Because the EHR incentive timeline is so short - healthcare providers who are eligible for meaningful use but don't participate will receive reduced Medicare reimbursements starting in 2015 - corners have been cut, says Haugen, co-author of Beyond Implementation: A Prescription for Lasting EMR Adoption.
Organizations know they should analyze workflow, but they want to get EHR software installed first - but workflow analysis never happens, providers adopt "a million workarounds" and EHR implementation best practices aren't followed, she says.
Mistakes are common - copying a note or diagnosis pertinent to Patient A into the record of Patient B, for example, because it's quicker than retyping everything - and, according to the Office of the Inspector General at least, can constitute EHR fraud, even if a provider's copy-and-paste activity isn't being done with higher reimbursements in mind.
Training can solve such issues, Haugen continues, but organizations often focus on generic, event-based training that clashes with clinical schedules. Today's physicians, nurses and technicians learn not through rote memorization but, rather, from "putting their hands on the controls," Haugen says, using a term that describes how airline pilots made the move from analog to digital cockpits in the 1980s. What's more, simply walking users through common EHR software scenarios offers insight into how they perform common tasks, which can help trainers reinforce good habits and in turn help users build "muscle memory as to how it's done."
EHR Workflow Matters Because EHRs Are Vital Data Source
Workflow is so important to the success of an EHR system than Kristin Russell, senior director of product development and marketing with Omnicell, sees workflow integration as the remedy for healthcare IT's longtime nemesis: Interoperability.
Two factors force this change, Russell says. The first is the juxtaposition of consumer systems that easily sync with Facebook, the Wii and other services with, say an automated medicine dispensing cabinet that forces a nurse to log in, pull a patient's record and dispense medication, only to enter the same information in the EHR moments later. Nurses want to "close the loop," she says.
The second factor is the healthcare industry's push toward more coordinated care. Groups such as the Cleveland Clinic, Russell says, now take a "zoom in, zoom out, zoom everywhere" approach to care - zooming in at the individual level of care, zooming out for the sake of population health management and zooming everywhere to connect to wellness devices and the Internet of Things.
In this model, the EHR serves as, well, the data source of record for a range of purposes, including health information exchange, billing and big data analytics. To paint a more accurate picture of a patient's health, an EHR should also collect and display data from medical devices as well as consumer fitness monitors or applications. Here, Russell says, EHR systems built as platforms as opposed to standalone, monolithic systems are better positioned to share data, work together and support workflow needs.
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