Lori Tishler, Vice President of Medical Affairs, Commonwealth Care Alliance
As I sat down to write this article, I thought about how many types of electronic health record systems (EHRs) I’ve worked with during my 20+years as a primary care doctor, educator, and physician leader. Including the one my current employer is working to implement, I count at least six different systems; that number probably doubles if I add secondhand exposure to EHRs from my husband’s clinical practices. Some implementations were done well, some not so well.
I learned how to use technology quickly, and I tried to be an early adopter of effective new systems, or at least been the early majority. Generally, I’m enthusiastic to try something new and better that will help me provide better patient care and communicate better with colleagues. That’s what using EHRs is all about.
Doctors want to take good care of patients, I promise. This means, first and foremost, that we want to be psychically present for those people who have entrusted us with their own or their family’s health. EHR systems that work well feel like an assistant in the room, helping to enhance my efficiency while allowing the patient-doctor connection to remain central. I love, for example, having the ability to insert a photo into a patient’s medical record (from my phone, no less!) or to turn my monitor toward the patient and show them their X-ray and see the awe and understanding on their face. That’s an amazing function of electronic records.
As a clinician using EHRs, one of my central concerns is how a system can help me synthesize and share the patient’s story—the narrative arc of the patient’s concerns. Too many EHRs downplay the heart of medicine—the patient’s story. Furthermore, my colleagues and I want to work effectively as a team, and that means we need to share information with each other, and also to transfer work that might be better and more efficiently done by a team member. A thoughtfully developed and implemented EHR system can help clinicians focus on our patients and provide compassionate, evidence-based, competent care–but a poorly developed and implemented EHR system can impede it.
"EHR systems that work well feel like an assistant in the room, helping to enhance my efficiency while allowing the patient-doctor connection to remain central"
Organizational leadership on every level has a huge role in successful implementation, adoption, and uptake of any new technology—especially EHR systems. Over my years in practice, I have seen this done well—and sometimes not so well. Here are a few carefully chosen principles to follow that makes the implementation process better for the users and can help to ensure enthusiastic uptake:
1. Choose your EHR product carefully and include the voices of the user in the decision-making process. I don’t just mean to follow a fair process, but to listen (ears, brains, and hearts) to what the users like and don’t like.
2. Visit other organizations who use the product and ask them what works, what doesn’t work, what people love, what they do not like. Ask them what they would have done differently and take their answers to heart.
3. Make thoughtful decisions. Just because a product can do everything under the sun, doesn’t mean that it should; in fact, if there are three ways to accomplish a simple task, it might be better to choose only one—the one that is best for your organization.
4. A new EHR system will only highlight broken processes—it won’t fix them. Use your leadership clout to define or clarify processes before you launch a system.
5. Communicate, communicate, communicate. There should be no one in your organization who doesn’t know about a new or updated system. Additionally, everyone should understand what to expect, when to expect it, and how training will work.
6. Don’t underestimate the importance of leadership presence during the roll-out of a new system. Feet on the ground in the first days is important, but showing up during the first weeks, months, and even year to ask about the product, cheerlead, and show empathy is invaluable. It also buys a lot of good will.
7. When things go wrong, and they will, good leaders acknowledge the issue, get out in front, and make transparent efforts to fix things, as quickly as possible.
8. Finally, a couple of two-word phrases go a long way. If it’s necessary, say “I’m sorry” and, almost always, remind your hard-working clinicians that they are doing a “great job.”
There is nothing inherently simple about EHRs. But like so many things in medicine, remembering that clinicians want to be successful—by their own and their patient’s definitions —and living by these principles can make a real difference in our ability to implement and use EHR technology to enhance the important clinical work we do and create an organizational culture built on trust, engagement, and mutual respect.