Principle 6 of a 12-part series on Optimizing Office EHRs
Make the EHR work for you, or let it own you!
Too many EHRs are put in for the wrong reason. But frankly, it is very difficult to have an office practice in the 21st century without a basic electronic medical record to hold and manage your patient records. I think it was the Greek philosophers who opined, "Know Thyself". And there has been many applications of "Know Thyself" in the past 2,000 years. So for our purposes, the principle is, you better make the EHR work for you or you will end up working for it!
I like to direct the sixth principle of optimization to the 8th Myth: "It's not up to me to fix my EHR." Well you are right. It's not your job to fix the EHR.
I am hoping, however, that you can use the 12-principles that I'm sharing and work with the "EHR fixer" in your sphere of influence to help you get more efficient and effective. That takes:
- Knowing what you need,
- Communicating your needs, and
- Working with the "EHR fixer" to help you achieve your goals.
I know that is hard. If you can publically complain about your EHR, you will likely find eight out of ten (or more) of your colleagues who agree. But is that the best place to be? Sure you need to ventilate. But if you are reading this series, you are most likely in the group that is sick and tired of his/her situation and would like to know how to make it better.
Let's start with an analogy
Back in the early 1990's I was practicing in Florida and did a lot of minor skin surgery. And we had a lot of technology in our repertoire. Punch biopsies, scalpels, elecrodessicators, cryoguns (like Mr. Freeze on the Batman show), liquid nitrogen and excisional biopsies. The trick was knowing what to do, which technology to use and what to refer (like melanomas and invasive cancers) to my dermatology and plastics colleagues. Yes I had been a surgical physician's assistant prior to med school, but all the technology was evolving and different. Each required its own indication, selection and skills.
I had a colleague introduce me to a new tool that really was great on non-malignant lesions like large warts, plantar warts, and the like, that just won't respond to liquid nitrogen. So I watched all the training videos, and learned to use the equipment. It was really unique technology (today that would be like the various medical lasers) and was so clean and non-scarring (which means scars that are perceived by the unassisted eye.). Anyway, it was awkward the first few times I used it, but eventually became the wonder instrument for many benign lesions with superior cosmetic results.
Eventually, I had a patient who came in with a serious cosmetic issue that had pretty much made him a social outcast for the prior 30 years. He had seen every specialist, had all the advanced treatments at the universities, and nothing solved his problem. As a new patient, it was pretty obvious that this had been a serious issue that no one could solve. So I wasn't ready to even offer that there might be a new solution.
So as I got to know him, I asked him one day if I could try a test removal of a small area of his lesions. He consented, and we did removal of less than 1% of his problem. He had great results, and for the first time in years had hope. My biggest concern was that the problem would recur like it did so many times in the past 30 years.
But over the next few years, I tackled his problem in small approaches, and the effects seem cosmetically wonderful without recurrence. Both of us were so pleased with the results. And with hope, he seemed to really be benefiting from his treatments and how others responded to him. It was so rewarding for me. And it was because I persevered and learned some mastery that benefitted many patients.
I understand the EHR challenges most of us
It's easier to adopt technology when you make the decision to own it. It took me over a year to purchase an EMR in 1993. Many of my colleagues thought it was unnecessary. I believed there were things that could be successfully automated in my workflow. I wanted to take some of the load off my mind and my documentation. Bottom line: I was committed to make it work.
Isn't that true with so many areas of our life. Once we make a deep commitment, everything seems to happen to move us forward. Obstacles fade away. We focus on our goals. We no longer have doubt. We meet each challenge with a need to overcome and conquer. What if you approached your EHR with commitment and zeal for 90 days.
Principle #6: Make the EHR Work for You
Are you "sick and tired of being sick and tired?" For me, I just knew that:
- I could not safely manage the tens of thousands of drug interactions in my little brain.
- Printed prescriptions (way before electronic prescribing) would help the community pharmacists get my patients the correct medication, dose and instructions more than my terrible handwriting.
- Up-to-date problem lists and allergies could be managed electronically on the screen better than on the inside cover of a manila patient chart folder.
- Getting more precise ICD-9 codes to the fifth digit (long before ICD-10) would improve my charge capture and reduce denials.
- I could reduce my "cognitive load" and be less stressed seeing 30-35 patients/day.
I will discuss "cognitive load" in the next part of this series.
Ultimately the ball is in your court. The EHR fixers cannot begin until you move from complaining to asking, "Could you work with me to help me get better using my EHR?" Or perhaps consider, "I am ready to learn one thing this week that will save me a minute on almost every patient." Perhaps you are ready to shadow a colleague, who is in the 20%, and really has figured out how to make the EHR work. When the student is ready, the teacher always seems to appear. So make a commitment, and get started today on how to make the EHR work for you.
Action Plan for Principle #6: Make the EHR Work for You
Take several days to think about this principle and write out your answers to the questions below:
- What tasks in my workflow could be done better by a computer? (And if you say, "nothing", you need to think longer.)
- Who do I know that seems to have the EHR figured out? How could I best learn from my colleague?
- If I invested two hours, to save 1 minute per patient for 80% of my patients, how long would it take me to benefit?
- i.e. How many days does it take me to see 200 patients in my office? (My breakeven for one improvement)
- How many do I see in a year? (My ROI)
- What if I could create 5 of these improvements in the next year?
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 an an EHR. See "Is Your EMR as 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" on this page.
- “Saved time” will keep us together
- Whenever I call you “friend”
- Read between the lines
- First measure the cost
- Eating the elephant one bite at a time
- 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.