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Same Vendor, Different EMRs?

“I had previous experience with an instance of this EMR at a different hospital, and that instance was much easier to use than the current version here at this hospital. I am not sure how they are so different.”

This comment was taken from the Arch Collaborative EMR survey, and similar comments have been shared from other survey participants. These providers are proof that different implementation approaches lead to different EMR experiences and environments. It’s clear to me that the first hospital in the above comment spent more time incorporating clinician input into the design and use of the EMR.

Provider organizations don’t have to guess at which philosophies and practices are best. Their peers have proved that clinicians are the key to delivering an EMR that is efficient for care delivery and provides high clinicians satisfaction. Organizations that include and cater to clinicians in the following areas are the most likely to be satisfied with their particular instance of their vendor’s EMR.

Implementation Planning and Strategy. A provider organization should solicit clinician input while creating a strategy for the build and implementation of the EMR. Various clinicians and specialists who will be using the EMR must be integral in the planning stages.

Several items should be discussed with these providers, including potential workflows and personalization tools. Workflow designs that incorporate personalization tools help to create an EMR-governance foundation that will support continued EMR advancements. This approach will increase efficiency and patient safety and encourage high-quality care.

Initial Training. Once the workflow designs have been defined, they must be built into the training process. Early results from the Arch Collaborative (published in Creating the EMR Advantage: The Arch Collaborative EMR Best Practices Study) show that peer-to-peer training is most effective. Nurses should be trained by a nurse, and physicians should be trained by a physician.

 At least six hours of initial training should be allotted to initial EMR training before clinicians begin using the EMR in a patient-care environment. Organizations that require fewer hours of initial training experience less satisfaction, and this trend can continue for years after the implementation of a new EMR. Clinicians who have helped design workflows and thoroughly understand them will probably find the EMR easy to use.

Upgrades and Continued Training. EMRs are often enhanced or upgraded at least one per year or as required to meet regulatory requirements. In many cases, EMR upgrades are poorly managed and clinicians receive little follow-up education on the new EMR capabilities.

In some instances, organizations try to provide enhancement education via emails; this is rarely effective. The Arch Collaborative research shows that the method of providing follow-up EMR education via departmental meetings has the highest chance of impacting EMR satisfaction. Such training, led by peer clinicians who can demonstrate best use cases for their workflows, is the most helpful approach.

Even just three to five hours of annual follow-up education can ensure that clinicians are aware of new EMR features and capabilities that can improve EMR efficiency and usability.

Governance. Even the best EMR could always use improvements. No one could understand better than clinicians which changes would be the most beneficial, so clinicians should be supported in their efforts to provide feedback on how to continually improve the EMR. This can be done only with a governance structure that isn’t saddled with multiple committees or long turnaround times for EMR enhancements.

Clinicians who must jump through countless hoops and wait for months or years at a time for their enhancement requests to be granted are likely to feel frustrated, and they are not likely to make helpful suggestions in the future. On the other hand, clinicians who can quickly and easily influence positive change are more satisfied with their EMRs.

The innovation resulting from a positive governance structure will create an EMR conducive to effective patient care. EMRs from the same vendor will always have some degree of workflow variance driven by different organizations’ care-delivery and environment needs.

But clinicians who use the same EMR across different hospitals or clinics should not see a significant variation between EMR workflows in the same modalities of care . . . as long as the workflows are designed, understood, and updated by clinicians.