Over the past 10 years I have implemented electronic health records systems (EHR) from California to The Virgin Islands and everywhere in between. My travels have landed me in 75 unique airports and I honestly cannot tell you how many times I’ve traversed ATL, DFW & ORD. In 2007 I turned down a trip to implement a hospice system in Hawaii because my wife was pregnant. There’s no way a husband who wants to stay married goes to Hawaii and leaves an expectant wife home alone. Sometimes we go to cool places but this vocation is not a glamorous one, not by a long shot.
Reality for EHR consultants usually involves driving for hours from the airport to the hotel and then on to the hospital in chilling darkness or driving snow. It’s no coincidence that North Dakota and Minnesota are leaders in hospital EHR adoption. I know because I was there. For EHR consultants the work week is a blur of highways, airline terminals, rental cars, cheap hotel rooms, terrible food and hostile clients.
I have implemented systems for home health agencies, hospices (home and in-patient) rural and critical access hospitals, family practice clinics and specialty practices. Regardless of the care setting or the role of the employee (i.e. clinical, administrative, records, billing, scheduling, etc.) the one thing they can all agree on is their dislike for the EHR guy.
I have been cursed out, threatened and harassed. I have witnessed doctors, nurses, administrators, clerks and assistants break down into tears, quit their jobs and/or get fired. In fact, one of the greatest compliments I have ever received was from a young medical assistant when she stated during an all-employee-meeting, “I don’t think this implementation has been that bad. So far, no one has cried.”
Change is difficult to accomplish in any industry but healthcare is particularly tough. It’s an extremely complicated ecosystem with multiple stakeholders and competing agendas. I completely understand why staff may hate to see the EHR guy cross their threshold. I represent changes in workflow that may shift burdens from one staff member to another and/or increase the level of difficulty related to some tasks while making others easier. Many times the systems I install make some employees feel threatened as manual-time-consuming-tasks become automated. At one home health agency an administrator whispered to me, “this software is great, I’ll be able to lay off three people.” She didn’t actually let anyone go. In fact, the opposite occurred. She ended up adding staff as her census increased after fully implementing our system.
Probably the highest hurdle to get over is convincing skeptical providers and clinical support personnel that my intent, by implementing the EHR system, is to help them enhance patient care. Initially, many providers see me as someone peddling technology that drives a wedge between them and their patients. Sometimes it takes some convincing, but eventually they come to understand that our goals are the same. If I didn’t believe that EHR technology was good for healthcare I wouldn’t be doing this job (see list of studies supporting the use of electronic health records at the end of this article).
The travel, long hours and stress take their toll but once in a while something happens that makes it all worthwhile. Like the time a patient stopped me at a practice and asked me why I was there. When I explained to him what I was doing there he said, “This is important work you are doing, thank you.” Or the time while working with the ER night shift at a rural hospital when a man came in mid-heart attack. I calmly stood by a skeptical nurse as she opened the patient’s electronic chart and clicked one button to order the full emergency cardiac work up including labs, radiology, respiratory, etc. As the physician examined the patient she and I watched as the other departments swiftly responded to the electronic orders she had entered. She looked at me and said, “Okay, now I get it.”
Less than two weeks prior to that night one of the ER docs had given me a public dressing down in front of the nursing staff. He shouted that if the hospital expected him to use the EHR he would quit. I was able to talk him down and continue the training session but the seed of apprehension had been planted and the nursing staff did not believe in what we were trying to do. Then the heart attack victim rolled in and they saw the benefits of using the system first hand. The physician did not quit and we got along quite well as the implementation moved forward. Once clinical staff understood that I was there to help and that the systems worked, they warmed up.
It can be a hard, often thankless job but it can also be quite rewarding. Especially, when you return to an agency, hospital or practice that has been on the EHR for a year or so and watch as they smoothly process patient data through the system. No more scrambling about searching for charts and nervously adhering countless stickers to pieces of paper while standing at the fax machine asking, “Where’s the hole puncher?” I love it when the staff members that treated me with disdain at our first meeting take me out to lunch and tell me that I was right and that they couldn’t imagine going back to the paper charts of the past.
I just smile and say, “I told you so.” Then I ask, “how can we make it better?”
Representative studies regarding the effectiveness of electronic health records:
Escobedo, M., Kirtane, J., & Berman, A. (2012). Health Information Technology: A Path to Improved Care Transitions and Proactive Patient Care. Generations, 36(4), 56-62.
Schriefer, S., Landis, S., Turbow, D., Patch, S. (2009). Effect of a Computerized Body Mass Index Prompt on Diagnosis and Treatment of Adult Obesity. Family Medicine, 41(7), 502-7.
Schenarts, P. J., Goettler, C. E., White, M. A., & Waibel, B. H. (2012). An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients. American Surgeon, 78(11), 1249-1254.
Redley, B., & Botti, M. (2013). Reported medication errors after introducing an electronic medication management system. Journal of Clinical Nursing, 22(3/4), 579-589.
McGuire, M., Noronha, G., Samal, L., Yeh, H., Crocetti, S., & Kravet, S. (2013). Patient Safety Perceptions of Primary Care Providers after Implementation of an Electronic Medical Record System. Journal of General Internal Medicine, 28(2).
Goodman, K., Grad, R., Pluye, P., Nowacki, A., & Hickner, J. (2012). Impact of Knowledge Resources Linked to an Electronic Health Record on Frequency of Unnecessary Tests and Treatments. Journal of Continuing Education in the Health Professions, 32(2), 108-115.
Reed, M., Jie, H., Graetz, I., Brand, R., Hsu, J., Fireman, B., & Jaffe, M. (2012). Outpatient Electronic Health Records and the Clinical Care and Outcomes of Patients With Diabetes Mellitus. Annals Of Internal Medicine, 157(7), 482-489.
Calman, N., Hauser, D., Lurio, J., Wu, W. Y., & Pichardo, M. (2012). Strengthening Public Health and Primary Care Collaboration through Electronic Health Records. American Journal of Public Health, 102(11), e13-e18.
Kern, L., Barrón, Y., Dhopeshwarkar, R., Edwards, A., & Kaushal, R. (2013). Electronic Health Records and Ambulatory Quality of Care. Journal Of General Internal Medicine, 28(4), 496-503.
Hoffman, S., & Podgurski, A. (2011). Improving Health Care Outcomes through Personalized Comparisons of Treatment Effectiveness Based on Electronic Health Records. Journal of Law, Medicine & Ethics, 39(3), 425-436.