As we anxiously await the final rule for meaningful use, it is a good time to reflect on a concept that the interim rule introduced – a simple, modular EHR intended for clinical patient management and care collaboration. The availability of these lower-cost, modular EHRs combined with the availability of complete, traditional EHRs integrated for health information exchange will hopefully create an EHR market that appeals to the majority of providers.
It’s obvious how the emerging market of lower-cost, certified EHRs and pending reimbursements lowers the cost barrier to adoption. But gaining value and meaningful use of an EHR requires more than the purchase of the product(s). It requires that the organization change its processes and habits to effectively use the system.
It is also obvious that humans don’t change easily. When we do, it usually involves a high degree of motivation in the form of immediate pleasure or reduction of pain. Now consider the current concept of an EHR. Most EHRs are designed to effectively re-engineer the practice – from how physicians and nurses document care, to how patient records are kept, to how the business is managed. This is like diet and exercise – it is ultimately good for the practice but involves a lot of change (and pain) without an immediate benefit.
What the interim rule opened the door for is a model that greatly simplifies what an EHR needs to do to qualify for meaningful use. In very simple terms, it recast the EHR from a physician-centric tool to a nursing-centric tool. This is because, except in cases where the rule specifically requires a physician to touch the system (e.g. CPOE), the elements required for meaningful use are part of the normal workflow done by nurses and staff throughout the day – not the physician.
For example, the type of patient documentation required of the EHR for Stage 1 meaningful use is what the staff and nurses capture when the patients come into the office for a visit (demographics, biometrics, current meds, smoking status, etc). Patient engagement, administration, public health reporting, quality reporting, and analytics are primarily staff functions. Exchanging information is also the domain of nurses and staff, from completing and sending orders, to collecting results, to processing prescriptions, to coordinating referrals.
So, if an EHR were provided that met Stage 1 meaningful use only – it would be a nursing tool. Physicians would seldom touch the system except to review patient information or initiate an order and utilize the clinical-decision-support capabilities of the system. This has the potential of greatly reducing the pain that adopting a conventional EHR causes to physicians who often must change their habits to conform to the EHR’s ways of doing things.
From the nursing and staff perspective, the benefit of an EHR is significant. The effort to do their jobs in a paper-based world is very labor intensive, and solutions that address these needs have proven successful because they reduce the amount of time and effort the staff spends doing day-to-day tasks.
Once the staff starts using the EHR to conduct their daily business, physicians can gradually be introduced to the EHR over time. In small practice settings, where one or two physicians make the decisions, this may be a critical factor.
Another thing to consider is that many of the processes that have proven to effectively lower the cost of healthcare are heavily reliant on nursing care. So envisioning an EHR that is more focused on the nurse as opposed to the physician, while heretical, may be what’s needed to achieve widespread adoption of the EHR.