EHR lessons learned from small practices: part 2


“If it isn’t broken don’t fix it” is an expression that we heard time and time again from physicians and administrative/clinical staff throughout the course of our small practice research study. However, it is important to understand that an EHR is not meant to necessarily “fix” a problem, but rather was designed to improve something that is already proven effective. One of the best ways to relieve these feelings of skepticism and mistrust is through proper transition support that eases the shift from paper to electronic records and provides implementation support and training. The best transition support will address both technical and practical challenges associated with EHR adoption.

When choosing an EHR solution, keep in mind that a vendor that provides comprehensive training and support for its solution will quickly alleviate feelings of mistrust and fears of workflow disruption, while simultaneously bringing to light the advantages that its EHR offers. While most vendors offer some kind of “cookie cutter” or one-size-fits-all transition support service, the most effective vendors will work to determine a practice’s EHR goals, and then offer customized support and training accordingly. Under this model of transition support, communication is streamlined and much of the trial and error that is often associated with implementing an EHR is eliminated. While perhaps the greatest emphasis of transition support needs to be focused on technical challenges, it is also important to address practical challenges, such as the EHR’s effect on the patient-physician encounter and relationship.  

For many small practices, one significant perceived threat presented by an EHR is to the commonly adopted “familial model” of care. Many small practice physicians feel a high degree of ownership over their patients, often viewing them as part of their extended family due to the common practice of “womb to tomb care.” Many of these physicians’ patients have come to expect a high degree of tailored attention from their doctor, predicated upon having developed a strong personal relationship with their physician. Patients who have come to know and appreciate this style of care also have concerns that an EHR system may compromise the practice’s ability to continue providing personalized attention. This is again a challenge that can be overcome by selecting the right EHR maintained by personalized transition support. 

Though it is true that many EHR solutions, particularly some older, legacy systems, may be a distraction or feel like an intrusion to intimate patient-provider relationships; more modern, mobile EHRs have been designed to work around this problem. For example: In order to ensure the EHR does not disrupt communication during an encounter, physicians should be instructed to position the EHR in such a way that they are able to face their patient while typing or accessing the system. One model that has been proven effective is to ensure the patient, provider and EHR create a triangle in the exam room, (versus having the EHR placed directly in front of the provider). As with efficiency obstacles discussed in earlier posts, a tablet-compatible EHR solution is one ideal way to overcome all of these issues as it can simply be positioned flat on any surface in the exam room and accessed as needed, thus not interfering at all with a patient’s space.

The decision to adopt and implement an EHR should not be taken lightly, and it is essential that a small practice take its time to become educated and make an informed decision, as there are implications that can be either very positive or detrimental. Beyond selecting a solution with the ideal functionality and usability to address a practice’s unique needs, it is also important to select a vendor who is willing to take the extra time to provide adequate tailored transition and ongoing support. Stay tuned for my next post when I will wrap up the lessons learned from our small practice research by addressing the most important issue associated with EHR adoption: quality of care.

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