From Device to Helpful Tool: Turning the Corner with EHRs

I am passionate about participating in the Arch Collaborative, because I feel that we as a group can better move all of our organizations forward, and make what we do for our patients easier, quicker, and less burdensome. By doing so, we can all have better outcomes.

At Ohio State University Health System, I’m most excited to look at where our physicians feel we are strong — and where they feel we are weak, and develop a plan to move forward in a positive direction. I am excited for constant improvement. You can’t get better without feedback. It is about learning from what others are doing and sharing what are we doing. It is thinking about how we can all move forward together.

A Focus on Education

Our number one focus for improving EHR satisfaction at OSU is education. If new tools come out, we need to figure out who is using them and who isn’t, and how we can teach physicians and nurses to be more efficient with those tools.

Education is also about trying to understand and address our providers’ and nurses’ greatest frustrations. In our survey, we learned that nurses felt like they were doing a lot of redundant documentation. We created a task force to identify areas of frustration, and see how we can help eliminate them.

Sometimes the right hand does not know what the left hand is doing. What I mean by that before solving an issue, we need to make sure we’re not already doing that someplace else. Let’s say that we get a mandate that requires documentation for X. We might already be working on it, but the tool might not be where people pushing expect it to be. If we are addressing the problem elsewhere, how can we maximize that effort? Or if we aren’t putting forth effort anywhere else, what needs to be added? It is better to evaluate what is already being done than to just implement an add-on every time.

Simplifying the Answers

Our physicians believe that they provide quality care with our EHR. That makes me happy, because that’s what we truly strive for: enabling the physicians to do their jobs effectively.

However, I struggle with the fact that our providers don’t think our EHR is easy to learn. Since we received the results from our survey two years ago, I’ve had many conversations with physicians, and I believe it comes down to the fact that there are so many ways to one thing in the EHR. Many times, our physicians ask me to just tell them the right way to do it. The answer is that there isn’t one right way. But because of that desire, we’ve started developing one right way to do things.

In my conversations with trainers, they often bring up the fact that we can do all sorts of things in different ways. I tell them to figure out the most efficient way. If a provider is struggling, I tell them to give the provider another option. Trainers must figure out what they think is the best method, teach it, and stop confusing the physicians and nurses with a dozen other ways. We have found this approach to be a little more successful.

Shifting How We Think about the EHR

I have a lot of ideas for continual improvement, some of which are so far outside the box I’m not sure the technology is there yet. But I would love to see a provider be able to walk into a room, have the computer recognize him or her, have a conversation with the patient, and then get a summary. The summary might not necessarily be in the form of a note, but the provider could edit it and turn it into a note.

I would love to see a shift from notes that are loaded with all kinds of things pulled from everywhere, to notes that actually convey what’s going on with the patient and what needs to be done. Information that exists in other areas of the electronic record needs to stay in those other areas and be used for decision support and critical thinking, but not necessarily as a part of the note.

We need to get to that next level where providers really start to benefit from the discrete data that exists in the EHR. The EHR could help control the flow of a visit; it could help the patient and provider identify risk factors and other important things. The EHR could become a tool to help providers with decision-making and prioritizing patient care.

We have enough data now to be able to do that; we just have to turn the corner and view the EHR as a tool that helps us as opposed to just a device that we record things in.

Sharing Opportunities

The Arch Collaborative is a great opportunity to share innovative ideas and opportunities for change, and to truly be able to do what the name says: collaborate. It has been really refreshing for all of us to work together to move forward with things that we all struggle with — I love that. I also love the fact that it reaches across all vendors and all venues.

The Arch Collaborative shows that there is not one right answer, which can be frustrating to some. It’s about picking and choosing what’s going to work in your environment, and what providers are going to be able to adapt to. It’s great to have a smorgasbord of data to compare successful groups, talk with them, and maybe implement a solution that combines the groups’ own ideas.

This piece, originally posted on KLAS’ blog page, was written by Milisa Rizer, MD, Chief Clinical Information Officer at OSU Health System, one of many organizations participating in the Arch Collaborative.