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Curbside Consult with Dr. Jayne 5/5/14

May 5, 2014 Dr. Jayne 2 Comments

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It’s time for another update in my ongoing saga about the physician group that our health system purchased. We’re in the process of preparing them to upgrade to the 2014-certified version of their EHR software. Initially, they balked at any suggestion of retiring their custom content. Our team has been diligently working on them and has convinced them to agree to approximately half of our recommendations.

At this point and given their resistance, I can get on board with half. It’s certainly more than none. Through discussion of their actual needs and observing their workflow, we’ve even identified a handful of customizations that we’re going to advocate that our vendor incorporate into the product out of the box. Ultimately, what allowed us to get the agreement we achieved was the idea they will be piloting the changes for a couple of months after the upgrade and then we’ll revisit them.

We added the pilot approach when we sensed they were stuck in analysis paralysis. The reluctance of the identified physician champions to make decisions was palpable. They feared backlash from their colleagues and claimed to be unable to reach consensus.

I’ve been through this enough times to know what kinds of darts their colleagues might start throwing, so I was happy to offer myself as a virtual human shield. If using the larger health system as the scapegoat for required change is what it takes to move them ahead, so be it.

Now that the decisions are made, it’s time to get their build underway and start preparations for testing and training sessions. I’m grateful the build will be fairly easy. Although large in number, most of the customizations are very easy. If we get in a bind on the timeline, we can always bring in contractors to knock it out quickly. As for the testing requirements, though, I think we’re going to be in for another fight.

Typically we bring in key end users to help us with testing. That way we can ensure that any unusual workflows they’ve come up with get put through their paces using the new software. Over time, we’ve aggregated many of these scenarios for our physicians into test scripts that our analysts can use to replicate their workflows.

The new group is a little bit of a mystery. though. I’m sure there are plenty of aberrant workflows we’ve yet to discover, so having access to their actual staff will be essential.

As we suspected, they didn’t want to let us pull anyone out of the offices or create a situation where overtime might be needed, so we had to get a little creative. I was able to pull together data from our previous go-lives and upgrades and convince them that if they let us leverage the users now, they will need less training right before the upgrade.

It still seems somewhat contrived that we have to produce data to convince them of a proven solution. I just have to keep reminding myself that they’ve come under our umbrella under circumstances that were less than willing.

I know there will be culture shock when they experience our training program as well. We require not only attendance, but participation in our sessions. Users are expected to demonstrate competency before they are signed off.

We use both written and practical evaluations for non-provider users. Providers are expected to demonstrate mastery by replicating 15-20 past patient encounters in the new system. Ideally I’d like to get them to do more, but we’ve found that’s about all we can get them to agree to.

We find that when users have completed a certain number of scenarios, they are able to get back up to speed more quickly in the days following the upgrade. It’s not rocket science – it’s a simple matter of practice.

Nevertheless, we often have physicians who fight us about the need to practice. It’s difficult to help them understand that documenting quickly and accurately in EHR while preserving the integrity of the patient visit is a skill, just like anything else they do. They wouldn’t try a new procedure on a patient without supervised practice.

Some of them try to tell us that they didn’t need any special training to document on paper. Although I’d agree that they didn’t need “special” training, they did need training. As medical students, we wrote hundreds if not thousands of patient notes, notes that were critiqued by our interns, residents, and attendings. Those of us in employed practice models had our notes further critiqued by coding and compliance auditors as well.

We plan to have our first testing and training event in a few weeks. We’re bringing in the non-physician staff first and will do our best to make the sessions not only educational, but fun and interactive. By winning their hearts and minds, it should make for an easier battle when it’s time to address the physicians.

I always like to bring homemade goodies to user events and this won’t be any exception. Right now this quick bread (made with an insane amount of butter, sugar, and sour cream) is a leading contender. Despite the calorie count, I can at least pretend it’s a health food. After all, it’s got bananas — how can it not be?

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2 Responses to “Curbside Consult with Dr. Jayne 5/5/14”

  1. 1
    Daddio62 Says:

    “Nevertheless, we often have physicians who fight us about the need to practice. It’s difficult to help them understand that documenting quickly and accurately in EHR while preserving the integrity of the patient visit is a skill, just like anything else they do. They wouldn’t try a new procedure on a patient without supervised practice.”

    This is an excellent line of reasoning which I am going to use when working with physicians on my next project.

  2. 2
    Anonymous Says:

    It is brilliant, it generate ideas for proceeding

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