Nurse: “I need help with the computer; patient transfer needs to be completed.”
Me: “Ma’am, the patient’s medications are on ‘MAR HOLD,’ which means Medication Administration Record Hold. Therefore, we cannot administer medication unless an attending physician releases this hold. Can we get the physician on the phone for him to reconcile the meds?”
Nurse: Reluctant to call the physician, insists on completing the transfer at the unit manager screen. Finally, she places a call to the surgeon and hands me the phone.
Me: “Dr. Smith, we are having issues with reconciling your medication request.”
Dr. Smith: In a voice of frustration, “I left the hospital. Can’t the nurse reconcile the medication? I know how to reconcile medication, but there seems to be something wrong with the system. Can you find someone else who can reconcile the medication?”
Nurse: Shoves another phone toward my face and exclaims, “It’s dietary.”
Dietary: “Please, educate the doctors to place diet orders in the system correctly! Patients are going hungry because they are doing it wrong.” Me: “Yes, I will do my best to teach them when I have the first opportunity.”
Dr. Anderson: Walks up to me and exclaims, “Can you help me order electrolytes? The pre-built order set is not set to our protocol.”
Dr. Robinson: “Why does the discharge prescription paper print at the location of the patient? What if someone takes hold of the script paper and forges my name? It should print at the location of the physician. You know what, I’ll just write the script paper.”
This is a typical day in the life of a physician informaticist when helping health care organizations implement new electronic health records (EHR). The process can be challenging, frustrating, and seemingly impossible to navigate. Often, the software needs to be fixed, and optimization of the software can seem painstakingly slow, which exacerbates the situation. However, a physician informaticist is the provider/end user’s advocate in the process. We continue to create ways to make the implementation process more effective and less stressful.
We want to improve physician satisfaction, and lessons learned to minimize burnout by being a bridge between the physician and the EHR during the implementation of the new system. We accomplish this by smoothing communication between clinical and operational staff. We have experience engaging with providers, allowing them to master the new electronic health records system.
In the scenario above with Dr. Smith, there was a glitch in the system, we placed a ticket for the issue with the technical team, and it was promptly resolved. I assisted Dr. Anderson in creating an order panel that reflected hospital protocol. After that was accomplished, I helped Dr. Robinson set up an e-prescription for controlled substances. Finally, I educated the providers on placing correct dietary orders as requested by dietary.
Imagine you're getting ready for a trip — without a map or GPS, it is nearly impossible to go far. The same scenario holds with EHR (electronic health records) use; if you don't have visibility into your IT infrastructure, you're not going to get far. The key is to eliminate inefficiencies, achieve financial security, and deliver optimal patient care. The challenges of COVID 19 throws in a new dynamic. Many hospital systems have adopted exceptional technology and virtual engagement tools that have continually pushed boundaries and exposed opportunities. Many hospital systems have had virtual go live engagements whereby utilizing remote support. Others have opted for hybrid training with the benefit of in-person and virtual training.
Healthcare systems can take a few steps to support a smooth electronic health records implementation experience to offset some stresses.
Data Migration-Migration of Patient Data from Current EHR to a New One
It can be pretty frustrating switching to a new EHR, and data migration can be one of the added stresses. The transfer of data from a previous EHR to the current one can often be disruptive and costly when poorly executed. Healthcare organizations need to think thoroughly about this process and give ample time to transfer previous data to a new system. Streamlined data migration will permit the healthcare organization to be more efficient and well organized; thereby, allowing staff to navigate patient charts easily, making data readily available.
Those days of navigating multiple EHR systems to find patient information are gone.
Physician Personalization- Customization of Note Templates and Shortcuts
Personalization is a building block to a successful implementation. It allows providers to create "personalized" specific templates. Personalization Labs usually consists of providers learning how to use Epic SmartPhrases, Macros, templates, order sets, and preference lists to streamline order and note entry. Hospital systems must adopt pre and post-go-live personalization sessions. This will decrease provider burnout, reduce stress, and improve efficiency.
Physician Champions- Pre- and Post-Go-Live Training
Physician champions act as departmental leaders during EHR implementation. They usually provide added value to the organization by teaching staff and act as liaisons. Frequently, they create specialty-specific templates and workflows documents for their divisions. Champions build a repository of tools for the most common EHR issues, thereby allowing providers to focus on fine-tuning their customized clinical documents to meet practice-specific needs. Healthcare organizations could benefit from selecting strong end-users from each department and utilize them in their implementation efforts. It can mitigate the potential loss of productivity and efficiency during the EHR transition.
Finally, hospital systems stand to benefit from third-party EHR consulting firms. These companies frequently bring added value to healthcare implementation efforts. With their expertise and knowledge transfer, healthcare organizations can build proficiency and efficiency in their EHR journey.
My Just Checking In has over 20 years of expertise and knowledge in assisting healthcare organizations to improve their efficiency and profitability. Our team can help transform your EHR implementation from a source of frustration to a successful and productive tool. Our goal is to enhance your patient care experience and improve your revenue cycle management.
References
Gillespine, E (2020, July 23). Ensuring a smooth "Go-Live" process in the COVID-19 era. Physicians Practice. https://www.physicianspractice.com/view/ensuring-a-smooth-go-live-process-in-the-covid-19-era.
Green, J (2019, May 7). Three Common Barriers to HER Implementation and How to Avoid Them. Modernizing Medicine. https://www.modmed.com/blog/ehr-implementation-challenges/
Cartwright, K (2020, July 21). Do You Really Want to Switch EHRs? Medicaladvantage.com. https://www.medicaladvantage.com/blog/switch-ehrs/
Siwicki, B (2020, May 11). First-ever Cerner ‘virtual go-live’ helps one hospital roll out EHR during a pandemic. Healthcare IT News. https://www.healthcareitnews.com/news/first-ever-cerner-virtual-go-live-helps-one-hospital-roll-out-...
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