Is EHR Optimization Possible?

At the Healthcare Forum Heather Haugen, PhD posited that the Promise of an Electronic Health Record (EHR) is that it “has the potential to transform healthcare by providing clinicians access to comprehensive medical information that is secure, standardized and shared.”  She then proceeded to remind us how far we have come on the journey of adoption, but that we still haven’t gotten where we need to be.  EHR is indeed a lofty goal, but we haven’t gotten there yet.

Plus, Dr. Haugen suggested that far too many people are focused on the EHR implementation and yet that’s only one milestone along the EHR journey.  In fact, she compared looking at EHR implementation numbers to talking about the number of weddings as opposed to the success of those weddings.  EHR implementations are just an event, but we continue to talk about the wedding instead of the marriage.

When you start to look at EHR as a journey, the first steps of Selecting, Building, and Installing are relatively short parts of the journey.  However, the EHR journey also includes: leadership engagement, speed to proficiency, performance metrics, and adoption sustainment.  Each of these are crucial to EHR adoption, but are much longer journeys than the initial implementation steps.

The journey of adoption is challenging, messy and dynamic and we may never actually arrive at “EHR Adoption.”   EHR adoption has a lifecycle that’s influenced by many factors including staff turnover and software upgrades.  So every organization must be prepared for ongoing education, training and engagement with their end-users to keep the EHR journey moving forward.

When considering this challenge, Dr. Haugen asked the question: Can data help us? And then she offered the following suggestions on how data can help an organization.

• Data saves time and resources by focusing on the right patients
• Data incents actions
• Data removes subjectivity

As Dr. Haugen said, “Measurement has impact.”  She then offered five key measurement areas where healthcare leaders can evaluate their EHR project.  Have users:

• Understood how the application impacts their job?
• Understood why the application was implemented?
• Felt that the leadership team is committed to the success of the project?
• Felt that the organization’s leadership helped them understand what they need to do to adopt the new system?
• Felt that communication from the leadership team helped make them feel more comfortable about the change?

Each of the above measurements is really focused on making sure an organization has user buy in for the EHR journey.  After you get past the EHR implementation stage, Dr. Haugen offered a series of other important questions you should understand and measure in order to optimize your EHR:

• How is the application being used?
• How are upgrades being adopted?
• How do we overcome workarounds?
• Who is struggling to use the new system?
• What areas of the application are confusing and could lead to clinical errors?
• How can we gain increased productivity?
• Inefficient workflows – what are they and how do we change them?

Each of these questions and measurements can help an organization realize where end users could use more or better EHR education.  Dr. Haugen suggested that the best way to close any learning gaps is to offer scenario-based learning that helps end users become more knowledgeable and confident in their work.

Dr. Haugen also offered a number of other early findings from their research on the EHR journey.  First, only a small percentage of users need one on one help.  Second, software upgrades erode adoption over time and so with every upgrade you need a commensurate effort to retrain adoption.  Third, optimization is the responsibility of clinical leaders.  Fourth, users want education delivered at the time of need.  Fifth, data still lives on paper.  Sixth, there is a lot of opportunity to improve productivity through more efficient workflows.

Dr. Haugen concluded that “Feet on the street are probably not going to be how we solve the optimization challenges.  The right data could help us solve the optimization challenges.”  The right data with fast, effective and sustainable training will take us a long way on the EHR journey to a secure, standardized, and shared medical record.

You can see Heather Haugen, PhD’s full presentation at the Healthcare Forum (embedded below):

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.