While attending a series of CHiME keynote speaker presentations this week, I found one physician’s views and materials extremely interesting. Certainly worthy of further discussion for those of us in the EHR consulting arena. Before diving in, let me say that overall I thought the presentation was a positive insight of the impact of AI on patient care and quality. Reviews and commentary on fantastic technologies in a wide range of apps and wearables impacting patient care and data management. Great slides, videos, and statistics to back up the overall theme.
However, there was one slide that possibly inadvertently placed blame regarding physician fatigue, frustrations, and burnout on EHRs, specifically Epic. The slide I am referring to showcased last week’s article from the NY Times about a physician’s experience with Epic.
If you have not read the article, Our Hospital’s New Software Frets About My ‘Deficiencies,’ I highly encourage you to do so. Here is the link: https://www.nytimes.com/2019/11/01/health/epic-electronic-health-records.html. You’ll no doubt find the articles spin comical and witty, but it drives an underlining message of EHRs shortcomings and failings due to disconnection with end user (physician) needs.
The presentation at CHiME showed one quote of the article in a slide…
“Who is Epic? I try to imagine. Perhaps a clean-shaven man who wears square-toed shoes and ill-fitting business suits. He follows the stock market. He uses a PC. He watches crime dramas. He never bends the rules. He lives in a condominium and serves on the board of directors. He rolls his shirts into tubes and arranges them by color in his drawers.
When you bring cookies to work, he politely declines because he is on a keto diet. He sails.
And he doesn’t know his audience.”
Like I mentioned, witty for sure, but negative undertones suggesting Epic is an uncaring, insensitive vendor who doesn’t understand physician needs. One colleague of mine wrote me a series of questions that as a consultant, we should all ask ourselves and our clients regarding these concerns highlighted in the article. With his permission, I wanted to share those questions that need answers, or certainly some thought.
1. Why did she have deficiencies on day 1? Was it a build issue or did they choose to bring legacy deficiencies forward?
2. How is it that she did not know what a chart deficiency was?
3. Did the health system run provider personalization labs or sessions in the physician’s lounge? If so, did she attend them?
4. Did she have exposure to EMRs in Med School?
5. Was she really so concerned about the distance that at the elbow support would have to walk to get to her that she didn’t request assistance, or would she prefer to curse the darkness instead of lighting a candle?
6. Why did she assume that clinical users are a homogeneous audience and that she typified them?
7. How much of her article had she composed, in her mind if not on paper, prior to her hospitals go-live?
8. What does she think about data-driven clinical decision making?
While I have to agree that the overall article attempts to bring issues to light, the approach is all wrong and the author takes zero ownership. The questions above hit to nail on the head. Another question we need to ask, did the San Francisco based hospital invest in clinical transformation and adoption planning? I’m guessing not. I really liked the question around personalization and training as well. All three of these areas (transformation, training, and personalization) tend to be overlooked during implementation…or not invested in at a level to tackle concerns highlighted by writer of this NY Times article.
Perhaps there is an overall negative association with EHRs regardless if Epic, Cerner, Allscripts, or Meditech. Perhaps it is not the actual functionality, system capabilities, or workflows that are the issue, but the disappointing position associated with physician dislike (and distrust) of EHRs. Another interesting quote from the article…
“Hence the hospital’s decision to switch to Epic, commonly viewed as the least imperfect of several imperfect electronic health record systems on the market.”
We probably see these clinician frustrations at our client sites regularly. As consultants we have a huge opportunity to continue to focus on clinical adoption of all IT investments, including non EHR areas. The primary talking point of the presentation was AI. If clinicians are having these types of issues with EHRs, where is their adoption and utilization going to be with other technologies? Every project we support has end user facing impact. Watching the presentation and reading this article only reinforces to me top consulting duties including; mitigating concerns, impacting utilization, and assisting with successful EHR adoption.
Have you faced clinical adoption issues? Thoughts on the NY Times piece? Share your comments below.
I enjoyed your post and felt I should comment, as I have trained Epic Health Information Management. This is the area of Epic that would track the deficiencies placed on the physicians. This is not a new concept for physicians to have deficiencies and to be made aware of them! Other systems do this and hospitals that are still on paper also place deficiency notes inside of patient files for physicians to see and address. The reason that Epic sends a deficiency note (or any other system) is to make the physician aware that they are not in HIPPA compliance. I have no doubt that ALL physicians have been trained and made aware that they will see these deficiencies in their Epic In Baskets. Epic uses a straight forward message because many physicians will say that they are not aware they have deficiencies! It is not an Epic problem, it is a healthcare wide problem area. Every year hospitals face loosing money in fines, due to the fact they are out of compliance. Physicians are overworked and burdened with having to record many items into any EMR system. I have heard Epic is working on streamlining the documentation process and possibly integrating more dictation functionality into their system, so physicians would have less to key in. I am sure deficiencies were never liked, but they are needed. The missing documentation issue is a serious problem and can hold up payment to hospitals or result in a loss of revenue. At a time when healthcare costs are skyrocketing, hospitals and physicians cannot afford to loose revenue, so please make the time to do your deficiencies!
While provider personalization and training classes failed to help her understand what a deficiency is and why it’s important and why a screen pops up for a deceased patient- those activities wouldn’t have changed the tone / voice of Epic (or any other EHR). Epic’s (and other EHRs) voice is a robot pushing clinical data driven decision making, compliance and most of all, productivity. Epic has an immense opportunity with their community to help providers with the proven emotional and physical toll of practicing medicine, and they totally missed the boat