training physicians in the EHR

Moving the EHR Forward Together

I am passionate about participating in the Arch Collaborative because I feel that we as a group can better move all of our organizations forward and make what we do for our patients easier, quicker, and less burdensome. By doing so, we can all have better outcomes.

For Ohio State University Health System, I'm most excited to look at where our physicians feel we are and develop a plan to move them forward in a positive direction, knowing where they feel we are weak. I am excited for constant improvement. You can’t get better without feedback. It is about learning from what others are doing and sharing what are we doing. It is thinking about how we can all move forward together.

A Focus on Education

Our number one focus for improving EHR satisfaction at OSU is education; we are trying to educate both our providers and our nurses where they are. For example, if new tools come out, we need to figure out who is not using them and how we can teach about those new things so that our providers can become more efficient with those tools.

Education is also about trying to understand and address our providers’ and nurses’ greatest frustrations. In our survey results, nurses felt like they were doing a lot of redundant documentation. We created a task force to identify where the frustration is and figure out what redundant documentation means to the nurses. Then once we’ve pinpointed the cause, we see how we can help eliminate it.

Sometimes the right hand does not know what the left hand is doing. What I mean by that is that we have to make sure that we explore what we are already doing and determine whether we are solving the issue someplace else. Let’s say that we get a mandate that requires documentation for x. We might already be doing something about it, but the tool might not be where people pushing for x expect it to be. If we are addressing the problem elsewhere, how can we maximize that effort? Or if we really are not putting forth effort anywhere else, what needs to be added? It is better to evaluate what is already being done than to just implement an add-on every time.

Simplifying the Answers

Our physicians believe that they give really good quality care in our EHR. That makes me happy because that really is what I strive for in what we do: enabling the physicians to give good quality care.

However, I struggle with the fact that our providers don't think that our EHR is easy to learn. As I have explored that issue over the last two years since we got the results and have had conversations with our physicians, I think that the answer comes down to the fact that there are so many ways to do something in the EHR. Many times, our physicians ask me to just tell them what the right way is. And the answer is that there is not one right way. But over the last few years, we've started developing one right way to do things because of that desire to know the best way.

I have discussions with the trainers, and they bring up the fact that we can do all sorts of things in different ways. I tell them to figure out the most efficient way. Then if a provider struggles with that way, I tell them to give the provider another option. Trainers must figure out what they think is the best way, teach that way, and stop confusing the physicians and nurses with a dozen other ways. We have found this approach to be a little more successful.

Shifting How We Think about the EHR

I have lots of ideas for continual improvement, and they are so far outside the box that I'm not sure that the technology is there yet. But I would love to see a provider be able to walk into a room, have the computer recognize him or her, have a conversation with the patient, and then get a summary. The summary might not necessarily be in the form of a note, but the provider could then take that summary, edit it a little, and have a note.

I would love to see a shift from notes that are just loaded with all kinds of things pulled from everywhere to notes that actually convey what's going on with the patient and what needs to be done for the patient. What exists in other areas of the electronic record needs to stay in those other areas and be used for decision support and critical thinking, but not necessarily as a part of the note.

We need to get to that next level where our providers really start to benefit from the discrete data that exists in the EHR. The EHR could help control what a visit is about. It could help the patient and provider identify risk factors and other things that are important. The EHR could become this tool to help providers with their decision-making and prioritization of the care of the patient.

We have enough data now to be able to do that; we just have to start to turn the corner and change the way we look at the EHR as a tool that helps us as opposed to just a device that we record things in.

Sharing Opportunities

The Arch Collaborative is a great opportunity to share innovative ideas and opportunities for change and to truly be able to do what the name says: collaborate. I think it has been really refreshing for all of us to work together to move forward with things that we all struggle with. I really love that. I also love the fact that the Collaborative reaches across all vendors and all venues.

The Arch Collaborative shows that there is not one right answer. Even though that can be frustrating to some, like I talked about earlier. The Collaborative is about picking and choosing what is going to work in your environment that your providers are going to be able to adapt to. It is great to have a smorgasbord of data to compare successful groups, talk with them, and maybe implement a solution that combines the groups’ own ideas.