When you want to achieve those goals
- How you will measure success
- The steps you will follow, and a timeline for achievement.
- Who is responsible for the steps
- The costs (time and money)
- Create four 90-day dashes for the year.
- Write all of this in your plan. Include timelines, accountabilities, dependencies, risks and benefits
- Know how you will communicate your plan to staff and patients.
- Develop a wall graphic to display your timeline.
- Set dates for celebrations.
- Set aside time every 90 days to review your efforts, lessons learned, and refine your plan for the next 90 days.
Good luck. Your EHR elephant awaits.
Catch the Introduction for this series:
More on the 12 Principles for Optimizing the Office EHR (Published weekly):
- Know what you want. See "First, do no (EHR) harm"
- Commit to moving forward. See "Don’t look back"
- See your EHR as a practice improvement activity. See "Where do we begin?"
- Use Your EMR as an EHR. See "Is Your EMR an EHR?
- Eliminate Waste. See "A penny saved, is better than a poke in the eye"
- Make the EHR Work for You. See "Know thyself".
- Reduce Cognitive Load. See “Saved time will keep us together".
- Patient Focused. See "Whenever I call you friend”.
- Rediscover Your EHR. See "Read between the lines".
- Invest for EHR Success. See "First measure the cost".
- Work Your Plan. See "Eating the elephant one bite at a time" on this page.
- Nothing’s “gonna” stop us now.
The 10 Myths of Office EHR
Myth #1: I don't own my EHR, so I cannot fix it.
Myth #2: We have the wrong EHR for my practice.
Myth #3: There is no way the EHR can save me time.
Myth #4: I just need to go back to paper charts.
Myth #5: EHR office notes are never going to be usable.
Myth #6: The EHR cannot make my patients safer.
Myth #7: I don't have the time to fix my EHR.
Myth #8: It's not up to me to fix my EHR.
Myth #9: To use my EHR, I have to see less patients.
Myth #10: You don't understand, my practice is different.