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Smoke Signals: How to Identify and Fix EHR User Concerns to Prevent Major Fires

The adage, “where there’s smoke, there’s fire” can be true in our world of healthcare information technology. The electronic health record (EHR) is far from running smoothly in many places, but too often as leaders, we get stuck in firefighting mode—working feverishly to stamp out or control ongoing brush fires instead of taking systemic actions to prevent them.

CIOs, Clinical Leaders, CIS Directors, IT Directors and managers can see smoke every day. If you field complaints directly, or analyze help desk call trends, utilization reports, LightsOn data, or conduct user satisfaction surveys, you’ll find points of friction where users have frustration or identify inefficiency. Over time these frustrations can become a fire.

In a worse case scenario, the heat from your disgruntled users reaches the executive suite and forces a major change. You end up with an expensive rip-and-replace scenario resulting in a multi-year upheaval that may have been unnecessary.

So how does an IT department move from firefighting to fire prevention? I have a few suggestions below based on my experiences, but it all starts with having systems in place for smoke detection.

  • Call data and help tickets are obvious ways to identify smoke. But IT leaders must monitor and analyze these data regularly to look for opportunities for system improvements. Larger fires tend to break out when user issues are viewed in isolation as individual help tickets. When viewed in aggregate, broader concerns may be identified.
  • The alternative to waiting for users to report concerns is to proactively seek their views. I’m a big believer in regular user surveys around efficiency and satisfaction with use of the system. Get specific with questions by role and venue, around time to document, order, review data, device connectivity effectiveness, and so on.
  • Use enterprise-level data analytics to understand system usage by department and role. Sign-on data, utilization reports, etc, all help tell a larger story around system adoption. Equally important is knowing how you measure up to similar hospitals. Ask vendors to provide usage benchmarks for their systems, and ask peers, through networking groups like CHIME or HIMSS, to share their key performance indicators (KPI) for an apples-to-apples comparison.
  • Observation by outside consultants can help identify workflow improvement opportunities. Sub-optimal workflows are sometimes a result of a rushed implementation but may also creep in over time because organizations fail to keep pace with code updates or upgrades. Workflow issues are common in most organizations. Some pain points I have personally observed in recent months include:
    • Physicians not all on the latest documentation tools
    • Electronic order sets not optimized
    • Nursing documentation is fragmented, inefficient or not upgraded
    • Devices that can be integrated onto the EHR, are not yet connected or upgraded
    • Part of the organization is on a different EHR with limited integration

It’s easy to overlook these issues if leadership is in reactive mode, putting out the little fires. Getting ahead of these requires proactive measures.

If you don’t already have it, start an interdisciplinary team that focuses on user issues. Use KPIs and internal data for discussion. Once you identify opportunities for improvements, prioritize them as urgent. Do this programmatically, not as a one-time fix.

If it takes spending money for outside help, find trusted help in expert consultancies. Set goals with them and empower them on the organizational team assigned to work with them.

Lastly, make sure you are initiating these efforts with the support and engagement of senior leadership.  Make the case that incremental, productive changes that improve system usage and user satisfaction are preferable to far more costly fires that threaten the stability of the entire organization.

Jim Beezley is Director, Cerner Consulting for Healthcare IT Leaders. Jim has led multiple, large-scale client engagements, supporting health system leaders with strategic goal setting & road-mapping, migration from legacy systems, implementations, optimizations, and user adoption.

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