Since the growth of Electronic Health Records (EHRs), many systems and policies have been built to make their use in patient care more effective. Of the most well known, perhaps, is the Meaningful Use standards created by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs, which provides incentives to organizations meeting certain criteria in their use of EHR. Despite this model to cultivate EHR adoption and appropriate use, physicians and organizations have found EHR implementation to be costly and burdensome. The American Academy of Family Physicians recently published a piece about the falling numbers associated with EHR Meaningful Use enrollment. The numbers demonstrate at least a 21% dropout rate between 2011 and 2012. The numbers are surprising; shouldn’t everyone be excited about using computers instead of handwritten notes and applying the numerous features to improve patient safety? From the inside, these numbers seem less surprising.
As a medical student, exposure to the aspects of billing, appropriate documentation and standards was limited. In my first week as a full-time physician I finally understood the obstacles to EHR use even at the basic levels. Despite two full days of introductory training on our EHR, I found myself on the first day feeling lost and frustrated on how to do the tasks necessary to provide patient care. Certainly, there are ways to improve the design and user interaction, but in reality the EHR is not overly complicated. The difficulty is in the training and preparation to provide hospital professionals with the necessary skills to deliver patient care in context. Training, if it happens, often occurs in a classroom away from the hospital context. The examples are meant to be broad instead of specific and relevant to the type of care certain professionals can provide. In my experience, more time was spent showing how to customize features we would never use instead of carefully outlining the steps to admit, treat and discharge a patient from start to finish – the reality of what we needed it for.
Instead of being able to catch up when required to use the EHR in real time, healthcare professionals are frustrated, blaming the EHR for being difficult to use and confusing. The technology, when used appropriately, has the capacity to improve our productivity so that more time can be dedicated to being in front of the patient instead of in a closed room writing notes. The barriers to making such a shift is difficult. The best people to do training are the physicians, nurses, practitioners, etc., who use the EHR daily in a particular field of practice and can demonstrate their practice. While EHR representatives and administrative staff can do a great job, their experience is limited to the to-list provided for training and not specific to the needs of their trainees. There are many stories of this experience. Now, how do we inspire organizations to take the leap to improve training for better adoption?
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