Curbside Consult with Dr. Jayne 9/20/21

I was recently invited to join a physician forum centered on EHR optimization. It sounded like a great opportunity to share what I know about getting the most out of your EHR and to help colleagues who might not have access to clinical informaticists.

I decided to familiarize myself with the group by going through old posts and was surprised at how many physicians had posted questions that didn’t receive any responses. I felt bad for those docs, sending their questions into the wind without anyone answering. I wish I would have been there for many of them because it would have been easy to point people in the right direction at the time. Here are some of the main themes that we as tech enablers should be aware of:

First, despite what we might think at times, physicians often want to learn more about what they can do with their EHRs and want to be better users. However, they might not understand the resources that are available to them, even if they are free or included in the cost of their system. There were a number of highly specific questions about a particular EHR, such as “How do I document XYZ procedure in my EHR?” Those were the types of questions that most frequently went unanswered by the forum. In my experience as an EHR champion, they would have been easy questions to answer had the physician contacted the EHR vendor’s help desk or online help mechanisms.

I’ve done consulting work for several of the vendors mentioned and they all have robust help desks and client support structures, and one has a lot of searchable hands-on videos that would have answered the questions. I can only guess that the physician didn’t know how to contact the vendor. Perhaps they are an employed physician and their organization’s internal help desk didn’t give them the assistance they needed, or maybe they’re part of a group where a managing partner or office manager tightly controls the information. I felt bad for them though, wondering if they ever found answers to their documentation questions.

Second, many of the physicians showed a high level of interest in ideas that went way beyond EHR optimization. One hot topic on the forum was that of bias in artificial intelligence. The discussion also covered ways that physicians could advocate to their institutions to try to minimize bias in their systems. Of course, this topic is likely much more relevant to those at academic medical centers rather than small primary care practices, but it certainly got a lot of conversation. Physicians care deeply about whether technical systems could be harming their patients and want to know more about predictive rules or algorithms that they might be presented with.

Third, the physicians were vocal about how vendors, including EHR and third-party vendors, might be using their patients’ data for profit. There was a near-universal lack of enthusiasm for cloud-based patient data being sold, whether it was for research or not. One particularly spirited discussion revolved around an EHR vendor who was alleged to have sold patient data to a nutrition and supplement vendor. Whether it’s explicitly allowed in a vendor contract or not, the physicians had negative feelings about anyone profiting off of their patients. There was particular opposition to the supplement vendor since supplements are not regulated by the US Food and Drug Administration. It’s also a $40 billion industry that causes a lot of confusion for patients and may require physicians to spend significant time on counseling and education, so I can see why they felt this way.

Overall, it looks like an interesting opportunity to be able to contribute, so I am looking forward to the next round of posts and seeing if I can be of assistance. Hopefully their moderators will be more flexible than those of a group I tried to participate in last year – I was kicked out of the group for “self-promotion” for mentioning that I worked for a chatbot vendor while answering a question about chatbots. Never mind the fact that I never mentioned the name of the company I was working for and didn’t try to solicit business, or that I was simply trying to establish credibility and provide transparency before giving a very specific answer to a question. It’s always interesting to see how these groups police themselves, so we’ll have to see how the new one runs.

Other than my foray into the physician forum, I spent most of the weekend heads-down on a big client project. They’re getting ready to go live with some new content this week and didn’t finish building it until Thursday afternoon. They had hired me to do their user acceptance testing so their crunch time became my crunch for the weekend.

Typically, I encourage organizations like theirs to have their actual end users participate in user acceptance testing, because only their end users know what their daily workflows look like. We all know that users are creative, and depending on the number of workarounds in a given system, they might not follow the prescribed workflows all the time if at all. I’m more than capable of testing the new content against the organization’s published best practice workflows, but even if everything passes my review, there is still a risk that they might have broken a workflow that they didn’t even know was in use.

“Document, document, document” is my middle name these days, so if things do go awry, I will have plenty of backup for the fact that I warned them that their plan was not ideal. So far, nearly everything I’ve tested has met the specifications although I’ve found some issues with the training materials and documentation that need to be addressed before go-live. They’re going to have the virtual equivalent of a fat stack of markups waiting for them when they arrive Monday morning, so I hope they had a restful weekend. I’m sure they’ll be throwing it back over the fence to me shortly thereafter, so I’m going to spend Monday resting up myself.

When’s the last time you had to work on a crunch time project? What’s your beverage of choice for all-nighters? Leave a comment or email me.

Email Dr. Jayne.