EHRs: How to drive better adoption, value and satisfaction

By Heather Haugen, PhD, Managing Director for Knowledge Solutions

Much progress has been made in the implementation of electronic health record (EHR) technology over the last decade. By some estimates, nearly three quarters of U.S. hospitals have successfully implemented and are using EHR systems today, up from single digits just six years ago.

It’s time to build on those gains and expand the use and application of electronic health records in reducing costs and improving healthcare quality across the industry. And, as always, the key to that step is supporting clinicians – building their comfort level, designing optimal workflows and putting the data found in electronic medical records to the best use.

For many reasons, though, getting clinicians comfortable with the use of EHR technology within the care delivery workflow has proven to be harder than expected. As with most large technology systems, the hard work starts after the technology people leave their systems in the hands of everyday users.

What we’ve found is that when clinicians actively embrace EHRs as a powerful healthcare delivery tool, and not just an administrative one, organizations go beyond “Meaningful Use” objectives and find new ways to make a real difference.

To maximize use and value of EHR technology requires engaged leadership, speed to proficiency, performance metrics and adoption sustainment practices (for more on these, see Knowledge Solutions). But first let’s look at the real EHR usage gaps.

Measuring the gap between installation and use

To quantify the problem, we asked healthcare organizations whether their EHR system could carry out four key tasks, and then whether clinicians were using those functions.

The results were a bit eye-opening, to say the least.

Testing and imaging results
EHR Adoption: 96 percent

First, the good news: the vast majority of physicians use EHRs to obtain testing and imaging results. In fact, wherever physicians have this option, it’s actively used.

That’s great: retrieving results is easy to learn, saves time and confusion and gives clinicians an immediate benefit. In an ideal world, it would be a good starting point to build on – but in reality, many doctors don’t get much further than this.

Computerized provider order entry (CPOE)
Installation: 73 percent
EHR Adoption: 44 percent.

By contrast, using the system to issue treatment instructions is harder to learn and more time-consuming– and it shows. While three fourths of organizations have this function available, it’s routinely used by less than half of clinicians.

Research shows CPOE is worth the effort. In particular, it offers real-time cross checks that can reduce non-intercepted serious medication errors by 86 percent. With medical errors killing 120 Americans per day, that extra check is a great safety net – and as a bonus, CPOE makes re-ordering repeat medications easy.

Clinical decision support
Installation: 84 percent
EHR Adoption: 41 percent

Clinical Decision Support alerts don’t just guard against allergies and drug interactions. Our studies show they significantly improve (and in some cases double) adherence to guidelines on vaccinations and screenings. We also found clinical decision support reduces complications by up to five percentage points and certain mortality rates by about 2.5 percent.

Clinical documentation
Installation: 91 percent
EHR Adoption: 55 percent

The gap here could deprive some physicians of the whole picture the next time the patient is treated – as well as the opportunity to spot patterns that can lead to outbreaks and possibilities for hospital acquired complications. A recent study showed that using EHRs to their full potential helped organizations identify 14 percent more infections, and in one-third the time.

Five ways to help clinicians make better use of EHR

Caregivers are pushed for time, and they want what’s best for patients, now. That means the reality for healthcare IT is that anything that’s initially slow or confusing will quickly get pushed to one side because it’s getting in the way of patient care.

The important thing is to understand the value of that instinct, to move away from the confusing, and find ways to use it in your favor.

1. Make training valuable. Often, clinicians see classroom-based training that covers the broad capabilities of the EHR application as a waste of valuable time that could be spent with patients – and that makes them distracted. That’s why they pick up simple things like getting test and imaging results, but leave more complicated processes like CPOE alone.
Instead, we’ve found it’s possible to cut training time by half – and see better outcomes – by focusing on the practical workflows people actually need day-to-day, that is  simulated to the way the EHR application will appear in the live environment. Suddenly, clinicians grasp the potential of EHRs as clinical tools, and start looking for ways to get real benefits from the system in the fewest clicks possible.

2. Be realistic about workload. In the earliest days, using an EHR made work slower and more difficult. The benefits come later, and returning to full speed can take a few months.
Being brutally honest about the likely difficulties – in your communications and your expectations about productivity to clinicians – creates room to embrace a new process, rather than work around it. It’ll also help colleagues to trust you when you talk about its benefits.
Be aware, too, that coming to grips with the new EHR system isn’t a one-off event; it’s ongoing. You’ll have new people joining, who’ll need to learn applications and associated workflows, and there’ll likely be new versions at least twice a year so look at learning as a valuable investment in your people.

3. Measure your progress carefully. Keeping track of EHR adoption – and identifying which functions are being used, and how well – is a crucial part of your ongoing change management, and will tell you a great deal about how effective your system is performing.
Understanding “who’s clicking where” will help you spot places where clinicians might benefit from a little extra feedback or support – and reveal areas where the workflows themselves can be improved.
Metrics like these are also valuable as you begin to measure the ROI of the application.

4. Share as much as you can. For many healthcare organizations, it feels like a brave step to share information internally about how well patients are doing. But this is the key to finding process improvements – and eliminating blind spots – that will impact patient health overall. The data, when fully absorbed and analyzed, will have the natural tendency to harness intellectual curiosity and patient concern.

5. Make it clinician-led, not IT-driven. Often, organizations look to the CIO to drive adoption of a new system once it’s installed. But in our studies, healthcare providers consistently see more successful technology adoption when clinical leaders also take a leadership role in ownership of the change.

In our experience, clinical leadership and role modeling can make the difference between physicians seeing EHRs as a bureaucratic imposition, or a valuable clinical tool.

Think about the long haul

Your EHR system can and should help to make your healthcare organization safer and more efficient, with better health outcomes.

But it can’t do it on its own. Like any medical tool, healthcare IT needs to be used by skilled, experienced hands, and minds that are always looking for new ways to improve patient care.

Picking up that experience and blending it with the clinical expertise in your organization takes time and consistent effort. It means active change management, sustained throughout the life of the system – not just at launch.

As I often tell our clients: don’t think of it as a wedding; think of it as a marriage and cultivate a well thought-out plan over time in order to realize the long-lasting impact of technology in healthcare.