Optimizing Office EMRs Principle 2: Commit to Moving Forward

Principle 2 of a 12-part series...

Don't Look Back

Commit a Plan for Moving Forward...

Don't look back! If you want an electronic health record (EHR) that adds value to your practice and to your users, then commit to moving forward.  You will not be successful living in the past.  We are beyond a time in healthcare where you can be optimally profitable and viable without an EHR. So it is time to make a commitment to accept that you have an EHR and determine how best to get value for yourself and the other users.

There may be some myths holding you back...

When I first deployed an electronic medical record (EMR) in 1993, I made the decision to leverage it every way possible. Today, when I am called to optimize or even "turn around" an existing EMR, I often find resistance from one or more physician users. Often resistance includes some of the 10 myths listed in Part 1:

  • Myth #1:  I don't own my EHR, so I cannot fix it.
  • Myth #2: We have the wrong EHR for my practice.
  • Myth #4:  I just need to go back to paper charts.
  • 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.

As a consultant, there are several things I want to know about the users prior to EHR Optimization:

  1. What value do they desire from their EHR?
  2. How are they using the EHR in their current patient care activity?
  3. What are their beliefs about their EHR/EMR?
  4. What are the "pebbles in their shoes" (i.e. the little annoyances) they experience in their EHR-enabled day?

(NOTE:  I will continue to distinguish between EMR (the physical technology) and the EHR (the content and workflow tools which include the EMR and sometimes other platforms. I will discuss this more in Part 4.).

I think it is helpful to cover each myth, with an affirmation (in bold) to overcome each myth. Then, you can create an action plan for this principle.

Myth #1:  I don't own my EHR, so I cannot fix it.

Compass Needle pointing to Commitment
Optimizing your office EHR begins with your commitment to success.

Whether you purchased the EHR yourself, or it was provided to you by your employer, you OWN your EHR.  And by that I mean you OWN your success or failure within your medical practice.  The demands of a medical practice seem to grow every year.  Successful practices today must provide evidence-based care, meet regulatory and payor requirements and achieve patient and staff satisfaction.

The physician, whether sole proprietor or employee, is the quarterback of the practice.  He/she sets the tone and pace for everyone else. If you are employed, your "boss" still wants you to be efficient, effective, safe, accessible, profitable, compliant and satisfied.  So remember the words of Henry Ford, "If you think you can, or you think you can't, you're right!"  Throughout this series, you should find some ideas that you can implement within your practice.  Many of these will not "cost" you redesign or major investment. Your staff and your "boss" want you to be successful.

Myth #2: We have the wrong EHR for my practice.

While some specialties are best served by specific workflow tools, most modern-day EMRs can be used effectively by most users.  Overcoming the myth begins with the affirmation, "I use my EHR to get the maximum value for my practice." This will start with the action plan in part 1 of determining what you want, and then determining goals and actions to achieve the results.

Once you have some written goals, determine the following:

  • Do I know how to best use my EHR to achieve my goal or do I need additional training?
  • Am I using all the tools available in my EHR that I could be using?
  • Is there someone in my specialty more efficient than me that I can observe?
  • What are the things I do frequently that I have not leveraged in the EHR?
  • Do I have the orders and documentation tools that I need for my most common visits?

Often you can work with your local IT resource to get valuable tips and tricks or to conduct some research with your EMR vendor regarding your needs.  Everyone likes to help someone on a personal mission to improve.

Myth #4:  I just need to go back to paper charts.

There is a reason you are on an EHR.  You or someone else made a major investment.  If you take Medicare or Medicaid, you suffer payment reductions without an EHR. Other payors may penalize you as well.  If you are in an Accountable Care Organization (ACO) or participate as a Patient-Centered Medical Healthcare Home (PCMH) you probably need your digital data for submitting analytics.  And the penalties for not using an EHR will continue to climb.  So going back to paper charts or not using an EHR is not warranted.  So the affirmation for your office is, "We're moving forward with our EHR. We're going to make it work for us!"

Myth #7: I don't have the time to fix my EHR.

My gold standard is that your EMR should save you 2-3 hours/day, which is what I experienced in 1993.  Working an average of 22 days a month, that was over 50 hours/month. As you achieve better efficiency, the payback will occur for the rest of your career.

Myth #8:  It's not up to me to fix my EHR.

Of course it is not up to you to fix your EHR.  But consider this.  Your support person(s) loves to help those who are open to it.  In my experience, if you approach your support person with a request to work along side to find opportunities to improve your efficiency, you probably will find a willing partner for improvement.  More solutions are open to those seeking them than to those with closed minds.

Myth #9:  To use my EHR, I have to see less patients.

Actually your goal is to see more patients in the same time as before, or to see the same number as before in less time.  Set one of these for your goal, then go through the steps of this 12-part series and decide which outcome you desire.

Myth #10: You don't understand, my practice is different.

Actually, I do understand.  Every practice is different.  And too often we use cookie cutter approaches to implement EHRs and then wonder why so many struggle.  Personally I want to create the ideal partnership:

  • The brilliant physician who best knows his/her practice, with
  • The EHR supporter who best understands  how successful physicians and providers leverage it for success.

As these two skill sets work together with common goals, we are likely to achieve success rather than failure.  It is hard to achieve success when half of the partnership fails to be "all in" or doesn't commit to the effort.

If you are not seeing success with your office EHR, commit to complete this series and set some personal goals to improve. You will be more successful if you determine several specific goals, the value of each, and develop an action plan.

Finding your value statement(s)

This week's activity will help you determine if there are beliefs that my be holding you back.  If there are, then decide instead to focus on your value statements: What you want and When you want it.  If you are a physician, you know that any treatment plan first begins with a good working diagnosis.  Then apply treatments that have worked for others in the past with the expectation for success.  As we proceed with the series, you will want to do the weekly exercises and tweak the plan until you achieve the outcomes you determine.  If you have any questions, email me at psmith@HealthITAccelerator.com.

Action plan for Principle #2:  Don't look back.

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

  1. Have I (or the person I'm helping) fully accepted my EHR?
  2. Am I moving forward with an expectation of success?  If not, can I suspend my disbelief and move forward despite my current situation?
  3. What value do I get/expect from my EHR?
  4. On a scale of 1-10, with 10 the highest:
    1. How am I doing on the value/benefits I expect/need?
    2. How proficient am I using my EHR?
  5. What specific measureable goal would I like to achieve in the next 30 days?
  6. How would I measure my baseline and my achievement of that goal at 30 days, three months and one year?
  7. What is the biggest obstacle holding me back?


Whether you are a physician, mid-level provider, office staff or IT support, learn the steps to improving the office EHR.

Catch the Introduction for this series:


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

  1. Know what you want.
  2. Commit to moving forward.
    • See "Don’t look back." on this page.
  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 us 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

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.

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