Optimizing Office EMRs Principle 1: Know what you want.

Principle 1 of a 12-part series on Optimizing Office EHRs

First, Do No (EHR) Harm

I was with some Family Practice colleagues in late September.  They reminded me how many physicians complain about their electronic health record (EHR) and how it has made their lives more difficult. I wish we invested as much effort in optimizing office EHRs as we do in writing articles on the topic of physicians' dissatisfaction.  In training, we physicians are taught a timeless principle, “Primum non nocere,” which is Latin for “First, do no harm.”  Sometimes I think we ought to demand it of our electronic medical record (EMR) vendors.

The harm part of the EHR comes when a physician (or staff):

  1. Is less efficient than before he/she implemented the EHR.
  2. Is less productive, and therefore less profitable, impacting his/her ability to practice medicine.
  3. Cannot demonstrate that the EHR has improved patient safety and elevated the quality of care that he/she provides to the patients.

I see physicians hating their EMR/EHR. Surveys suggest over 80% of physicians who have an EHR are unhappy with it.  I really cannot blame most of them. However, many don't know what they need to do differently to change it.  I recently helped a practice who had implemented an EHR 8 years earlier, move to full adoption.  It is usually not just one factor holding practices back from success with health IT solutions.  However, there is a process that has helped countless physicians move away from the "harm" and to productive use of the technology. It’s time to share some history and lessons learned.

My EHR experience began with vendor selection in 1992

It’s been 24 years since I converted my family practice office from dictated notes and paper charts to paperless EMR workflow. It was three years before our hospital automated and I had my first e-mail account.

There were only three things I wanted from my EMR workflow:  time, money and peace of mind.

 I was working too many hours, had too many inefficiencies in my office and I wanted to leverage the computer to make my practice safer for my patients.  I was able to achieve those goals very quickly. I also got to observe others who were less successful with the conversion.

By the end of my first few months of implementation, I was typically spending two to three hours per day less in my office. In fact, I typically left the office at 5 PM, with my work done, as the final patient was checking out at the front desk.  It took me less than a year to pay off my investment, and to leverage multiple opportunities for patient safety.

Four years later I had sold my practice and switched my career to informatics.  I think my experiences with an early EMR has guided me on sound principles of implementation and optimization. I have also had the opportunity to assess the efforts of others.  This has allowed me to see some good and many poor EMR implementations. I often see the same mistakes made over and over

Over the next 12 weeks I will cover 12 principles that will help physicians, staff and IT implementers to change their perspectives on the office EHR.  The goal will be to move away from "harm" and into healing. It starts with Principle #1.

Principle #1: Know what you want.

Sometimes EHRs produce the often-repeated self-fulfilling prophecy that it will make the physician work harder, see less patients and distract the physician from giving excellent care. And there is no doubt that a poorly deployed EHR can achieve one or more of these unintended consequences.  Throughout this 12-part series we will provide you tips that will help you to start to turnaround your EHR experience.  The ultimate goal is to improve your efficiency, productivity, profitability and patient safety.  The 12 principles will serve as your building blocks to get there.  Each part will provide some practical tips that you can leverage.

However, nothing in the world will help you overcome your current pain if you do not want to do something different.  You will not act differently if you do not believe you can obtain different results. Let me state 10 common myths of office EHRs that represent some recurring beliefs:

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.

Whether you are a physician, mid-level provider, office staff member or an EHR IT implementer, we hope that our series will help you to create EHR value rather than harm.  And focus on two key attitudes as you review this series:

  1. Don’t try to fix everything at once.
  2. Be an EHR winner and not a victim.

So suspend your disbelief for the next 12 weeks.  I hope I can provide you some actionable ideas that will help you overcome the "harm" of your office EHR.

Action plan for Principle #1:  Know what you want.

Take some time and write out your answers to the questions below:

  1. Which of the 10 myths resonate with my current situation?
  2. How would I prioritize the four improvement goals above?
    1. Efficiency
    2. Productivity
    3. Profitability
    4. Patient Safety
  3. What other goals would I like to achieve in my practice in the next 1-2 years.
  4. What is the biggest obstacle holding me back?

Catch the Introduction for this series:


More on the 12 Principles for Optimizing the Office EHR (Published weekly):

  1. First, do no (EHR) harm
  2. Don’t look back
  3. Where do we begin?
  4. Is your EMR an EHR?
  5. A penny saved, is better than a poke in the eye
  6. Know thyself
  7. “Saved time” will keep up together
  8. Whenever I call you “friend”
  9. Read between the lines
  10. First measure the cost
  11. Eating the elephant one bite at a time
  12. Nothing’s “gonna” stop us now
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If you have an interest in Medication Safety, download the free e-Book: Med Wreck: Proposing a Solution for the Nightmare of Medication Reconciliation available exclusive on our website.

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