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5 Ways to Boost Physician Acceptance of EHRs

By Liz Jones, for HealthLeaders Media  
   November 09, 2010

The process of implementing electronic medical records (EMR) involves a lot of moving parts. Hospitals must find the right software vendor, work with that vendor customize the EMR system to the facility's needs, ensure that the software interacts with other programs that the facility uses—the list goes on and on.

Hospital leaders should pay as much attention to how the process of EMR affects end-users—particularly physicians—as they pay to the process of selecting and designing the software. Physicians are the hospital's primary source of revenue, and hospitals run the risk of losing some physicians who feel that they don't have the time to learn new software. Therefore, ensuring that their experience is trouble free should be a top priority. The following are five things every hospital should do for physicians when implementing electronic medical records.

  1. Identify physician champions

Medical staffs should identify physician champions—ideally one champion per department, in addition to one champion for the medical staff as a whole. Physicians champions should attend all meetings related to EMR, answer questions from medical staff members, and spend face time with those who are resistant to change.

Physician leaders should form an EMR committee. At Tucson Medical Center (TMC), the vice president of medical affairs led this committee and included members of the medical executive committee and others who showed considerable interest in EMR. The committee met twice a month for almost a year to work out what features the EMRs would have, how it would operate, and what it would look like, says Elizabeth Warren, RN, director of professional staff services at TMC.

If your medical staff struggles to get physicians to come to EMR meetings, you may consider paying them, moving the meetings to a more convenient time, and/or providing food if the meeting coincides with a meal time, says Brian J. Cammarata, MD, medical director of informatics at Old Pueblo Anesthesia, which partners with TMC. On occasion, Old Pueblo Anesthesia paid its physicians an hourly rate to attend these meetings. "It doesn't approach what they would otherwise earn providing clinical care, but it is an incentive," Cammarata says.

Physician leaders who are engaged in the EMR design and implementation process can help prepare other physicians for the upcoming changes. "We were able to have a fairly substantial group of physicians who went out and could sell it [to other medical staff members] and speak to it with great intelligence because they had participated since the very beginning," says Warren.

  1. Design a training program that accounts for varying needs

When designing a training program to help providers learn EMR, hospitals must take into consideration that some physicians have never sat in front of a computer before, while others consider writing code for their own software programs a hobby.

Medical staffs should provide physicians who have little to no computer skills personalized training before the medical staff rolls out organizationwide training for EMR. If the medical staff fails to do this, these physicians may become frustrated and opt to practice at another hospital that does not have EMR.

"We made the medical staff office a safe place to come and admit what you don't know," says Warren. "We had people available to teach them computer basics on a one-on-one basis in a private room where they could ask whatever they wanted and no one would get mad or laugh. As long as they were honest with us, we could help them."

On the flip side of the coin, it is important not to excuse physicians with extensive computer experience from the EMR training, says Warren. Although a physician may be a computer whiz, EMRs are customized to each hospital's needs, and physicians must become familiar with all of the specific bells and whistles. "We made the same number of educational hours the same for everyone," she says.

At St. Mary's Hospital in Richmond, VA, one of 14 hospitals in the Bon Secours system, physicians trained in different tracks according to their typical patient volume, says Brian Fillipo, MD, vice president of medical affairs. For example, high admitters received the most training and support; occasional consultants received a level of training that was conducive to their volume. "The number of courses they do online and in person varies according to the type of privileges you have the type of patients you take care of," says Fillipo.

Both TMC and Bon Secours required all physician and non-physician providers to be trained within 12 weeks of using the EMR on the job. If a provider does not use the EMR within 12 weeks after being trained, he or she must redo all or part of the training. The software is complex, and providers may forget what they learned during their training if too much time lapses.

  1. Make superusers available during go-live

Superusers are individuals who are well-versed in implementing and using EMR. These individuals may be from your own medical staff, from nearby hospitals that have already implemented EMR, and/or from the EMR software company. Your organization will likely need to pay these individuals, especially if they are taking time away from their independent practices.

At TMC, superusers dressed in red shirts for the 30 days after the EMR went live so they were easily identifiable if a physician had questions (TMC has since referred to these experts as "Red Shirts"). "We had multiple tiers of leadership and expertise in the building for at least 30 days," says Warren. After 60 days, Red Shirts were still available on every unit, just in fewer numbers.

It is important that physicians are paired with the same superuser(s) throughout the process of going live, says Fillipo. "I think one of the challenges with EMR is that there is more than one way to do it, and for physicians practicing in a chaotic environment where they are trying to multitask, you can't have four people telling them how to do something four different ways."

  1. Allow providers extra time during go-live

Allow physicians additional time to complete their work as they learn the software. For the first several weeks of the launch, TMC extended the time for each procedure to accommodate physicians' learning curves as they navigated the EMR the first few times.

It also added an extra 30 minutes for each transfer (i.e., from pre-op to surgery suite to post-op). "There is a physical handoff of a patient, but there is also an electronic handoff, and if you forgot to do that part because you were new at it or you were taking too long, it could slow the system down," says Warren.

In addition to extending the amount of time physicians had to conduct their procedures and transfer patients, TMC also had physicians in most specialties team up in doubles during their procedures for two weeks. By doubling up, one surgeon could focus on the procedure while the other surgeon could focus on inputting data into the EMR. A Red Shirt superuser was also in the room during all procedures for the first month to help physicians navigate the software.

  1. Provide special amenities to take the pain out of launching the software

As a special thanks to physicians during the first two weeks of launching EMR, TMC created a special menu in the cafeteria, and all meals were free. The hospital also invested in an on-site car detailing service. When physicians arrived in the morning, they handed their keys to a detailer. Leaving the hospital with a clean car was just a small reward for the time they took to learn the EMR. "We recognized that we couldn't make it pain-free, but we could let them [the physicians] know that they are important to us," says Warren.


Liz Jones is an associate editor with HCPro. She writes Medical Staff Briefing, co-writes Credentialing & Peer Review Legal Insider, and co-manages www.MedicalStaffLeader.com.  She can be reached at ejones@hcpro.com.

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