How to recover from a bad electronic health records implementation [PODCAST]

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“Is your health care organization reeling from a bad EHR implementation?

There have been rumblings from hospital leadership and congressional committees about the Veterans Administration (VA) Hospitals’ implementation of the Cerner Corporation electronic health record (EHR) replacing the VistA EHR. The $10 million EHR overhaul has been controversial since the staggered rollout started in Spokane, Washington. One report noted that months after the go-live, fewer users knew how to operate the system well.

From the perspective of an outside informaticist, such frustration can be multifactorial. The typical issues are made worse by the COVID-19 hospital restrictions on normal hospital operations. However, many of these issues could have been mitigated by offering expanded in-person expert support to hospital staff supported by virtual technical assistance.”

Afua Aning is a physician informaticist.

She shares her story and discusses her KevinMD article, “How to recover from a bad electronic health records implementation.”

This episode is sponsored by Tradeoffs, available on your favorite podcast platform.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Afua Aning. She is a physician informaticist, and she wrote the KevinMD article “How to recover from a bad electronic health records implementation.” Afua, welcome to the show.

Afua Aning: Thank you, Dr. Pho, for having me.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Afua Aning: Sure. I finished my medical education but found a niche in medical informatics. As I navigated through my experience, I found that I had a particular niche, but yet there wasn’t a lot of representation of people of color, and that’s why I came up with a company called My Just Checking In, where we help physicians navigate through their implementation process.

Kevin Pho: Not everyone in my audience is familiar with what a physician informaticist is. So tell me exactly what that is and a typical day of the cases that you see.

Afua Aning: Medical informatics is becoming a big thing. It’s practically, how I’d explain it, a hybrid of IT and clinical. Our main goal is to make the process of workflow efficient and easy for physicians and providers that utilize the electronic medical records, so electronic medical records such as Epic, Cerner, OSCAR. We’re there to help them with the ease of the implementation.

Kevin Pho: Now, is there a fellowship or a course that physicians can take if they’re interested in the field?

Afua Aning: There are, and there are some residency spots, especially if you want to be a CMIO, which is chief medical information officer. So there are some courses that one can take to be in this industry.

Kevin Pho: All right. So let’s talk about the KevinMD article that you wrote. It’s titled, and it’s very relevant, “How to recover from a bad electronic health records implementation.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Afua Aning: Health care informatics is a powerful tool, but only if it’s used effectively and implemented well. That’s why I came up with the five E’s to help health care organizations through their implementation process.

So the first one is evaluate. Health care organizations need to evaluate their workflow and see if there are any gaps that they need to deal with. The second one is to eliminate workflow process waste. Oftentimes they feel the need to replicate tasks that they were completing in the old system to the new, and that may not necessarily be true.

The other one is engage. Engage both clinical and IT staff in the process. Allow them to work cohesively so that they can work on tasks efficiently. The next one is entrust: Trust in expert health care IT, medical informatics support. And the last one is to learn from your experience, whether it’s success or failure.

Kevin Pho: Now, every electronic health record implementation has a certain amount of disruption, no matter how smooth it goes. What separates a successful EHR implementation from one that is a failure?

Afua Aning: To me, what separates it is basically supplying good support, clinical IT experts, right? I have this example of a Tesla. If you’re spending a lot of money on obtaining a Tesla, you would want to at least know the functionality and the maintenance of it, right? So it’s the same way with electronic medical records. Health care organizations are spending millions, if not billions, of dollars, and yet oftentimes there is a lack of expert IT support.

Kevin Pho: And what are some of the reasons behind that? Because you figure a lot of health care organizations, if they’re spending millions and millions of dollars implementing electronic health records, would want the necessary support. So from your experience in dealing with various health systems, what are some of the root causes why they’re not providing the proper support?

Afua Aning: Multiple factors, I would say. For example, what happened in the VA, when they had to halt their implementation because they felt that they had inadequate support. I feel like COVID has also brought in some challenges, right? We’re seeing where health care organizations have to pivot, and they have to utilize more remote support. It is my belief that there needs to be a combination, a hybrid of both remote and people on the ground, to make the support useful and better utilized.

Kevin Pho: So let’s say I’m in charge of a health system, and I’ve implemented an EHR system, and it’s not going according to plan. From the title of your article, how can that health system recover from a poor electronic health record implementation?

Afua Aning: Assess your workflow and see what’s going on, right? Try to have some team building. Allow the staff to air out their frustration and see what they’re feeling about the implementation process, and then the groundwork will begin. Look at the workflow. Contact your IT and the clinical staff and see.

I would say find some physician champions, because they are the eyes and ears of their department, right? They’re better able to see what the needs of their departments are, so utilize them. And just be mindful. Listen to the clinicians and what their frustrations are, and try to implement, and make sure that you have strong, better IT support.

Kevin Pho: Now, from your consulting experience and from all your work with all the other health systems when they’re implementing new electronic health records, what would you say are the biggest red flags or the biggest mistakes that you’ve seen from your personal experience?

Afua Aning: Hospital systems feel that they need a lot of people on the ground, and that is usually not the case. You just need expert support. So I don’t know if companies sell these hospital organizations that package, or that they need a lot of bodies on the ground. What I would suggest you need is strong individuals that can deliver, that know multiple modules, and that can help your organization. You don’t need that many individuals.

And you need to be in charge of the process of hiring these individuals that come to your organization, and I think that’s very imperative. You need to know who’s coming on the ground to support you. I mean, if you were to bring somebody on board for any hire, you would look at their resumes, but at times hospital organizations do not do that. They trust that the company is vouching for these individuals, and that may not be the case.

Kevin Pho: So give us an example. Are you saying that one of the mistakes you’re seeing is that hospitals are bringing in hundreds of people on the ground, but these people aren’t qualified, or are they less than helpful when it comes to assisting with that transition? So what exactly is the problem with the people, in most cases, that they’re bringing in?

Afua Aning: Well, a case in point is the VA implementation. One physician said that she called the call center, and the individual said that it was the first day on the job, and the physician knew more than the person that was supposed to help them. So oftentimes that’s the experience that these staff have to deal with.

Kevin Pho: We’re talking to Afua Aning. She is a physician informaticist, and she wrote the KevinMD article “How to recover from a bad electronic health records implementation.” Can you share a little bit about the cost? What are some of the costs when a health system poorly implements an EHR system? What’s the cost to them?

Afua Aning: Not only does it cost them the time, but it costs them millions of dollars, right? Millions of dollars, because it’s not cheap to implement this software, and it’s not cheap to bring on clinical or IT support. So I feel that health care organizations need to be very mindful when they’re bringing on support.

Kevin Pho: And from your experience working with various health organizations, what is the percentage of success when an organization transitions from paper to EHR?

Afua Aning: I would say at least, because, you know, it makes things efficient. It makes workflow easier, and it also makes things cohesive, and it allows other physicians to also see the records easily, and for the records to be accessible.

Kevin Pho: And if you share one tip with health organizations thinking about making a transition or even changing EHRs, what would your one tip be to these organizations?

Afua Aning: Health care organizations spend millions, if not billions, of dollars on implementing the electronic medical records, and yet staff often feel unsatisfied. So by investing, by supplying better medical informatics, it would allow better adoption and efficient workflow.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Afua Aning: As physicians and as clinicians, we need to be our advocates, not only for ourselves but for our colleagues. It’s known that over 400 physicians commit suicide yearly, and I feel that health care informatics can introduce efficiency to alleviate some of the stresses.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Afua Aning: Thank you for having me.

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