Thursday, May 13, 2010

Narrative Key to Physicians Acceptance of EHR Systems

Hidden in an article that reviewed nursing opinions on computerized records: (AFT: Nurses Express Mixed Opinions on Computerized Records) was a striking data point

While 73 percent said implementation of the systems went smoothly, many problems were identified, including 52 percent who said physicians are refusing to use the new systems. Yikes - that alone is a pretty revealing statistic that suggests that hidden behind implementations are a lot of reluctant users
The overall results suggest mixed view on the value of computerization (49% said "new computerized systems have had a positive effect on patient care") there are negative effects
While they see computerized systems improving some aspects of care, pluralities of nurses also say that these systems have had a negative effect on stress levels (49 percent) and morale (37 percent).
and more importantly:
50 percent of the nurses said the computerized systems have had a negative effect on the amount of time needed to chart patient information, while 38 percent said they have had a positive effect, and 12 percent said they have had no real effect.
So half the clinical staff believe these systems are adding to the time necessary to chart patient care. While the recommendations include a list of additional resources, training and involvement the glaring omission in my mind is the lack of consideration of the impact which implies an acceptance that it is reasonable to accept that the system will add more time to the burden of documentation? Better to reject this demand (which in one facility I heard about equated to a reduction in patient throughput volumes of 30-40%!) and identify solution's that don't add burdensome and time consuming tasks but instead save time. Now there's a radical thought.

Interestingly there was a conference held last week in Boston (Governors Health Information Technology Annual Meeting) that included presentations from David Blumenthal the National Coordinator for Health Information Technology, HHS, Kathleen Sebelius Secretary of Dept HHS and the Massachusetts Governor Deval Patrick  On the second day a Panel Session - "Getting Clarity - Developing Effective Health IT Policies and Standards" included a question to the audience:
“How many doctors are in the audience?” – a sea of hands went up.
“How many are using an EMR?” – about 2/3 of the hands remained up.
“How many of you love it?”’- 2 hands remained: Dr. Larry Garber, who is a medical director for informatics at Fallon Clinic, and Dr. Michael Lee, a practicing pediatrician at Atrius Health.

As pointed out in this piece in FierceHealthIT Saving healthcare with the clinical narrative what is striking about these two individuals is that they are both avid users of speech recognition. The principle is clear. Clinicians prefer to use their voice to capture clinical information. Failing to provide this feature and effectively blending the narrative into the EHR while facilitating the easy capture of discreet data is a surefire recipe to poor adoption and less than stellar acceptance by physicians of clinical systems.

Narrative and the easy capture of the narrative is both good for adoption but more importantly it's essential for high quality clinical care.

Where are your systems with this technology and do you include the narrative and if so is it easy to do so?