Action Wheel Leadership

Medical Records

Leadership Project: Electronic Medical Records Optimization

Project Leaders:  Terry General Practitioner and James General Practitioner


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Medical Records Optimization

The installation and activation of the Allscripts EHR was completed on September 11, 2012. While the “Meaningful Use” criteria and deadline were recently met, use of the EHR remains inefficient, and nowhere near complete. 

Terry and James applied the principles of the leadership program to diagnose what seemed to be going on, and what was really going on. 

The clearest statement of the current reality is that installing and activating the EHR is just the first step of optimizing its use.   Dozens or even hundreds of templates must be reviewed and customized to fit the needs of this specific installation. 

To help understand why this process seemed so slow, James and Terry led a Pilot Project to create, customize, and optimize the template physicians would use to conduct “Normal Male Physicals”.  The current “normal” template takes too many button clicks, and does not match the procedure actually used to do a physical.  Of the 3 page screen of items to be clicked, dozens of them are not necessary for a physician to complete a normal physical. 

James and Terry created an “average” normal physical form by consulting several physicians.  This recommended new form was submitted to the new EHR Coordinator to be updated within the live system. 

Three months later, this one template has still not been changed.  All physicians have gotten is carpal tunnel syndrome, and lowered productivity from the excessive and unnecessary mouse-clicking. 

The conclusion?  If each change takes several months under the current structure, and there are dozens, or hundreds, of these scenarios and templates to modify, this will be a long and painful experience.  Initial diagnosis shows that this seems to be a structure issue.   Although an entirely new structure was put in place to manage the ongoing rollout and customization of the EHR, it seemed to not be working. 

The real, root cause of this issue is an unclear mission, and misaligned power.  None of the people in place within the new structure have the time or power to make the ongoing changes that will continue to be needed for the foreseeable future.  While they’ve been given the responsibility, their other roles have not been reduced; all of them have multiple critical roles which need to be balanced with these new responsibilities. 

The organization has a new mission to ensure the rollout of the EHR goes smoothly and successfully.  This new mission has been put in the hands of key players, but no meaningful changes were made to ensure these people were effectively trained, ready, and had the time to attend to these new responsibilities.

Without further attention to this issue, the EHR will be inefficient for the foreseeable future, and changes and customization will be slow and painful.

Project Impact: James and Terry have been able to pinpoint the root issue of power and mission in this project. Each individual, assigned tasks in this new system, must be given the authority to prioritize their jobs and follow through on work required with this new system. Without clear goals and priorities team members will have split goals they cannot achieve.

Key Healthcare Impacts:

  • Leadership: Identified and resolved priority EHR forms for physicians
  • Addressed systems breakdowns
  • Risk mitigation with regards to physician burn-out and productivity
  • Administration/Doctors working together to grasp implications of EHR systems roll-out.

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