With EHRs in and going in, here is my take on what we may be facing. To keep the conversation as simple as possible, let us focus just on the EHR and — for the purpose of this discussion — set aside the discussion of Meaningful Use, Certification, and interoperability.
EHR we learned, is a ‘two-comma’ eight or nine figure expenditure. Chances are your EHR project had a name, a war-room, and a multi-faceted team of warriors. There may have even been little EHR frippery and tchotchkes like EHR mugs and T-shirts. The project probably had its own mission statement, and it most certainly had a 1,000 line-item work plan.
Was the project a success? Do not concern yourself with whether it came in on time or whether it was over budget. Do not concern yourself with whether it met or will meet Meaningful Use. Those criteria are neither necessary nor sufficient. The only question that really matters is does it work? Does it do what you bought it to do?
Here is my exceptionally simple theory regarding how the question should be answered. Once implemented, did the EHR increase your productivity?
This should not be newsworthy, but if productivity decreased, your eight or nine figure EHR project failed. For those whose productivity is down by double digits, one could state those projects failed miserably.
What does a double-digit productivity loss translate to for a several hundred bed hospital? My friend, the VP of finance for one of those hospitals, tells me the cost of the productivity loss is a number followed by at least six, maybe seven or eight zeroes. Let us agree that however many zeroes the productivity loss creates, any zeroes are too many zeroes.
So, here we are, eye to eye with a productivity loss. What are our options?
My favorite option is the one that suggests retraining the users. Let us review the facts. You developed an extensive training program and you paid a lot of money to train the end users. The training was given by experienced trainers. Trained users use the EHR. Untrained users do not use the EHR. Without meaning to be overly cynical, was it not the trained users that delivered the productivity loss? So, why would anyone think that doing the same thing twice would produce different results?
Another option is to re-implement the EHR. I am willing to bet that no matter how painful it was, the implementation was done correctly. I think we can agree that re-implementing EHR would be a waste of tens of millions of dollars.
The other option many hospitals are trying is dumping their EHR and implementing a different EHR. This one I call, “Blame the EHR.” While the blame is in the right place, the end result will be the same.
It may not matter what EHR you implement. The EHR you implement, whichever one it is, was not designed to work in your hospital. It was generically programmed to work in a hospital, any hospital. And however far your hospital’s specific design requirements are away from the generic hospital norm determines how much your productivity will drop. All one has to do to understand this is to watch the doctors and nurses use it. Watch the clicks, the drop-downs, the screen navigation, the page changes, the mouse moves, and all of that typing. These all take time, lots of it. And all of this time is to perform new tasks, and each of these tasks is what is eating away at productivity. Retraining does not make these tasks go away.
So, what is the solution? Your users need a better way, a smarter way to use the system. How the EHR is being used needs to be designed and reconfigured by people who design and configure systems for a living. It needs designers to apply their human factors and user experience skills.
And it needs a project to do this. Instead of pretending the problem does not exist and instead of trying to explain it away in the belief that somehow the ship will right itself, you need to create a real project, give it a name, find the resources, and hire a design team to reconfigure the EHR to meet your users’ needs.