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Part VI: Misplaced Focus on Features Rather Than Practice Goals

Here is the sixth installment of WRS Health’s 10-part series dedicated to Dr. Lawrence Gordon’s recent white paper, “10 Implementation Mistakes to Avoid: Why Practices Fail.” Each segment of the series examines one of the 10 most common implementation mistakes by medical practices when implementing electronic health record (EHR) systems.


Many practices fail with implementation because they have a laser like focus on features instead of a focus on practice goals and processes.

In, “Factors and Forces Affecting EHR System Adoption: Report of a 2004 ACMI Discussion,” Joan S. Ash, PhD and colleagues state, “There needs to be communication that helps the users understand that while it may take longer to enter an individual order, there will be impressive payoffs downstream. It also needs to impart an understanding that the system is not just replacing a paper system; there will be a fundamental change in workflow that will help users do their work better. It also needs to be honestly admitted that there may be difficulties for a while, but that places that have implemented such systems in the past claim they would never go back to paper.”

In a Medical Economics article, entitled, “How to Choose The ‘Right’ Electronic Medical Record System,” Joseph G. Cramer, M.D, a Utah pediatrician reveals, “We failed to focus on the most important part of the decision – the human/computer interface. We talked about how the practice management system handled claims, the viability of the vendor, and reliance on national standards and certification. Our IT guy told us he liked the computer language. But we didn’t listen to our guts on the design of the computer screen that we would have to look at for hours on end. It is about functionality and workflow. It is all about design, which we see every day, but mostly ignore. Mention design and people think fashion shows. But EHR design is more critical than skirt lengths and fabric. Design of the computer screen and the underlying program is how our brains see the whole picture of the patient.”

Emphasizing, that human/computer interface is the key to success in adopting a web-based EHR, Dr. Cramer acknowledges, “People talk about the learning curve. The reason for the steep slope of our curve is poor design. If the design were correct, then the clicks and their results would be intuitive. One does not need an instruction manual to open a door. Proper design leads to doing the right thing. Poor design makes it easy to do the wrong thing–the door doesn’t open, or it slams shut on your fingers.”

The case of Comprehensive Women’s Healthcare in Texas, an OB/GYN also opens a window on the importance of focusing on goals. The practice, which is staffed by two physicians and a nurse practitioner, serves about 100 patients a day. In choosing their first Electronic Health Record, the practice had a sharp focus on their goal of streamlining the entire workflow in order to achieve the highest efficiencies. Barbara Buckley, NP says, “Our EHR software company has an online patient portal and that impressed us because our patients can go online and accomplish a lot of things. The patient portal saves patients time and increases the efficiency of Comprehensive Women’s Healthcare. We have put all of our forms online so that all of our patients can fill out their paperwork before they come in. The patient portal also allows patients to request appointments. In this day and age of email it is a way to let patients keep in touch with us. It is also HIPAA compliant. If it is midnight and patients want to request an appointment they can message us and we can set up an appointment when we open the office. Patients can go to Walgreens at 7 p.m. If they find out that they need a refill, the pharmacy can send an electronic message authorization.”

Comprehensive Women’s Healthcare is also answering requests from patients with the software’s General Messaging capability. “If our office is closed and patients are at home and they have a billing or medical question, they can still pose the question. Because we use EHR Messaging, patients can make a query about an appointment, their condition, a refill or a bill. The question is waiting and we answer it soon as we see it,” says Buckley.

In addition, the EHR patient portal also enables patients to input their medical history, surgical history, family history, medications, allergies and social history prior to their first visit. “It’s a huge time saver in healthcare. You get up to the minute, accurate information,” claims Buckley.

Since patients don’t want to spend a lot of time in the waiting room, the patient portal enhances the quality of the time that patients spend with physicians. “When our patients are in the office they can spend time talking about their health and not filling out paperwork.”

Dr. Chin further explains that the process is always in motion.“Many system implementers believe that once a system is implemented, their work is done. But the truth of the matter is that these systems are constantly changing. Application software, operating systems, hardware, technology, and medical knowledge about diagnosis and treatment are constantly changing. The myriad combinations and interactions of all these changes will keep a project team “implementing” at all times.