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Random Musings about the EHR from an End User


With ICD-10 rapidly approaching, our resident PA, Stephen Hanson looks at the importance of EHR usability in the transition.

An EHR’s rate of provider satisfaction really depend on who you ask. While trends have shown that the usability of EHRs has improved and contributed to a rise in provider satisfaction with their systems, there is still a long way to go. As we approach the eve of the ICD-10 implementation, more system interfaces are adapting functionalities that seem to integrate more into providers’ day-to-day use.

There are some interesting trends that are evident when you look at how EHR implementation and provider satisfaction has evolved.

The first is that, in my opinion, larger provider groups utilizing EHR technology in their practices tend to be more satisfied than smaller or solo, provider practices. This makes intuitive sense. Larger organizations have more information technology (IT) support, and more training and support staff available to help providers effectively use the EHR.

Contrast this with the solo or small-group practice environment, where providers don’t have a lot of support geared towards understanding their EHR. It makes sense that there is more dissatisfaction and confusion that results from their EHR implementation and usage.

The other factor, in my opinion, is cloud based EHRs result in a higher level of satisfaction among users, as opposed to server-based EHR implementations. I believe this is a result of the mobility of the EHR. This is the way in which we utilize our private practice EHR. Our system is iPad and cloud-based, allowing us to easily access every aspect of our health record on the go.

We can also do this from our mobile phones. I use this utility of our EHR daily as I’m on the go from the office to the inpatient environment. A static, server-based environment just would not work in our dynamic and mobile plastic surgery practice.

One of the problems that we have with our community hospital system is that upgrades are continuously performed, with little to no warning from IT regarding these changes. This typically results in much frustration of the end user as these changes often appear at the most inopportune time.

Therefore, imagine my surprise when I logged on this past week and was confronted with an entirely new landing page when selecting a patient record. It was a complete and dramatic makeover. The page navigation took some relearning but for the first time in a long time, it made sense.  I took the time between patients this week to study this implementation and help other providers who were frustrated while struggling with the changes.

The way that the new landing pages work is that all pertinent patient information (e.g., chief complaint, labs, diagnostics, documents, past history, etc.) are arranged in a vertical format from top to bottom. This is easily reordered by dragging the sections up or down. Interspersed within this list is a text box for subjective, review of systems (ROS), and objective findings. This allows the provider to dictate (we have enterprise level dictation integrated with our EHR) or type in these fields, while looking at the vital data that needs to be correlated in a cohesive manner to create a pertinent, unique and complete chart note. Simply put, it looks great.

At the bottom of the list is a “Create Document” option. You are given an assortment of documents (i.e. history and physical examination, consult, progress note, free text, discharge summary, etc.), and by clicking on the appropriate document type, your pre-populated subjective, ROS, and objective information is populated into the note. You dictate an assessment plan and click the signature option. I can work with this as it matches my work flow on the floor, and is a nice step towards making the hospital EHR friendlier to the needs of the provider.

I’m hoping (as is every other provider struggling with the modern world in medicine) that the next generation of EHRs will ultimately look similar to this format, designed to focus on the end user – fulfilling the goal of making the practice of medicine truly patient-centered.

As the transition from ICD-9 to ICD-10 approaches, ease of documentation when using EHRs is increasingly critical for patients and providers. Understanding ICD-10 will aid in both reimbursement and in documentation. For providers wanting to brush up on ICD-10 information by specialty and state, AAPA has prepared resources as well as a FAQ sheet where providers can learn more about the switch to ICD-10 and how to best prepare.

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