How to Avoid Stagnation in EHR Change

This is the tenth in a series of excerpts from a recent Arch Collaborative exclusive webinar, hosted by Taylor Davis and featuring Rob Schreiner, MD, President of Wellstar Medical Group.

Taylor Davis:

"What are the keys to the building on these changes?"

Rob Schreiner:

"Right. So in the next slide is just a simple graph or chart.

I didn't fill it in, but, here's a few examples in each column of what went well in our change efforts (to give our audience an idea of what we're talking about here). So we expected that direct observation of the docs and staff during a typical work day. At baseline we anticipated that direct observation would be important. We didn't anticipate the innumerable and nuanced problems and workarounds that we noticed: That weren't even memorable to them because they'd been doing those workarounds for so long and suffering the pain of them so long they didn't even mention them in conference room.

And we incidentally discovered glitches in our EHR build for that particular specialty. For example: the need to update health maintenance recommendations or the need to modify some of our best practice alerts.

And we didn't anticipate creating the culture of continuous improvement that we did. Yeah, we did expect the folks on the team to be happy with the better future state and going home earlier, and having a more civil day, and being able to visit with one another during lunch instead of see patients or close out charts. We did expect that.

But what we didn't expect was the culture change that occurred. So after we left, they pick the next pain point and they sort of had the template of how to make that better and didn't really need us to hold their hand through it. And they've been picking other things to get better.

One example of what we would do differently? So this is the middle column, we would develop and we did develop a more structured and efficient process to train the docs and staff on the EMR.

That is to say to get them at a proficiency level on the EMR, particularly with the new workflows. We were doing it in a "catch as catch can" fashion. We were sort of chasing people around the office saying, "Do you have five minutes or 10 minutes? I'd like to show you something really cool that you're going to love and you're gonna use it every day." We now do it in a more structured way.

And we also modified the initial EHR training at the time of orientation and on-boarding: rather than shooting for, "just the facts, just the basics, just give me what I need in order to turn on the machine and start typing." - Now we ensure competency in basic functionalities for that particular specialty."

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Photo Cred: Shutterstock, Robert Kneschke