The conversion from paper to electronic health records (EHRs) taking place in the U.S. health care industry is a massive undertaking that’s bound to have some fallout. One of the most unfortunate forms of this fallout is the loss of physicians who are too close to retirement to bother with the costly and time-consuming switch, or who simply can’t get the hang of using an EHR system.
The latter cases often make the news, because unlike those who chose not to make the transition, these physicians were willing to get on board with the change, and spent the time and money trying, but just couldn’t make the adjustment. It’s easy to feel sorry for these docs — interfacing with modern technology often requires a certain amount of dexterity and familiarity that some older physicians may not have.
The latest EHR fallout case to make the news is that of Dr. Steven Kottemann, 63, who was placed on administrative leave in September by his employer, Springfield, IL-based Memorial Health System, after failing to achieve proficiency in the hospital’s new EHR system. Some of Kottemann’s patients, upset by the decision, established a website in support of him.
Dr. Kottemann claims he had no computer skills before the hospital transitioned to EHRs, and faults the hospital for buying a “lousy system” that was deleting his dictations. He tried typing his notes instead, but a minor stroke in 2008 made this difficult for him. A spokesperson for Memorial says that Dr. Kottemann was treated fairly, and that he was given additional EHR training and scribes to help keep up. Memorial also says there were other factors at play in Dr. Kottemann’s suspension, but did not elaborate.
Memorial is not the only health care practice to require its physicians to demonstrate proficiency in an EHR system. Several years ago, Beth Isreal Deaconess Medical Center instituted a bylaw change that requires all of its clinicians to use the EHR system as of 2010. During a presentation on meaningful use at the HealthMart 2011 conference in Worcester last month, Dr. John Halamka, CIO of BIDMC, told attendees that doctors who don’t use the EHR system simply cannot practice there.
BIDMC administrators are not just trying to be tyrannical — the organization believes this requirement is necessary for the delivery of safe, quality coordinated health care to its patients. It’s almost a moot point anyway, as all physicians practicing in the state of Massachusetts must demonstrate competency with EHR systems by 2015 or lose their eligibility for license renewal.
But regardless of these mandates, health care organizations would strongly prefer not to lose any clinicians as a result of an EHR implementation. Many of the speakers at the HealthMart 2011 conference echoed the sentiment that solid EHR training and steady communication before, during and after rollout is crucial to keeping EHR users on board.
The experts at HealthMart offered a number of tips on how to successfully train clinicians to become meaningful users of an EHR system:
- Establish user groups and super users;
- Provide “just in time” EHR training as well as online, on-demand training and webinars;
- Schedule individual training for those who really need it (like ultra-busy physicians who can’t come to regular training sessions);
- Hold training sessions during times that won’t interfere with clinical work, like during lunch or in the evening, and provide food so clinicians can feel like they’re getting two things done at once (lunch and learn);
- Have people at the elbow of clinicians as they’re learning the new system;
- Communicate regularly via email or newsletters, encourage users to share “eureka” moments (i.e. figuring out a better way to do something in the system).
While a solid EHR training plan will help clinicians make the transition from paper to electronic health records, even with the best training and deployment, a few may not make the cut. But they will likely be in the minority: Dr. Halamka said out of 1,758 eligible professionals that attested for meaningful use, he recalled only four that opted to either quit or retire.