Friday, May 7, 2021

Overcoming the top EHR implementation challenges

Technological innovations have disrupted the healthcare industry in several ways in the last decade.


Gone are the days when healthcare providers were forced to handle large paper medical files to collect, manage, and retrieve patient information. The ubiquitous shift from document-based storage to Electronic Health Record (EHR) systems has been one of the most extraordinary reforms of our times.

A 2019 poll by the Henry J. Kaiser Family Foundation found that 45% of U.S. citizens are of the opinion that EHR systems have upgraded the overall quality of care.

However, as with any other technological innovation, EHR implementation comes with its own set of unique challenges. Here is how providers can overcome some of the most common EHR challenges.


1) Security of Patient Data


Keeping data secure is a concern for all businesses in all industries; however, when you are a part of any healthcare organization, it becomes more of a challenge.

According to a 2018 report by HIPAA Journal data breaches of 500 or more healthcare records were being observed at a rate of around 1 per day. By the end of 2020, that rate had nearly doubled with the average number of breaches per day soaring to 1.76.

Healthcare data breaches are infamous for having instilled hefty penalties on the organizations and individuals that commit them, whether knowingly or unknowingly. Such breaches can also tarnish the reputation of the organization in the global market since they are often highlighted in the news.

Therefore, any healthcare provider looking to integrate an EHR system with their practice should first try to educate themselves on ways they can mitigate cybersecurity risks and keep sensitive patient information safe.

For instance, without implementing adequate security controls, a server equipment outage could bring your EHR operations to a complete halt and expose sensitive patient data to cybercriminals. Hence, it is essential to have a data recovery and backup plan in place in the event your storage system crashes, is attacked by cybercriminals, or suffers a partial failure.

Utilizing cloud servers as a back-up option can enable you to access your EHR data in an event such as this, while also offering protection against any potential natural disasters that end up harming physical storage systems. The cloud furnishes supplemental layers of security to your data since it comes loaded with features such as multi-factor authentication, access controls, etc.

One best practice here would be to store all EHR data with a cloud hosting provider that adheres to the rules mentioned within the Health Insurance Portability and Accountability Act (HIPAA).

Another effective way providers can ensure optimal data security while implementing an EHR system is taking into consideration a few network security actions such as:
  • Implementing procedures relating to the downloading and removal of EHR to reduce the risk of unprotected records being lost or stolen,
  • Using password-protected devices and tablets,
  • Encrypting information so data cannot be easily accessed,
  • Implementing periodic network assessments can help identify potential issues before they become a problem.

Forward-thinking healthcare leaders are also increasingly paying heed to including data security features within the EHR early in its development stage. Assuring that your EHR software complies with HIPAA rules and other recommended regulations from the ground level up can rid yourself of extra effort needed later in development or after a breach occurs.


2) Data Interoperability


Sharing clinical data both within an organization and outside of it with other providers is crucial for delivering care in an efficacious manner. Despite government incentives and regulations to encourage greater interoperability, data sharing remains a serious issue among healthcare providers. This is especially true when it comes to electronic health records.

The scope of this problem is exemplified in a recent report that discovered that close to 32% of individuals who went to the doctor in the 12 months preceding the findings of the study reported experiencing a visible gap in information exchange.

Substandard performance, with respect to interoperability, not only poses healthcare providers with issues concerning practice management and performance, but it can also negatively affect patient satisfaction rates for that practice.

Keeping patients at the center of care is one key to shifting our healthcare system to a value-based model. Interoperability is a vital element of this work since health systems can bridge from population health outcomes down to clinical decision-making at the point of care if systems can exchange information easily and quickly.

So then, how exactly can healthcare providers boost interoperability when it comes to her implementation?

Several progressive healthcare providers are now utilizing a host of emerging technology solutions, such as Natural Language Processing (NLP), to produce datasets from previously static records to improve population health. By deploying such state-of-the-art tech solutions, providers can more easily focus their attention on patients rather than paperwork.

In case a facility is using a virtual care delivery model, one best practice would be to integrate the facility’s EHR system with the telemedicine platform to boost interoperability of patient records and other important health data.

One excellent example of an organization that has reaped the benefits of telemedicine and EHR integration would be that of the Blue Ridge Medical Group, based in Georgia.

Dr. Dillon Miller, the Institute’s Medical Director, says in a recent interview with her Intelligence:

“The telehealth tool being embedded into the EHR makes it very user-friendly. Because it’s very easy for my staff to use, it also makes it easy for patients to have consistency on both ends. And the fact that it’s web-based, means patients do not have to login to a specific app for a visit. They get a text message or email, click a link, and it’s connected.”

Although the challenge of data interoperability is a complex one, thinking about ways you can counter it can greatly improve your organization’s overall functioning and ameliorate patient outcomes.



Closing Words


Apart from the ones mentioned above, there are many other challenges that different providers may face at different stages during the implementation process.

Educate yourself about industry best practices, look at what your counterparts are doing or study other use cases to determine where problems might arise for you. EHR implementation isn’t a one-size-fits-all solution, nor should it be given the variation in medical specialties.

Healthcare providers need to realize that EHR implementation is more of an ongoing process.

Only when you experiment with different approaches and are willing to embrace change, will you be able to come up with a solution that meets the needs of your practice. You need to be on the constant lookout for ways to improve the overall process and deliver patient-centric care in the best possible way.

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Thursday, May 6, 2021

Limit physician burnout risk by analyzing company culture, contract criteria

Physician burnout has become a national epidemic. Although it was a concern before COVID-19, burnout has increased over the past year with many physicians feeling more stressed and overworked than ever.


For those looking for a new job, the following are some key considerations that might limit potential for burnout.



Find out everything you can about the culture of the employer you may go to work for.

Even if the financial offer from the employer is substantial and the location is perfect, there are sometimes more important factors to consider!
What do physicians who work there say about the work culture?
What is the physician turnover rate?
Does the employer support physician flexibility and quality of life, and what policies do they have that reflect this approach?
How does the employer support their physicians with the administrative burdens of medicine?
Are there scribes or nurse practitioners that help with charting?
How can a physician express concerns and does the employer listen and respond?

Although no employer is perfect, my clients can often get a sense about how the medical staff is treated by asking these types of questions and hearing what other employees (as well as the employer) has to say!

Physicians should not be afraid to ask questions about the employer’s view on physician lifestyle and concerns about burnout during the interview and contract negotiation process. An employer with an indifferent/uncaring response could be evidence of a bad fit for a physician who is prioritizing lifestyle issues. More often than not, the way an employer handles themselves during contract negotiations provides important insight on how they treat physicians on a daily basis or when important issues arise.


Quality of life for a physician often comes down to location, schedule, duties, and call.

When negotiating a contract, these are key items to focus upon.
Does a physician have a say in the schedule or call?
Is there administrative time to complete medical records?
Does the physician have to work an unreasonable minimum of patient contact hours, which can contribute to burnout and fatigue?
What say does a physician have concerning his/her locations and duties?

Physicians like to know where he/she will be working and should understand if expected to travel between multiple locations, which can be stressful and impact overall productivity. Physicians expecting to work in a certain role (e.g., outpatient) should be clear if he/she does not want to end up doing inpatient work unless there is an agreement to do so. Another common issue is physicians unexpectedly being scheduled to work evenings, weekends, and nights (depending on specialty), despite having discussed a specific schedule during the interview process. All of these work issues can result in personal stress and unhappiness.

Unfortunately, many employers object to adding any promises on these topics to the written contract or even agreeing that the parties will work out these issues by mutual agreement. This means that physicians must either have faith when entering into a contract that the employer will honor their word or walk away from the job opportunity.


The biggest dilemma for many physicians is balancing their financial goals with lifestyle ambitions and concerns about burnout.

Often the trade-off for a significant financial package are the terms that affect job satisfaction. When physicians take on roles with aggressive productivity formulas or large base salaries with minimum production goals, there must be an understanding that there may be less flexibility on other points that directly impact financial performance. Typically, more patient contact hours, call, and travel to where patient demand is greatest can be a requirement for the high-producing physician. These types of roles often include longer hours, more weekend and after-hour expectations and less personal time away from work.

When it comes to avoiding burnout, a physician must understand his/her own personal goals and seek a contract that will meet those needs. Sometimes, however, unexpected events may occur, or the physician may find the new job is still not a good fit despite appearing to meet the physician’s objectives. I believe the best contract is the one a physician can walk away from easily if he/she is unhappy. Physicians should always understand and be able to live with the exit strategy in the contract that is signed. Does it lock the physician in for a period of time? What are the consequences when the physician leaves (i.e. tail, non-compete, repayment of a bonus)? A physician must make sure he/she knows the answers to these questions before signing any contract!

There are many factors that cause physician burnout, and most cannot be controlled by any physician. Those looking for a job with a more minimized chance of burnout can start by evaluating the employer they choose to work for and the contract they sign.


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Tuesday, May 4, 2021

The evolving role of APPs in post-COVID healthcare

Prior to the COVID-19 pandemic in 2020, the U.S healthcare system was already preparing to face a shortage of primary care providers. According to the Association of American Medical Colleges, the States could see a shortage of nearly 122,000 physicians by 2032.


How the pandemic will affect this shortage is yet to be determined. There is evidence that physician burnout, which was a rising problem pre-pandemic, has been exacerbated by COVID-19. According to a September 2020 survey by Medscape, 64 percent of physicians surveyed reported increased burnout due to the pandemic.

One possible remedy for the current state of healthcare is greater use of physician’s assistants (PAs) and nurse practitioners (NPs) to meet the demands of patient care. While using advanced practice providers (APPs)—such as PAs and NPs—to provide patient care has long been customary, the surge of patients during the pandemic has allowed for APPs to practice to the top of their license and make an impact on population health.


Adapting Educational Programs


Educating healthcare professionals during a pandemic created an unprecedented set of challenges in healthcare education. As health networks and teaching hospitals, faced the beginning of COVID-19, multiple issues prompted a cease in student clinical rotations. Procurement of PPE, design of student policies and protocols, and safety concerns are just a few issues that rightfully disrupted healthcare student experiences. For healthcare educators, this rapid change required programs to pivot and creatively determine how to provide required educational components, training experiences adequate to meet learning outcomes, and continued standards of educational competency.

Navigating through the pandemic has allowed program faculty and leadership to incorporate innovative curricular components to enable students to continue to progress through their education while appropriately managing the challenges of the pandemic. Currently, didactic adjustments due to online learning requirements, preceptor burnout, office space limitations due to social distancing, and increased competition for clinical placement sites from programs that are working to graduate their students all still create challenges for healthcare faculty. Throughout these challenges, many faculty continued to instill a sense of calm in their students, addressing fears and concerns, and managing expectations of inexperienced healthcare providers.


Incorporating Virtual and Simulation Tools


Increased use of virtual and simulation experiences is one strategy for healthcare educators to continue providing educational content. Long used to augment teaching, simulation is integral to training. The pandemic has encouraged educators to use virtual patient experience software and design and incorporate content-rich simulation cases to enhance student learning. However, many of these resources are costly, and budget limitations of some higher education facilities may limit available options.



Broadening Roles and Recognizing Benefits


As we continue to prepare for the post-pandemic future of healthcare, we must continue to allow APPs to maximize their skills and experience in expanded roles. Leadership within our healthcare systems can benefit from the expertise of PAs and NPs. For example, many hold additional advanced degrees in business or education. Responsibilities and leadership opportunities are shifting to incorporate more APPs in middle and upper-level management. Allowing APPs a voice in health network policies and procedures can lead to better .e of these individuals throughout the healthcare system, improving patient outcomes and resource utilization.

The U.S. healthcare system is navigating the one of the most challenging landscapes in generations, but these challenges have also led to many positive changes. First, COVID-19 constraints prompted providers to expand patient care through telemedicine. The technology that allows patients to access quality, convenient care from the safety of their home should remain post-pandemic. Second, the challenges have inspired a camaraderie that is much needed in medicine. A key to traversing the challenges we are all facing is relying on our colleagues to offload burdens whether intellectual, physical, or emotional.

Our sense of moral obligation and our belief in making a positive impact can be passed on to the next generation of medical providers. These students and newly graduated providers possess a resilience that the COVID-19 pandemic has intensified. They faced adversity and uncertainty that forced them to adapt quickly and adjust to a rapidly changing healthcare system. These students entered their new careers amidst the reality of a crashing job market, the ambiguity of a novel virus, and an already stressed healthcare system. Further research will allow us to determine how this generation of healthcare providers’ resilience and motivation will impact patient outcomes.

There is no doubt that the COVID-19 pandemic has made indelible changes in our healthcare system. As we continue to manage the new normal of our roles as providers, we must continue to find ways to support each other and our healthcare colleagues, including educating our students, providing accessible resources, and optimizing APCs’ skills in expanded roles in our networks.


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