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Oct 8 2014   11:24AM GMT

At-the-elbow physician support a must-have for EHR implementations

Posted by: adelvecchio
EHR, EHR implementation, EHR selection

1412785372_1412785172_Kathleen M  Myers MD low resGuest post by Kathleen Myers, M.D., FACEP, founder and chief medical officer of Essia Health

Amid the many changes to the practice of medicine over the last 10 years, the most dramatic impact at the point of care has been integrating new information technologies and systems, especially the EHR. Introducing a new or upgraded EHR system is a major undertaking for any hospital, clinic or medical practice. A successful EHR implementation goes beyond selecting the right IT vendor and system. At-the-elbow physician support has become an essential component of successful EHR go-lives, ensuring physician engagement and satisfaction, and letting them focus on patient care while meeting the new technology requirements.

At-the-elbow support is in-person technical expertise provided by external EHR specialists to physicians at their place of work — be it their office, an examination room or even the operating room — before, during and after EHR go-live. EHR specialists embrace the way that physicians learn best, in real time.

There are three key reasons hospitals should consider externally sourced at-the-elbow support for EHR go-live: physician buy-in, patient satisfaction and productivity.

Physician buy-in: Training doesn’t equal support

It goes without saying that physician buy-in is crucial to successful EHR implementations and upgrades. Anecdotal information suggests go-lives that have minimal assigned provider support or support from internal staff are associated with significant provider frustration, challenges with implementation and, on rare occasion, failure.

Many health systems focus their time on selecting the right EHR software but don’t think about ensuring the effectiveness of the software by providing support to physicians — support that goes far beyond computer lab training. Most physicians don’t learn well from cookie-cutter classroom curriculum. It’s not their environment. They want to engage in conversation about the EHR when they’re in an actual patient care environment.

Without buy-in from physicians, the whole go-live — or even the profitability of the hospital or health system itself — can be affected. Surgeons, for example, are an important group from which to gain buy-in in the months leading up to a go-live, given the influence they have over where their patients have their surgeries. If orthopedic surgeons don’t feel involved in the process or adequately supported on the EHR itself, they can make every CEO’s worst nightmare come true and take their total hip, knee and other elective surgeries to another nearby hospital.

The process of gaining buy-in begins with thoughtfully looking at each subgroup of medical staff, and then helping them develop the content and tools they’ll need to care for patients. At-the-elbow support can help them develop these tools. It also includes asking them simple questions like, “What are you worried about?” and “How can we help you?”

Quality patient care: More support means less waiting

When physicians are learning to use an EHR, it means one thing for patients: waiting. Waiting to be admitted, waiting for medication and to be discharged, et cetera.

“I have not run ‘on time’ since we implemented our EHR,” is a common complaint among physicians. When physicians receive at-the-elbow support, they quickly become more comfortable and confident with the new EHR system. This means they can return to their pre-go-live baseline faster, so tasks don’t take longer than they used to before the EHR was implemented. Physicians that are not fumbling with the computer can better interact with their patients, enabling them to provide more focused care throughout the go-live and beyond.

Productivity: Keeping long term drop-off at bay

Though a short term drop-off in productivity is a natural consequence of an EHR go-live, with the right level of physician support, hospitals can make sure the drop isn’t a sustained one.
An orthopedic surgeon with a once-a-week operating room time block might have conducted five knee surgeries in eight hours before the go-live, but the hospital might suggest that the number of cases be scaled down to three to provide time to learn how to use the EHR system. With at-the-elbow support, surgeons can normally get back to their full case load in two to three weeks. Without it, they may never return to their pre-go-live baseline.

At-the-elbow support: The basics

At-the-elbow support begins after physicians complete basic computer lab or online EHR training. A key difference with at-the-elbow support versus training is that it is conducted in a patient care environment, instead of a training playground. In this environment, physicians can see how patient flow will work and what EHR tools they will need to be successful.

The process involves several one-on-one individual or small group meetings with an EHR specialist before the go-live, where workflows are reviewed and tools are developed. The orthopedic surgeon, for example, would build pre-op, intra-op, post-op and discharge note templates for every common case, as well as customize order sets, before the EHR goes live. These sessions also help them get faster on the EHR as they build their skills. When their first case is scheduled after go-live, an EHR specialist joins the surgeon in the operating room and will be there every step of the way, from the time the patient arrives for surgery until they’re in the post-anesthesia care unit recovering. The EHR specialist remains in close vicinity to the physician so assistance can be provided immediately.

Implementing an EHR is a big investment in time, money and human resources. Planning the right level of provider support is critical to realize a strong financial return on an EHR investment. Without provider support, an EHR system implementation may result in physician frustration, a long term drop-off in productivity and patient dissatisfaction. At-the-elbow support before, during and after an EHR go-live can optimize the provider and patient experience and help technology be an asset, not just a requirement.

Kathleen Myers, M.D., FACEP, is an emergency physician and founder/chief medical officer of Essia Health. She can be reached at

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