Clinical analyst, application specialist, super user, EHR Champion; what do they all have in common? A person specially trained to use a particular system. Even the most “customizable” system currently requires someone to know how it works, to set it up to conform to the limitations of the system built by developers and engineers. “If you do this, click this and type that, look it’s magic and our system does what it was programmed to do.” But what if you miss a step, or don’t follow the training and decide to do it your own way, because to you it makes more sense to click there, type here and then do that? Do you get an error saying you did it wrong, please try again and do it this way? Or, and here is the frightening part, the system doesn’t care. It keeps going and that critical piece of functionality (like allergy checking) gets skipped over.
I started on the path to Health Information Technology when our emergency department switched from paper charting to the electronic record. I went to the training and became the “super user”. At first it was great, look, this system does this, look how easy it is. It processed billing automatically, it exported orders and imported results, it was awesome! No more stickers stuck to my scrub top for supplies used, no more paper towels with reminders of what had to be written in the legal record later, no more chasing the doctor down to interpret the scribbles on what he wanted ordered. Life in the ED was grand and I actually had time to take care of patients.
But then the complaints started. “How come this is here”, “Why do I have to go there to chart this, I want it here”. Our system was great at being able to customize, but now my “super user” status became a full-time job just responding to change requests and enhancements. Naturally the budget didn’t allow for extra hours to do patient care and system maintenance, so as a good ER nurse always does, I started prioritizing requests. My new mantra was “Yes, it would be great to do it this way, but it will take me this amount of time, which I don’t have”. The transition from hero to pariah was faster than you can imagine.
I became the evil System Overlord who was making everyone’s life miserable because time constraints forced me to begin telling users “things have to be done this way, this is how the system is currently set up.”
On the other side of the spectrum, is over-customization. We worked with a client who customized themselves to death. They had the ability to create forms specific to any individual, and the providers thought it was great. Problem was, CMS decided that they wanted to start keeping track of some of that data-those pesky quality measures.
When we were contacted to help set up the data extraction for quality reporting, the client’s system had over 1000 custom forms, and everyone was charting what they wanted, the way they wanted it. The people using the system were happy, but the folks in the quality department were pulling their hair out. Take a simple measure like smoking status. It should be 3 options, yes, no, or former. The measure for this site became unreportable because the patient said he quit this morning. In the course of a single visit, one person had charted “yes, current” on their form, the next person selected “former smoker” on the choices they had, and the provider selected “yes, but trying to quit”. These were all correct answers based on the perception of who was asking, but since all the forms were separate, no one could see what the others had chosen.
Which brings up another point, why are we asking the same questions 3 or 4 times, don’t you trust the person who just asked? But that is a topic for another discussion.
As SEIUS was being developed, we thought we had the perfect electronic health system.
But it wasn’t the perfect electronic health record, we hadn’t mentioned anything about super users, customization, or standing at the bedside talking with our patients. So, we sat down and wrote another version of SEIUS, and looking at it now, I realize we have the perfect electronic health record, and I felt it should be included in this blog, it goes something like this:
You shouldn’t work for your system, it should work for you.
We want to provide the perfect electronic health system. A system that you like, will use and does what you need it to. SEIUS was designed to be user friendly, easily customizable, and we are happy to hand over the instructions if you are so inclined. But why not let us take care if it for you so you can focus on what matters most, taking care of your patients?
I don’t believe in “train them and shift to customer support”, I want to keep it personal and work alongside you. I believe in that philosophy so much, I returned to the battlefield for first-hand experience at how things have progressed over the last several years. I currently am nursing at a correctional facility, and had the opportunity to start from the beginning, using paper forms and transitioning to an electronic health record. More details on that in the next installment.
At MCI, we provide innovative and responsive health systems integration and design services for some of the nation’s leading healthcare providers. With a focus on patient engagement and safety, we offer improved patient outcomes through systems interoperability and enhanced data sharing.
We help healthcare providers improve patient care by changing the way patient data is collected and shared using a convenient cloud-based solution. Through collaboration and cooperation, our custom-designed solutions seamlessly integrate clients’ health records, extract data, and generate comprehensive reports automatically or on-demand in any format and across virtually any platform in use today.
“Our mission is to design and build a system that works the way you want it to. Healthcare providers will be able to collect, share and use their patient data more effectively to make more informed decisions. But most importantly, it ensures clinicians will be able to make care decisions based on access and utilization of all available medical information through a custom user experience.”
Marc Meyers, RN
President and Founder
About the Author
MC Integration founder and president, Marc Meyers, is an Army veteran, former EMT and ER nurse turned IT guru who has experienced the difficulties of using and managing healthcare IT systems in the field and the value of having a better system for healthcare in his personal life.