Doctors' 10 Biggest Mistakes When Using EHRs

Kenneth J. Terry, MA

Disclosures

May 01, 2013

In This Article

The Way the EHR Is Used

Mistake #3: Neglecting to Perform a Workflow Analysis

Many practices neglect to figure out how they're going to get their daily work done with the EHR before they implement it. "It's a matter of configuring the software around their workflow," says Anderson. "But rarely does anybody do that. The practice installs the product and then lets the doctors start using it without asking any questions."

This can have adverse consequences. For example, Anderson notes, if the EHR isn't set up to send normal laboratory results to nurses, the doctors may be swamped by results that they don't need to see. If the EHR's messaging system isn't turned on, or the product doesn't have such a system, the staff may not know how to communicate with physicians and vice versa. Nurses may not even know which patients to room first if the EHR isn't set up to tell them when those patients arrived.

All this should be mapped out in advance before the EHR is implemented. Otherwise, practice managers or IT people may have to reconfigure the EHR while the doctors are trying to see patients -- and then teach everyone how to use the revised features. Anderson urges practices to do the workflow analysis before they train their staff on the EHR.

Mistake #4: Undertraining Doctors and Staff on EHR Use

You can cut training time in half if you do a workflow analysis first, Anderson says. Nevertheless, he observes, "Doctors pay too much for software and not enough for training." A doctor typically receives about 3 hours of EHR training, which is barely enough to learn how to handle a patient visit, he says.

Rosemarie Nelson, a Medical Group Management Association (MGMA) consultant based in Syracuse, New York, agrees that physicians don't receive enough training. Many of them tune out or leave the training session after they've learned how to document a visit -- although that's only a small part of what they need to know, she points out.

"Now they can do a visit, but they don't know how to optimize what happens between them and their nurse all day," Nelson says. "They don't know how to use the inbox. They don't see what all the possibilities are."

Nelson doesn't believe that people can learn how to use the EHR all at once, because there's too much to absorb. A good way to continue learning, she says, is to take the online courses that many vendors offer. Also, she recommends that the technology guru on the staff be authorized to "round" on EHR users once every 3-6 months. By observing what users are doing -- be they staff or doctors -- the guru might be able to show them shortcuts or easier ways to do things, she says.

Mistake #5: Refusing to Purchase a Laboratory or Device Interface

Sure, lab interfaces can be costly. But not having connections with your major laboratories can cost even more in wasted time during patient visits, Nelson points out. If laboratory results are faxed and imported or scanned into the EHR in PDF format, they're stored in a separate part of the EHR.

For a doctor to compare current laboratory values with the previous results, he or she has to pull up 2 different documents and find those values, which can be inconvenient when you're seeing a patient. Having discrete laboratory data coming into your EHR is also required for Meaningful Use and can help you move normal results to a patient portal.

Not having interfaces between your EHR and medical devices, such as ECGs and vital sign monitors, can also make your workflow clumsy and inefficient. It's difficult to look at a printout of an ECG while you're viewing other data in the EHR, and scanning in those documents doesn't work well, Nelson notes.

It doesn't have to be expensive to add interface devices, Nelson says. You can buy PC-based devices, and manufacturers provide applets, small software programs, that you can download to connect those devices to your EHR.

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