Imagine participating in an EHR advisory group for your area.
Every month or so, you meet to hammer out and vett new directions that your medical record will take. Which mods to bring in, when to do major and minor upgrades, how to educate physicians and staff about the transitions, and so on.
And every month, you’re surprised with what folks rate a PASS or a FAIL. Every single time.
I’ve been in these fun little shoes. It’s embarrassing if you’re the “physician champion,” and one of your duties is to minimize organizational surprises from doctor pushback. Being surprised keeps life interesting, but entertainment value is limited when it means going back to the drawing board.
Sooo…I’ve distilled a list of 7 Key Tests — filters — to grade new features before they get too far down the development pathway. Looking back on our Group’s meetings minutes, I think they work pretty well.
Part 1 deals with the first four tests.
1. Any Information To Be Filed Must Have Doctor Approval Or Awareness
This is a biggie for medicolegal reasons. As an IT advisor or the practicing physician, you want to be real careful about bringing anything into the chart without some kind of signoff process — the data must pass doctor eyeballs before it gets filed away in the digital bowels of the chart. The physician is ultimately on the hook for info in the chart, and docs hate it when they’re tagged for abnormal results that apparently they never saw, and thus couldn’t have acted upon.
Protocols for colleagues and assistants fall under this. A mid level or colleague may be empowered to refill certain meds without consulting with the original doctor, for instance — but only because the protocol to do so has already been worked out in advance. The doctor has already “laid eyes” on this workflow, and approved it.
Nothing gets filed without a doctor being flagged on it. It doesn’t have to be a big hairy approval deal, but physicians need a chance to maybe do something, if warranted.
2. External Resources To Take Care Of Scut In A Cheap, Dedicated Fashion = PASS
As noted in a previous post, doctors are super busy. Taking care of “scut” — in this case, repetitive tasks that could be handled just as well by someone below the physician’s level of licensure — frees up mountains of resources. And there’s always plenty of scut.
The doctor could grind through it. The office staff could grind through it for less than the doctor being tied up. And if possible, and external agency, like a practice management group, IPA, or even a private company, could grind through it in an expert, hyper efficient fashion for even less.
Examples of this include signing patients up for secure portal (email-like) communications, and gathering results and consultant notes prior to the next follow-up appointment.
The business proposition is to maximize the doctor’s time. Doctors work best, bringing their observational and decision making skills to bear, not running around calling for test results, or waiting around for callbacks.
3. Get Doctor Signoff Before Proceeding With System Changes — Repeatedly
You’d think it’d be enough to show ask someone once if they like a new feature. But it ain’t necessarily so.
Doctors evolve, like anyone else. Especially if any proposed modifications will take time to develop and implement, they are going to continue to change and mature during the development process. When the IT group turns around with the final product, the doctors may have advanced out from under it, and say, “Who the heck came up with that bright idea?”
Doctors need to be shown, repeatedly and explicitly — not just conceptually — how major mods are taking shape.
4. 1-Click Is Best, 2-Clicks Is Status Quo, Anything Else…Not So Good
This is a tough one; it lies almost entirely in the realm of the vendor, or an external group creating modifications.
But doctors are busy folk. They do repetitive tasks with almost every patient.
Whether looking up info or taking action, key repetitive tasks should be 1, maybe 2 levels tops, away from where they are on-screen.
Physicians will eventually complain if these take more than 2 steps — and will immediately be grateful if a 9-step process gets pared to 4. Or 1.
