| | AUGUST - 20209UTLOOKHealthcare Tech delivery systems must adhere to; we know that there are data and reporting needs and requirements at many levels; we also know that the EHR can be harnessed to improve care and outcomes while simultaneously putting the joy back in medicine. Atul Gawande recently wrote in The New Yorker about the frustrations physicians have working with computerized records, and the divide it can cause when caring for a patient. While I don't disagree that this is one possible effect of an EHR implementation, another is that the EHR can actually work for you and make you more effective and efficient ­ there has to be a mechanism to raise and address these concerns, however. Gawande cites some common complaints with having to put discrete information into the EHR ­ some of this arguably could be fixed in his system by being taken automatically from other areas of the chart, using a default value, and otherwise improving the workflow. The need for this discrete information should also be examined ­ who is using it and is it really necessary? Does the physician have to be the one who enters it? Does it need to be discrete, or could natural language processing help identify the necessary elements? We should be examining clinical workflows and then designing the technology to support it, rather than forcing the clinician to conform to the technology. The EHR is often cited as one of the main contributors to the trend of increasing physician burnout. How do we turn this around? How do we design an EHR that helps physicians do their work more effectively and efficiently? Here are five things you can do as you implement or optimize your EHR:1. Involve end-users in the design of the system2. Start with the clinical and operational workflows and design the system to meet those needs, rather than the other way around.3. Emphasize the need for not just initial training, but ongoing training and personalization of the EHR with end users. Personalization is one key way to improve efficiency.4. Measure the impact of the system. Design changes will be better informed if you have data to know how the system is being used and the impact it is having.5. Encourage a culture of problem solving rather than learned helplessness. Areas for improvement are much more likely to be addressed if an end user raises them as issues rather than internalizing them in a negative way.Much the same way we encourage patients to tell their physician if something is wrong, encouraging end users to speak up when something is bugging them about the EHR is the primary way to help identify a problem. The EHR has to be designed to support the work of health care professionals to effectively and efficiently care for a patient. While I, and many other medical informaticists, are spending our careers trying to make sure it does, it helps when the entire health care community remembers that we are all in this together. HTRebecca G. MishurisThe EHR is often cited as one of the main contributors to the trend of increasing physician burnout. How do we turn this around?
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