What to do when EHR fails

Watching the Olympic track and field trials motivated me to lace up the shoes and hit the road—thank goodness I had not been watching synchronized swimming.  I had not run in eight months. 

It had been nine-and-a-half years since my heart attack.  My last run, on a seventy-eight degree day concluded with a no expenses paid ride to the ER in the back of an ambulance.  A cardiology nurse just happened to drive by and spotted my formerly athletic physique sprawled on the lawn of an elementary school.  I was trying to remember what it felt like to breathe. 

This Sunday the temperature was one hundred and two—a dry heat, much like a convection oven.  I ran three miles.  I was in so much pain that even my eyebrows hurt.  My “big bang” approach to starting to run again was the wrong way to attack it.  The next day I reverted to how I learned to run in high school; run five minutes, walk five minutes, repeat.  And guess what, it worked.  Did the same thing today over five miles and it felt pretty good.

Often the old way of doing things is the smartest way.  Take your electronic health records system.  Please. 

I was having dinner with all of the hospital CIOs whose EHR had increased their productivity.  After waiting twenty minutes I realized the other person was not going to show.  My guest was to have been the chief medical information officer for a large hospital group.  He told me that after implementing their EHR the group’s productivity had fallen twenty percent but the group was now running ten percent ahead of their pre-EHR productivity.  Probing, I discovered that the group’s thirty percent productivity improvement was achieved by reverting to the old way of doing things, charting at the end of their rounds.

Recently I completed a review of a large hospital to assess the impact of its EHR.  Net-net, its productivity, as measured by the number of patients seen during rounds, two years post implementation, was down thirty-four percent.  The new steady-state.  Imagine having to explain that to your CEO.  Apparently, it does not require much imagination since hundreds of hospitals have seen productivity decreases of between twenty and thirty percent.

Of those hundreds, how many have implemented a plan to regain their lost productivity?  Dozens are redoing the training—you heard it here first—that will do almost nothing to offset the loss.  The training was done correctly the first time. 

Others are throwing out their first EHR in favor of another application—HIT Rule 101 “When everything goes to heck, blame the software.”  The reason this approach has not worked is because while one group of smart individuals is dumping system A in favor of system B, another group of equally smart individuals is dumping system B in favor of system A.

Why is a productivity loss of this magnitude or of any magnitude so important?  Let us return to basics for a second.  Whether the cost of the EHR was fifty million or a hundred million the argument remains the same.  Most hospitals, rightly so, have discarded the idea of trying to argue for a three to five year ROI—it does not exist.  You’ve done the math.

The next question is whether one can argue that the intrinsic benefits of having an EHR can offset having spent millions of dollars on an IT system with no ROI.  Quality of care.  Safety. 

What’s up with that?  If productivity is down by a third—the number of patients seen during rounds—while the quality of care and safety may be up for two-thirds, one can argue it has not gone up for the other third.  Knowing that the other third are still receiving care, the only way for that to happen is to increase staffing.

So, if your hospital spent fifty or a hundred million dollars on its EHR, and has lost productivity, chances are you feel you are stuck with having only two choices to recover from the productivity loss, both of them bad.  You can either go back to the old way of doing things, or you can hire more clinicians.  Neither approach gives you a positive ROI.

There is one strategy that will work, redesigning the User Interface, the EHR screens the clinicians see.  This can be done in such a way so as to make people want to use the system.  Do this and everyone benefits.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s