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Readers Write: The Secret to Engaged Physicians at Go-Live: Personalize the EHR
The Secret to Engaged Physicians at Go-Live: Personalize the EHR
By Dan Clark, RN
Dan Clark RN, MBA is senior vice-president of consulting at Advisory Board.
I often compare an EHR implementation and go-live to getting a new smart phone. Out of the box, it’s a powerful tool, but it doesn’t truly become effective until you start to download applications, add your email and contacts, and pick a personal picture as your background.
Just like your new smart phone, EHRs aren’t ready to perform at their best out of the box and always require some degree of personalization. EHR personalization may sound like one more step in a long, multi-staged implementation and go-live, but it can often be the difference between adoption and rejection.
New technology will always be a disruption, but personalization can minimize a new EHR’s negative impact on patient care by matching new tech to existing clinical workflow, not vice versa. While it’s important to focus on “speed to value” with a new EHR, health systems that take the time to personalize workflows for specialties and individual providers typically see a much higher rate of adoption and a quicker return to pre-go-live productivity.
Health systems should consider a multi-layered approach to personalization. At the very least, health systems should design technology that aligns the EHR to serve high-level strategic goals, such as quality reporting and provider productivity expectations.
When it comes to the individual user level, almost every health system starts with didactic classroom trainings that may combine users from a variety of different clinical and administrative areas. While this is a good baseline, it’s challenging to teach a course that applies to doctors and nurses, front office staff, and revenue cycle alike. Physicians, specifically, report that these sessions take time away from their patients and don’t always provide the value they are hoping they will.
Because of this, one-on-one opportunities for personalization are most efficient and have the biggest impact. I typically see health systems tackle one-on-one personalization support in a couple of ways. The first is setting up a personalization lab. Prior to go-live, we set up a 24/7 personalization lab right in the physician’s office or hospital. This gives clinicians the opportunity to stop in with ad hoc questions, or better yet, make a formal appointment with a clinical EHR expert. These sessions are guided by an extensive checklist of EHR personalization options, fine-tuning everything to the clinician’s preference and specialty.
One orthopedic surgeon came back to the personalization lab four times, and that was after she had already completed the classroom training. We worked with her to personalize specific workflows, order sets, and even simple things like page setup in the EHR.
Personalization serves as just-in-time training and is usually well received by the clinicians. Sometimes this training takes the form of a mobile workstation in the hallways that caters to clinicians’ in-the-moment questions during their breaks and doesn’t pull them away from patients. This kind of assistance is also usually well received by clinicians since it gives them a chance to ask a question about a real patient scenario.
The trick to getting EHR and go-live training right, in any scenario, is to provide the right support—other clinicians who will stand at the elbow with the providers as they navigate real scenarios and issues. And staffing your personalization lab with clinicians will give you the best bang for your buck, providing your staff with clinical and technical expertise. Trainers that combine EHR acumen with clinical expertise and knowledge of appropriate workflows can help clinicians hard code best practices into the technology in a way a technical expert may not.
EHR go-live is an anxiety-ridden time for all health system staff, clinicians and non-clinicians alike. It’s important that all staff feel they have the support, training, and preparation to use the EHR to its fullest potential to impact patient care.
You said, and rightly so, ” It’s important that all staff feel they have the support, training, and preparation to use the EHR to its fullest potential to impact patient care.” The element that seems to be missing is motivation. Newer physicians are of course much better at adopting technology but there are still holdouts and I’d go so far as to say we still have many holdouts in adopting healthcare technology. As an industry, we spend extraordinary amounts of time talking about how to get patients engaged and the conversation sometimes comes around to something along the lines of applying financial consequences to making poor health choices because hitting people in their wallets seems to be a motivator but even that doesn’t last as people frequently revert to previous poor choices.
Workplace wellness programs show recent evidence that already healthy people are the most active participants even when there is a small pot of cash (incentive) to be earned for demonstrating healthy behaviors for anyone participating. Similarly, providers will leave incentives on the table all day long but if you send along a negative payment adjustment, providers will roar for more time. (see the transitional year(s) light requirements to avoid the negative payment adjustment for MIPS). In the sticks and carrots analogy, carrots don’t seem to work in healthcare. So while I agree that that suggestions in this post regarding support and preparation are important, it seems that we haven’t yet figured out how to properly motivate.