Let’s face it: doctors don’t like documentation requirements no matter what form they take. Remember back to the days of paper charts for a moment, because you hated those too — piles of them on your desk and sometimes on the office floor, reminding you of the visits you still needed to remember and document.
The Electronic Health Record takes away the piles, but puts a whole bunch of new stresses on us to keep our charts complete. Are things worse than in the days of paper? A significant number of physicians say yes.
Here is what a recent AmericanEHR survey learned in 2012:
~ 39% of doctors would not recommend their EHR to a colleague
~ 34% were very dissatisfied with their EHR’s ability to decrease workload
~ 32 % had not “returned to normal productivity” since EHR implementation
~ 37% were dissatisfied with their EHR’s ease of use
~ And every time physicians are surveyed about stress and burnout … documentation and EHR workload make the top 5 list
In my work with hundreds of overstressed doctors, many of whom blame their EHR for much of their burnout, I have noticed three areas where a slight change of attitude and focus can make a huge change in the quality of your documentation and take a lot of the struggle out of your work day.
1) Don’t Be a Hater
One of the biggest problems with EHR implementation is our attitude toward the technology. We treat the computer and the programs as if they rose from the very fires of hell to torment us. This blaming and hatred produces a very interesting behavior.
We fail to embrace the technology and never learn how to use it well.
Let me ask you a question. Do you really think the EHR is going away? This is the future. If you don’t embrace it and learn to be an expert at it … you are only guaranteeing you will struggle. Here is an important mantra to adopt:
Every User Should Be a POWER USER
There are three ways to become a Power User:
a) Take all the training your vendor gives you – twice. Make sure your nurses and receptionist do too. Learn everything there is to learn from the vendor’s trainings and realize that is just a basic foundation.
b) Develop every single ounce of the customization options for your software so that it matches your personal practice:
Templates
Quick Keys
Any type of templated automatic entry the system is capable of
Take the time to match as much automation as you can to the diagnoses, procedures and patient encounters you see the most in your practice.
Any time you find yourself doing the same keystrokes or typing our mouse patterns (the “broken record”) that is a cry to customize that piece of your EHR to automate that sequence
c) Study your existing Power Users
Who are the people in your practice that DO NOT COMPLAIN about the EHR?
Who are the doctors/nurses/receptionists that everyone acknowledges are the existing Power Users in your practice?
Sit just over their shoulder – the way an umpire in the major leagues leans on the back of the catcher – and watch exactly what they do when they are charting. If that means you accompany them into the exam room … so be it.
And don’t ask them what their favorite shortcuts are … have them show you EXACTLY what they are doing that makes it looks easy. Then you do that too.
Just one tip from a Power User colleague can make a huge difference in each patient encounter.
2) End the Death Match
Many doctors overlay the new documentation requirements of the EHR on top of their paper chart patient flow process. You change your documentation to EHR and then try to jam it into a patient flow process that you perfected in the days of Paper Charts. Don’t do that. This sets up a Death Match between your old flow systems and your new EHR.
The Death Match dynamic magnifies the frustration and struggle for everyone involved.
Meld the two, don’t make them duke it out. Look for ways you can alter the way you see patients so the EHR documentation is built into your patient flow.
You will have to alter your patient flow processes to accommodate the EHR. Accept it. Notice the ways you see patients that get in the way of EHR charting and brainstorm ideas on how to meld the two. And please don’t think you have to come up with all the answers here. Because solution #3 is just around the corner.
3) Use Your Team
EHR implementation is the perfect time to rise above your Lone Ranger Programming and utilize all the brainstorming power of your patient care team. Gather your receptionist and nurse (or anyone who is involved in your patient flow before and after you see them) and get everyone’s ideas on how to refine the process.
This involves you stepping out of the traditional doctor leadership paradigm as the person with the answers who “gives orders” to the team. Here you are asking powerful, open ended questions that start with the words What or How. Here are some examples.
~ What do you see me doing that I can stop – or you can do better?
~ What ideas do you have on how we can do things differently to make documentation easier?
~ How can we share the charting activities more effectively?
In most cases your team has important ideas they have not shared with you because you have not given them the green light in this way.
There you have it:
1) Don’t be a Hater – Become a Power User instead
2) End the Death Match – and meld your Patient Flow and Documentation Systems
3) Use your Team – Tap Everyone’s Skills and Experience
PLEASE LEAVE A COMMENT on your experience with EHR Implementation, especially the tools that have worked for you.
Here is a link to an EHR Implementation success story in a rural, solo practice in Wisconsin from this weeks Medical Economics Magazine.