Sunday, December 9, 2012

The Catch-22 of the Physician Champion Role

Yes, I'm a geek. When my girls were in high school, their friends were amazed that they received texts from their mother. One daughter has commented on Facebook that her mother is more tech-savvy than she is. At the beginning of 2012 my interest in the healthcare benefits of social media was born and I began blogging. I investigated and use LinkedIn, Twitter and Google+ while remaining attentive to Pinterest, AboutMe, Doximity, Instagram and others. So when my employer offered me the position of EHR Physician Champion for our physician group a couple of months ago, I took on the challenge. And challenge is the operative word.

Presently there are about 25 physicians in our 180+ multi-specialty group "live" (using electronic records). In a meeting specifically called to discuss "Provider Go-Lives", three individuals tasked with implementing EHR turned to me and said, "So Dr. Nieder, how can we encourage doctors who are not embracing EHR to do so." Hmmm....good question.

Let me preface these remarks by stating that our administrators have tried everything in their well-researched knowledge base to make this transition work. As we move forward improvements are made with every new Go Live. My immediate response was two-fold:
  1. In training, don't give physicians the impression that using an EHR is using a paper chart in electronic form. It is an entirely new way to document and, unfortunately, the learning curve resembles third year medical school with IT support instead of attendings. It is every bit as daunting. 
  2. Encourage the doctors to shadow with someone already successfully using the system. 
The next question was harder. "What can we do to push the physicians who are balking?" Ah, therein lies the rub. Of course I recognize that the question was also my responsibility in the role of Physician Champion. To answer it, I was going to have to do some thinking. There are many reasons doctors give for not wanting to use EHR as posts by Palmd, HealthcareTechReview, MITTechnologyReview, and others attest but the biggest one in my system is that it slows down physicians whose salaries are based on productivity. 

My understanding of the value of EHR is simple enough--more legible notes, better population care using "big data", enhanced patient care using clinical decision support tools, improved documentation to increase reimbursement, establishment of direct patient communication through portals, healthcare savings by reducing duplicate test ordering, and improved communication between providers in continuity of care. Even though our present system is poised to realize all these goals, the only one it is capable of performing at this very moment is legibility. So how can I convince physicians to use a tool that is going to slow them down (i.e. reduce their pay) and doesn't yet have the necessary functionality to improve patient care?

As a geek, the EHR experience has me torn between two emotions: incredulity at its lack of usability  and that sinking sensation I remember from the late 80's when the software rarely did what it was advertised to and crashed all too frequently, freezing the computer and forcing the user to restart both the software and often the entire system. The promise was there but the reality was long in coming. So too is today's EHR. 


  1. (I'm not 100% sure if this is 100% related, but here it goes.)

    So often it comes down to "you get what you pay for" for some. If the company is willing to put the funding behind it, to provide the resources to make things happen, it will happen. If the company wants all these improvements to happen, but will not back it with the resources necessary to make it happen, it will be an uphill battle.

    I am working as an IT support person in a healthcare related company. We are often asked to make improvements to the physical equipment and/or to the process & procedures within our organization. When we report that it will cost $X.XX to make something happen, we get push back to figure a way to make it happen at a much less cost. We find less expensive solutions, but often we find ourselves spending more time and energy (read: $$) patching it together.

    Is your employer providing the resources to ease the transition? Resources can be people to train, people to 'hold hands' and train some more. Resources can be equipment that works, and is current. Are they providing TIME for people to get used to the new things? I hope the answer is Yes to at least some of these things.

  2. Baptist is absolutely providing resources to ease the transition. The bigger problem is with the EHR vendors not being "ready for prime time" and with healthcare systems like Baptist underestimating how long it would take to get the EHR up and running.

  3. Hello,
    I was searching for "patientEHR" and came across your website. I am a retired software developer. I have been developing an EHR. A partial list of governmental databases that I have incorporated into the system include: ICD-10 CM, ICD-10 PCS, NDC Product, NDC Package, Drugs@FDA , CDC Vaccine , CDC Vaccine Manufacture, DailyMed, RxNorm, Metathesaurus, SNOMED CT. Scrounging up the database files and connecting to their various API's has been a challenge. At the same time, I have been developing the presentation layer, or user interface. I also have a working HL7 parser and communications daemon but only parse hl7 laboratory test observations and hl7 pharmacy prescription requests. I do not have connections to any actual labs or pharmacies yet. I believe my system has the potential to break some barriers. Soon, I hope to begin the marketing of the system. The first step is going to be to put it online for people to actually use. (I hope to do so at the end of January or sometime in Feb.). I would like to open source it but that presents many problems as americans are so greedy. I also thought of setting it up to run small ads in a sidebar to help support the system. In any case I am going to offer the system to the health care community for free. The system can run as a SASS or on a stand alone server in a medical facility or it can be internet based like your current website is. Security is built in already but need to be enhanced. Since I am not a medical professional (I worked in the health care industry for quite some time) the system is going to need feedback from health providers. I would like to contact you when I bring it online and ask you to take a look at it and possibly provide some feedback. Please let me know if you would have any interest.
    frankindelicato AT