Billions of dollars are being spent each year on HIT. Clinicians are paying for these systems, and by paying I mean either in dollars, if they put up the money themselves, or in time, which is often the case when EHR decisions are made by administrators. How can a physician’s productivity and focus on the patient be maintained while using an EHR at the point of care, and why do many systems fall short on this?
In the rush to get HITECH dollars, it was easier for HIT companies to attempt to build clinical systems on top of the huge legacy transaction-based systems already in place. So, here we are with clinical functionality grafted onto administrative and financial systems with the minimum retrofitting done to cash in on the HITECH gold rush. And I think the graft is being rejected. Estimates are that more than 50% of EHRs will be replaced within three to five years.
How do we avoid a repeat of this debacle? By providing usable clinical systems that can be deployed at the point of care, without slowing clinicians down, or getting in their way.
So, how do we do that?
1) Give clinicians what they need, when they need it.
Easily said, not so easily done. With all the focus on population health, big data and predictive analytics, it seems we have forgotten that, for the most part, the most basic unit of healthcare is the patient/clinician encounter. And, at that point, the physician wants to see what is relevant for this patient, for this specific clinical presentation, at this particular point in time. On demand, instantly. This has almost nothing to do with big data, but is more likely to be in the form of “little data.” What is needed for this specific patient, today?
2) Provide software that supports the clinical thought process.
I am not talking about fixed templates, or combinations of fixed templates. The physician’s thought process is not fixed or easily predictable. One clinical finding can change the entire picture in an instant, and no one can build enough templates to address all the “oh, by the ways”. The underlying technology must be responsive to the clinician’s thought process, and must also accommodate their preferences for how they interact with the system.
3) Give clinicians something that looks familiar.
Another case of “easier said than done.” Provider preferences for presentation and workflow vary between provider types (physicians, nurses, allied health professionals, etc.), specialty, settings (ambulatory versus inpatient versus home), and other considerations. One size does not fit all. And now there is meaningful use and other new requirements. The point-of-care user interface must be able to intelligently present relevant clinical data for a patient in the format preferred by the specific provider.
4) Training in one hour or less.
Physicians are some of the most highly trained professionals on the planet. Medical school, internship, residency, and being trained to think without sleep for 24 hours. Yet, the minute you put them in front of an EHR, they struggle with it. And we try to blame it on them. If the systems were properly designed, and accommodated the clinical thought process, the training ought to take no more than one hour. If it takes more than that, we are getting in their way, slowing them down and ticking them off. Give them what they need, the way they want to see it, and they will love it.