In January of 2013, the United States healthcare system spent about $2.8 billion on healthcare IT. In January of 2018, that number increased by 2.5 times up to $7.1 billion – mostly on EHR investments[1].

What problems are we supposed to be solving with that spend? Adhering to government regulations, improving quality, increased patient care, singular records, and interoperability? Whatever the reason, there is a common problem undermining the incredible investment made into the EHR market: physician dissatisfaction.

KLAS® has recently reported that of close to 8,000 Physicians recently surveyed, 43% were overall dissatisfied with their EHR experience. And this is not simply due to the clicks but because of a greater systemic issue of the perception of having lost control over the care they were trained to deliver as well as a perception that they cannot improve their current situation. It’s not only about the perceived lack of usability of the EMR’s, but how can healthcare organizations make their EHR investments consistently successful for their clinicians.[2]

So, let’s take a moment to highlight the emotional current state vs ideal state of EHR usage while targeting some tactics we can do differently to enhance usability, acceptance, and impact.

Common EHR emotions include:

  1. Stupidity: I was barely trained and don’t know how to use this software
  2. Disconnect: The software is not personalized. What’s in it for me and my patients?
  3. Hopelessness: Nothing is going to change. We use it to use it. No one cares about why I’m not happy.

Building upon the secrets of motivation[3] and applying those to an EHR, we need to challenge our internal culture and governance to develop a foundation based on teamwork, trust, and training that fuels the fire of:

  1. Autonomy: I am involved in this EHR – be it decision making, design, build, testing, outcomes reasoning, disease management impact, specialty-specific impact, etc
  2. Mastery: I want to get better with using this EHR. I have the visibility to transparent and trusted metrics that illustrate my impact to the EHR, and to how my patients are better served by the EHR
  3. Purpose: I know why I am using this EHR. The purpose must be tangible at the local level. Not why do I have to use it, but what is it going to do for me? For the broader vision, do we recognize that we are a part of something much greater?

At the end of the day, behind the various EHR’s, we are dealing with just “0’s” and “1’s” despite the incredible price variances. What is unique is how the health system is positioned to take advantage of and realize the purpose of the EHR. Now it’s time to rethink how we truly change the adoptability of the EHR.

  1. Clinician Decision Making
    • A no-brainer, right?
    • It’s time to break down the Silo’s – this is not, nor has it ever been an IT project
    • The governance must be CEO / Board / Executive Team developed & championed by all leaders – with a culture of commitment and collaboration designed for innovation, change, and transformation
    • Autonomy and Mastery
  2. Training
    • Have you heard that Doctor’s must be trained very quickly and in small segments? “Here’s a few 7 minute videos to watch at your leisure before we go live.” “Call the help desk if you have questions.” Simply put – this does work.
    • Within the Arch Collective, it was found that successful organizations spend 6 or more hours on each new physician training them on the EHR, its purpose, your role, and how to leverage the EHR to be a better Doctor – taught by clinicians.
    • These same organizations provide continual training opportunities for Physicians to further empower them on their usage under a continual workflow improvement campaign – based in metrics and transparent information provided to the Doctor’s
  3. Personalization
    • Do you have a smartphone? How long did you spend personalizing your smartphone to make it work for you? Would you be upset if your personalized settings were reset back to the manufacturer’s settings? The phone would still work though – just not as well as it could – for you.
    • Think of the EHR like your smartphone. Our training should be how to use the phone – although that is the foundation. The training that will make the EHR more usable and drive better outcomes is based on how I can personalize the EHR based on my unique workflow and needs.
  4. Culture
    • Culture matters more than the EHR selected
    • Successful organizations have a culture where IT is a service to the organization helps enable user empowerment.
    • These same organizations are able to actively listen to their clinician complaints and concerns and actively engage in improvement plans focused on clinician success, autonomy, mastery, and purpose

It’s time to empower true problem solving by first, stop the casting of blame on the EHR’s themselves. We, as health systems and providers, have so much control in our own culture, governance, visioning, branding, build, design, testing, deployment, metrics, and ongoing training. It’s up to us to set the expectation and value-based objectives of the EHR and to enable a community of autonomous and EHR masters who understand their greater purpose and are able to get more out of the system then they put into it.

 

Resources

[1] Beckers: “Health IT spending last year prioritized EMRs” January 2018 – Julie Spitzer

[2] KLAS: “Creating the EMR Advantage” Arch Collaborative EMR Best Practices Study January 2017 – Taylor Davis

[3] Daniel Pink: “Drive”