It has been 5 years since the passage of the HITECH Act portion of the Affordable Care Act. The purpose of HITECH was “to promote the adoption and meaningful use of health information technology.” While the result of this legislation has been the significant increase in the adoption of EHRs, most of the potential benefits of digital technology have yet to be demonstrated. there are multiple reasons for this lack of proof.
The portions of meaningful use directed at patient management (versus documentation) have not been fully implemented. In addition, according to an excellent report “Lessons from the Literature on Electronic Health Record Implementation” by the Urban Institute, “Training best practices include obtaining organizational commitment to invest in training, assessing users’ skills and training needs, selecting appropriate training staff, matching training to users’ needs, using multiple training approaches, leveraging the skills of role models (clinical leaders, champions, super-users, training coordinators), providing training support throughout the implementation process, and retraining to optimize use of the EHR.”
I would like to focus on the physician IT champion (either on an enterprise or office level) as a key component of this strategy. The role of the physician IT champion is to keep physicians up to date on the changes to the EHR and for maintaining physician buy-in to ongoing improvement projects involving the EHR.
1. There will be improvement and expansion of digital health care technology. The EHR is among the first large scale forays of Digital into mainstream health care (imaging was first). The near future will see expansion to include mobile medical apps and telehealth. I believe that standardization of EHRs, the growing focus on development of mobile health strategies (as described in a HIMSS Analytics Mobile Survey), and a large body of pending telehealth legislation will all accelerate this expansion. Physician IT champions will assist in implementation of the EHR as well as integration of these new interoperable pieces. Home grown enterprise IT projects involving analytics, clinical decision support tools, registries or any combination of these requires an intermediary between the IT department and clinicians during both development and implementation.
2. EHRs will continue to become more complex. As EHRs incorporate more data related to either regulatory requirements or changes in the IT structure, physicians who are operating on marginal familiarity with the system will become overwhelmed. The more familiar one is with the basic unit of operation, the easier transitions will become. The IT champion is the clinical face of IT in the trenches. Interacting with champions with good communication skills, knowledge base, and empathy will be the difference between an IT success and failure. The imperative of implementing more complex IT integrations across increasing numbers of affiliated care entities (either within an enterprise or as part of an ACO) will benefit from physician IT champions who can support local clinical IT leaders. Many enterprises are now either using or shopping for their second EHR system for various reasons. As more complex regulatory requirements are mandated in later stages of meaningful use, the role of physician IT champions will by necessity increase to assure success.
3. EHR buy-in is a trickle down phenomenon. Physicians are the leaders of the health care team. An unhappy leader is detrimental to patient care in multiple ways. Frustration and anger directed toward the EHR sends a message to other team members including clinical and clerical, discouraging them from embracing, customizing, and respecting the technology. This in turn can increase risk of privacy breaches, mistakes in data input and transfer, and ultimately clinical errors, all of which are risk management liabilities. A physician who is not well-trained has an increased chance of misguidedly having a negative attitude towards the technology. In turn, the opportunity to transmit good IT practice (which makes it a better user experience) to junior or new team members will be lost.
4. Quality of patient care is at stake. The EHR is fertile ground for both improving care and for making clinical mistakes. The old adage, “garbage in, garbage out’ is no truer than when applied to the EHR. An IT champion sending the message that good IT practice will not only make care easier but safer, with the patient always at the center of the discussion, will garner the loyalty of all providers. There are many limitations of present day EHRs which are barriers to optimal patient care. This will change over time and IT champions will be on the forefront of providing those improvements either within existing systems or conveying user recommendations for newer systems. Establishment of this relationship gives IT leadership a clinical face which providers can relate to. I see it analogous to a neighborhood with a foot patrol police presence.
5. The physician champion role is not a new one. The institution of physician champions in the clinical arena has been shown to be successful. Extension of this concept to the IT sector is a welcomed prospect when one considers that the EHR was unfamiliar territory initially to most physicians. The combination of limited initial training, ongoing time constraints, and increasing complexity beg for creation of such a role. Physicians have been familiar with the role of key opinion leader and other physician leadership roles. The IT champion would be among the most appreciated of all.
The AMA recently issued an executive summary entitled “Improving Care: Priorities to Improve Electronic Health Record Usability.” This identifies concerns that the EHR vendors should address. The implementation of a system including physician IT champions addresses issues which users need to improve upon to maximize benefits and minimize liabilities. More importantly, better EHR usability facilitated by the IT champion can improve physician job satisfaction.
David Lee Scher is a cardiac electrophysiologist and a consultant, DLS Healthcare Consulting, LLC. He blogs at his self-titled site, David Lee Scher, MD.