"It's an expensive solution, but the solution is training," says the private practice cardiologist who practices at MemorialCare's Orange Coast Memorial Medical Center in Fountain Valley, Calif. "Front-load the system with people."
What that means is an organization should provide lots of up-front training of the medical staff in the use of the software before the go-live.
Then, make sure there are enough super users - trained clinicians and support staff - on duty during go-live so physicians and nurses know that help is no more than five minutes away.
"That makes a huge difference," Schiff says. Once a physician gets too frustrated during the early days of using EHRs, they may not fully accept the technology and become a meaningful user, he contends.
MemorialCare medical staff is mandating physicians attend eight hours of training before go-live to maintain their privileges at the hospitals. Some physicians will strongly object and the response must be, "That's fine, but you'll no longer be on staff at this hospital," Schiff says. So far, very few physicians have left; Schiff believes one or two may have left because they were within six months of retirement.
But when physicians first start using EHRs in a real-world environment, they don't remember everything from the training classes. With enough super-users on hand, physicians can get issues resolved quickly and the super users can show them early benefits of the technology, such as how an EHR can speed the generation and completion of orders.
Schiff also advocates strong physician representation when selecting, designing and implementing an EHR. He co-chaired a clinical design advisory group at MemorialCare that included about 15 physicians. The more physicians involved during this period translates into more physician champions an organization will have from the start.
But when it comes to implementing an EHR at a physician practice, Schiff advises a slower approach. His private practice automated records six years ago, bringing physicians live one at a time.
The result was only a minor drop in revenue, almost a blip, instead of a substantial disruption by doing a big bang go-live. "It took each doctor two months to get really comfortable with the system," he recalls.
Schiff uses the Dragon speech recognition software of Burlington, Mass.-based Nuance Communications in his practice. He strongly advises hospitals to adopt such technology when putting in an EHR. MemorialCare now is piloting the software at one hospital.
Schiff has seen anecdotal evidence that speech recognition software speeds physician acceptance of EHRs. "Doctors want to express their thoughts in the chart, but by the time I type two sentences I already have a headache and haven't yet said anything."
With speech recognition, he can chart in real-time with the patient participating, then give the patient a printed document that includes such information as a medication list, problem list, and last stress test and cholesterol level. "When I'm finished with my 12 to 14 patients in the morning, I shut my laptop and I'm done."
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