Back in the day when I was a burgeoning kendo student, I read an account about a visiting fencing master.
The writer, an established member of a kendo club, was looking forward like everyone else to the visit of this celebrity sensei. While having practiced kendo for nearly seven decades, the guest was appallingly fast, and had a reputation for winning known throughout Japan. He was, in a word, amazing, and every bit as impressive in person as his record suggested.
When the guest asked the writer to practice with him, the club member was practically beside himself. What special techniques and feints would he be privileged to witness? What insights into timing, distance, and psyching-out your opponent would he be party to?
“I’d like to work the overhead strike,” the guest requested.
WTF??? thought the writer.
“Yes,” the master said, wiggling his bamboo sword experimentally, “I think I’ve almost got the hang of it, now.”
First Walk, Then Fly, Grasshopper
Mixed martial arts metaphors aside, it’s always a Good Thing to return to the essential core of EHR rollouts: getting physicians up to speed with the new technology.
No matter how many new features a given product has, attention to this basic workflow training matter will never be misguided.
If you can’t be too rich or too thin, you can’t possibly be too adept at documenting patient encounters.
The temptation can be great, at the organizational level, to focus on high-end developments. That’s natural: it’s an organization’s “job,” so to speak, to take the long view:
- data mining
- pay for performance
- Medicare compliance and audit proofing
- RAF coding
All the things that the future of medicine and medical practice survival will depend upon.
But docs…docs just want to survive the day.
Take It In Steps
There are 3 distinct steps or stages to EHR competency, and — you guessed it — individual doctors focus on one end, while organizations focus on the other:
- Stage 1: Finish the day, notes done, nothing taken home, no reassembling notes at day’s end
- Stage 2: Communicate efficiently with patients, and regularly update chart data
- Stage 3: Be a Power User, whatever that means to you, but including strategic feature usage
Neither focus is wrong. Physicians need to feel comfortable with the daily grind basics before they’ll give a hoot about more advanced features. Organizations need their providers to migrate to more advanced features, which ultimately make the groups more competitive and viable in a chaotic health care market. Everyone needs to get comfortable with the full spectrum, which makes intrinsic sense.
What’s debatable is how best to accomplish this.
The One Ring To Rule Them All
In the next post, I’ll break down an approach to Stage 1 competency that’s worked for me, my colleagues, and a number of small group primary care physicians. Sometimes it just takes a trail of breadcrumbs, to help you find your way through the twisty turny forrest.
Meanwhile, chew on this, the central key that unlocks all the EHR hurdles a doctor will ever face, a secret that is literally worth thousands in medical IT consultant fees.
Get this, and you will pass “the hump” between you and effective, efficient EHR use, and the medical record will be your tool and aide, no longer your tormentor.
Ready?
Really ready?
It’s All About Attitude
Not Medicare e-prescribing, not patient portals, not customizability, not intuitive interfaces. And, no, not about INTEROPERABILITY.
Nope.
Those are external bells & whistles. Beautiful, no question, and jewels beyond price, to physicians and groups ready to use them.
But before you went electronic, you were documenting on paper, and not doing too shabbily.
The magic is in your attitude — how you look at your documenting world and choose to do whatever is necessary — not the software, nor the electrons, nor the pen and ink, for that matter.
YOU decide when you’re going to suck it up on any given day, and do what’s necessary, even if a bit tough on you, with a smile. Or when you’re going to carp and moan with the rest of the chorus.
There’s The Carrot, And There’s The…
Face it: presented with a choice, most of us will choose the easy way out. And it’s easy to go on about how hard it is to transition to an EHR from paper (true), how your MSO isn’t instituting obvious improvements as fast as you’d like (probably a good reason, they ain’t dumb, you know), or how your tech support sucks (valid critique, time to take some major action).
What seems hard, but is actually just as easy — thanks to an attitude adjustment — is having to make due with no choice in the matter:
- You’re going to adopt an electronic record system — ours — or you can kiss your contract goodbye, there’s 5 guys who want your spot.
- The system you get is the out of the box system, no tweaking or fine tuning, you gonna ask me a valid question?
- Our tech support has had its wrist slap, we’ll watch them, now get back to work and do your job while they do theirs.
Fun? No, but it’s remarkable how many large and quite successful mega groups, nationwide, operate daily on exactly these principles. Human beings can “adapt” quite well (in this case, get on with business) when there’s no room to flap their arms and squawk to their buddies.
Is every single user having a meltdown with your system? No? Is there a goodly number of folks who are working with it just fine, thank you?
Hmmm…
I Owe It All To The Martial Arts
Nobody deserves to be abused, and being bound at legal gunpoint to a product that is broken to bits is absolutely grounds for piping up.
But barring that, take a lesson from any of the Asian martial arts.
These other phenoms did it, and so can you.
Your system the real deal, proven, not some fly-by-night invention? Check.
Other students ahead of you looking pretty good with the school? Check.
Good instructors present, going to be there for you, living examples of how well the system can work? Check.
So get with the program, already. Welcome, your first lesson starts with your next visit, and it begins and ends with the overhead strike.
The rest is up to you.
