Show the EHR who's boss
By Stacey Butterfield
To optimize your electronic health record (EHR), you need to find a translator, said the speakers at the session "How to Make the EHR Work for You and Your Patients" on Friday morning.
And they don't mean the staff you summon when a patient isn't fluent in English. "Find your translator who knows how to speak doctor and speak geek," said moderator Matthew Sakumoto, MD, ACP Member, a primary care physician with Sutter Health in San Francisco.
Such translators can help physicians communicate with tech experts to resolve their EHR-related problems, and every health system should have at least one. "It seems like at least a quarter of what I do," said David Wetherhold, MD, chief medical information officer for ambulatory systems at Scripps Health in San Diego.
It may turn out that your concern has been encountered by other clinicians and already has a fix, added Kristin M. Mitchell, MD, FACP, a primary care physician in Soldotna, Alaska.
"Sometimes there are workarounds," she said, adding that it's not even always necessary to go to the tech team to find them. "It has helped me a lot to talk to people who are closer to residency who have been through lots of different EHRs. They often have a different way to sort of hack the system to make things work." User forums, specific to your EHR manufacturer, are another good place to learn such tips and tricks, the experts noted.
When the only solution is an actual change to the EHR, it can be a little more difficult to achieve, especially for those on the outskirts of a big health system. Dr. Mitchell works in a hospital-affiliated community practice. "And I find one of the challenges is that I don't have a really high-level physician advocate in my organization," she said.
That's no reason to give up, though, the experts agreed. "If you don't speak up, no one knows you're having a problem and no one's going help you," said Dr. Wetherhold.
To increase the chances of getting a solution, think of some way to frame the problem as a broad issue, rather than an individual one, advised Dr. Mitchell.
"If it's just me wanting [a better way] to refer across the street to my specialist, that's going to be much harder to do than 'We need a better way to reach all of the patients who are due for vaccination,'" she said. "That sort of question is more likely to resonate with the system and more likely to be something that can be solved."
When making your case for change, also remember that even if the decisionmakers are physicians, they may not be experts on your practice setting. "I have never worked in a small practice, so I need to listen," said Dr. Wetherhold. "One of the things I've learned is that what office staff and [medical assistants] do in a small practice is very different than what we would have them do."
That understanding led Scripps to allow its smaller community practices to have different EHR security protocols, in which medical assistants could complete tasks they don't have access to in other facilities, he explained.
Customizing the EHR to meet local needs has important benefits but also carries downsides, Dr. Wetherhold noted. "There's a lot of argument about whether you want to try to stay standardized as much as possible, because as new things come in, if you're too far down the road of customization, that new function won't work like you expect it or won't work at all."
There are a number of resources that can help physician leaders resolve such thorny questions, including ACP's Patients Before Paperwork Initiative, the experts noted. "You don't have to figure this out on your own. Doctoring is hard enough as it is," said Dr. Sakumoto. ■