A Lesson in Listening to your Providers
It was the best of clinical times, it was the worst of clinical times,
It was the age of information, it was the age of misinformation,
It was the epoch of innovation, it was the epoch of frustration,
It was the season of electronic solutions, it was the season of click fatigue.
A widely understood notion within the health IT industry is that most providers sympathize with the latter half of these modernized Dickens statements. Historically, the level of provider dissatisfaction with EHRs is staggering. A 2017 survey found that the majority of providers are still unhappy with their EHR.
Who feels the largest brunt of EHR complaints? The answer: CIOs. The constant flow of grumbles is so steady one is almost driven to pity Chief Information Officers. As one CIO lamented, “my doctors count every click, then we hear all about it.”
In the following article, we would like to contrast two EHR consulting experiences that we had last year, 2017. We will profile two CIOs, both of whom were fully responsible for their respective EHR system, and how each responded very differently to the same EHR challenges. In highlighting the rewarding experience of one, and the painful experience of the other, we dare to beg the question: Is the success of the product fully determined by the EHR vendors? Or does IT hold some of the cards?
In both cases, dissatisfaction with their EHR was pervasive throughout their clinics. It was a populist revolt against the EHR status quo, and all fingers pointed to their current system.
In February 2017, we were presented with two clinics planning to leave their EHR. Both claiming that the amount of user complaints had left them with no choice in the matter. In both cases, dissatisfaction with their EHR was pervasive throughout their clinics. It was a populist revolt against the EHR status quo, and all fingers pointed to their current system.
Both clinics had one foot out the door, with a replacement EHR all but certain. In both cases, we recommended to remain on their current system, and to invest in customizations and improvements to meet the providers’ needs. On pure business sense, we argued that the cost of leaving far outweighed the cost of improving their current system, and that we could get the system performing the way they wanted, where the staff would be happy.
Despite a great amount of effort on the part of eMedApps, one CIO remained stubbornly in their direction. There was no turning back. Despite all the attempts that eMedApps made, they were leaving and that was final. The other (with apprehension), agreed to an eMedApps Discovery Session to determine if things could actually improve, though they remained very skeptical.
“The most important thing we found was that many of the issues did not stem from the application, but from organizational decisions made without user input or consideration.”
After spending three days onsite and sitting with the staff, we learned that the main frustrations revolved around system slowness, random boots from the system, multiple login processes, excessive data capture around quality initiatives and regulatory requirements, workflow optimization, and lack of ongoing training. Additionally, team members felt frustration around the multitude of tasks that took them away from patient care. The most important thing we found was that many of the issues did not stem from the application, but from organizational decisions made without user input or consideration.
We provided this clinic with direction on how to fix their system inhouse and we gave them proposals should they desire to hire us for the work. We assured them that almost all their staff grievances could be solved, and the capability to meet their clinical workflows was all available within their current system, and that they need not spend hundreds of thousands on a whole new EHR.
They agreed and hired us for the work. The first thing we did was perform an upgrade to the latest version. Then we made some changes in the system and altered some configurations for better performance. But we knew we needed to get with the users, that the bulk of the work was done with one-on-one time with the people who use the system every day. Essentially, what we did was make sure the providers were heard. We complied a massive list of things that they hated and then built solutions for each problem. One doctor had 20 things changed in two days.
The outcome of this project was a resounding success. Almost a year later, the complaints of this clinic have drastically declined. No system is perfect, but the staff is far happier with the improvements and management was thrilled that the expensive alternative to switch EHRs was successfully averted.
Now to the second CIO…. (Prepare to cringe). We received a call four months later requesting help to move them back onto their old EHR. We later learned that they failed to test their new system properly. They didn’t ensure that the necessary workflows were available in the new system, which lead to a very botched rollout and increasingly unhappy staff. Finding themselves in a worse situation than before, they were more open to listening to our recommendations.
We went through all the configurations and customizations we would perform on their previous system and how we would get them quickly reimplemented. They immediately hired us for the work. During the reimplementation, we went through the same process that we did with the other clinic, and finding almost identical issues we proceeded with the same solutions. We listened to the users, and gave them a system they desired. As their vendor for EHR support, we are happy to say that the staff and management are far happier than they’ve even been.
If EHR pollsters interviewed either of these clinics, before the customization, EHRs would again receive pretty poor reviews. However, in light of this story, and to bring us back to the original question: Is the success of the product fully determined by the EHR vendors? Or is customization to meet the organization’s user needs critical to success?
Something to consider…
