27 minute read
RISK TIP
Telephone Communication for Healthcare Providers:
Safety Strategies
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BY NICOLE FRANKLIN, MS, CPHRM, PATIENT SAFETY RISK MANAGER II, THE DOCTORS COMPANY The way we communicate has changed dramatically over the years. Even with the introduction of technology-based communications, such as social networking sites, telemedicine, and texting, the telephone call is still the most widely used communication tool between healthcare providers and patients. Telephone conversations can, however, present difficulties and may be inherently deceptive if both parties lack the ability to observe nonverbal communication (for example, facial expressions, eye contact, and gestures) that clarify and qualify what the voice is expressing.
When casually or carelessly conducted, telephone communications can lead to diagnostic errors and misunderstandings that may culminate in professional malpractice claims.
To find out more about what differentiates The Doctors Company from other medical malpractice insurance carriers as a physician-first insurer, contact Matt Lawrence at 310.492.4845 or mlawrence@thedoctors.com. CCMA members receive additional savings!
TELEPHONE COMMUNICATION WITH PATIENTS
Creating comprehensive, clear guidelines for telephone encounters with patients is critical in mitigating risk. Establish practice guidelines and ensure that all office and clinical staff are trained on their roles in communicating with patients by telephone. Protect yourself from potential liability by following these general practices:
• SMILE WHEN GREETING PATIENTS. Research has shown that people are able to tell if you are smiling by the tone of your voice. Warmly express to patients that you are happy to speak with them today. This interaction may be the first impression that a patient has of the practice or the staff, and it is a factor in patient satisfaction.
• TRIAGE AND REFER ALL CRITICAL CALLS TO
EMERGENCY SERVICES. Examples of critical calls include abdominal or chest pain, fever of unknown origin, high fever lasting more than 48 hours, convulsion, vaginal bleeding, head injury, dyspnea, casts that are too tight, visual alterations, and the onset of labor. For more information on this topic, read our article, “Telephone Triage and Medical
Advice Protocols.”
• OBTAIN AS MUCH INFORMATION AS POSSIBLE about the patient’s presenting complaint, medical and surgical history, current medications, and allergies to help you arrive at an accurate appraisal of the patient’s condition. Listen carefully and allow the caller both the time and opportunity to ask questions.
• SPEAK TO PATIENTS CLEARLY AND SLOWLY, and enunciate carefully. Use easy-to-understand language that avoids medical terminology.
• OBTAIN THE SERVICES OF AN INTERPRETER IF YOU
ENCOUNTER A LANGUAGE DIFFICULTY. Follow the
Americans with Disabilities Act (ADA) requirements for patients using telephone auxiliary aids or services, including interpreters. For more information, see “ADA
Requirements: Effective Communication.”
• AVOID DISTRACTIONS, such as checking email or attending to other duties, when speaking with patients.
Drowsiness, fatigue, or distraction on the part of either party can affect the ability to communicate effectively. • ADHERE TO HIPAA RULES and regulations to maintain patient privacy when communicating over the telephone, both inside and outside the office. Use a low voice when discussing protected health information, and implement reasonable safeguards to avoid disclosing information to others not involved in the patient’s care.
• DEVELOP WRITTEN PROTOCOLS for front office/ unlicensed personnel to help them respond to patient questions and concerns. An unlicensed individual cannot provide medical or dental advice. Clinical/licensed individuals answering patient calls cannot exceed their scope of practice.
• PRESCRIBE OR ADVISE BY TELEPHONE only when you have reviewed the patient’s allergies, medications, and medical and surgical history. If providing new instructions to the patient, such as changing a medication dosage, ensure understanding by asking the patient to repeat back the instructions to you. Document the patient’s understanding in the medical or dental record. For more information on this topic, read our article “Rx for Patient
Safety: Use Ask Me 3 to Improve Patient Engagement and
Communication.”
• ACCEPT A THIRD PARTY’S DESCRIPTION of a medical or dental condition only when you have confidence in that person’s competence to describe what he or she sees. If descriptions are unclear, the patient may require an office visit.
• MAKE PROMPT REFERRALS if the patient’s call concerns a medical or dental problem that is outside your expertise.
Proactively track the consultation and expected report, and follow up with the referred provider and patient.
• CONFIRM THAT PHARMACISTS UNDERSTAND ALL
DOSAGES and instructions for drug prescriptions given by telephone. Spell out any similar drug names and use individual numbers for dosages, such as “five zero” for 50. Include the reason for the use of the drug. Insist that pharmacists repeat information back to you. Do the same with facility personnel who take your telephone orders. A safer approach is to use electronic prescribing or fax the medication order.
• VERIFY AND DOCUMENT THE PATIENT’S
ADHERENCE with telephone advice through a follow-up contact to ensure continuity of care.
PROVIDER CROSS-COVERAGE
When you will be away from your own practice or covering for another provider, these additional strategies can help you avoid problems:
• IMPLEMENT A COMMUNICATION PROCESS between cross-coverage providers. In several instances, a covering provider has been held completely responsible for damages resulting from a telephone misdiagnosis while the original provider was exonerated.
• GIVE A BRIEF STATUS REPORT on your acute patients with notice of any anticipated patient calls when handing off care.
• DOCUMENT ALL CALLS in the patient record. Brief the primary provider on all calls during your coverage period.
• PRESCRIBE ONLY THE AMOUNT OF MEDICATION
THE PATIENT REQUIRES during the period you are covering for another provider. Pain medications and narcotics should be refilled or ordered only in small amounts and per state regulations.
DOCUMENTATION
Disagreements about what was said during telephone conversations can be a major problem in professional malpractice cases. Follow these documentation processes to mitigate this risk:
• DOCUMENT ALL PATIENT TELEPHONE
CONVERSATIONS in the medical or dental record— including those received and returned after hours. Include the date and time of each contact and when follow-up is completed.
• RECORD ALL DETAILS IMMEDIATELY about the information you received, what you advised, and the orders you gave. This action is especially important when a telephone call occurs after office hours or on a weekend.
• IMPLEMENT AN OFFICE PROCESS for calls received during office hours. Office staff should tell the caller when the provider is most likely to return the call. Include tracking and follow-up to ensure that the caller’s questions and problems are resolved and documented.
• DOCUMENT A PATIENT’S HOSPITAL MEDICAL
RECORD with telephone conversations about the hospitalized patient—including any conversations with nurses or other providers.
Effective telephone communication and its documentation are vitally important in preventing and defending litigation. For additional risk reduction strategies see our telehealth resources and our article “Smartphones, Texts, and HIPAA: Strategies to Protect Patient Privacy.”
For further assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email to patientsafety@thedoctors.com.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
MICRA Modernization 2022
Historic agreement brings new and sustained era of stability around malpractice liability.
In a historic agreement, Californians Allied for Patient Protection (CAPP) and the Consumer Attorneys of California have announced a consensus on legislation to modernize the Medical Injury Compensation Reform Act (MICRA). The modernized approach to MICRA— introduced as Assembly Bill 35 in the legislature and jointly authored by Assembly Majority Leader Eloise Reyes and Senator Tom Umberg—will extend the longterm predictability and affordability of medical liability insurance premiums, while keeping MICRA’s essential guardrails solidly in place for patients and providers alike. For decades, California’s landmark medical malpractice laws have successfully struck a balance between compensatory justice for injured patients and maintaining an overall health care system that is accessible and affordable for Californians.
Over the years, California’s physician and provider communities have repeatedly defended MICRA through expensive battles at the ballot, in the courtroom and in the legislature. This year, with the so-called Fairness for Injured Patients Act (FIPA) slated for the November 2022 ballot, we were again facing another costly initiative battle that could obliterate existing safeguards for out-of-control medical lawsuits and result in skyrocketing health care costs. “For the first time in a generation, we were met with an opportunity to achieve a meaningful consensus between competing interests through a modernized MICRA framework that could protect both the rights of injured patients while keeping MICRA’s essential guardrails solidly in place for patients and providers alike,” says Robert E. Wailes, M.D., president of the California Medical Association (CMA). “At times like these, we have an obligation to protect patient care and to seize a historic opportunity for a brighter future for California’s health delivery system.”
The Threat
If approved by voters, the FIPA initiative would have effectively eliminated MICRA’s cap on non-economic damages by creating a new, broadly-defined category of injuries not subject to the cap. This would have resulted in a significant increase in litigation with unpredictably high verdicts and no less than an immediate doubling of malpractice insurance premiums. The non-partisan state legislative analyst predicted FIPA would have resulted in more than $11 billion a year in increased health care costs. This would have had a chilling effect on the entire health care system, with the trickledown effect borne primarily by low-income patients, who would face higher costs and restricted access to care. The initiative also directly targeted physicians, putting personal assets at risk.
A Modernized Framework
A new consensus has been reached between health care, legal and consumer advocates on legislation to modernize MICRA. This agreement unifies stakeholders and puts the interests and wellbeing of Californians ahead of historic conflicts. The compromise reflected in this legislation will ensure that health care is accessible and affordable, while balancing compensation for Californians who have experienced health care related injury or death. “This balanced proposal modernizes and updates MICRA while preserving its essential guardrails, strengthening provider protections and providing for fair compensation for injured patients,” said Dustin Corcoran, CMA CEO and Chair of the Campaign to Protect Access and Contain Costs. “This framework is essential to our shared goal of health access for all Californians. We look forward to working with the Legislature and the Newsom Administration to enact this historic proposal.”
The modernized framework preserves MICRA’s protections while providing a fair and reasonable increase to MICRA’s established limit on non-economic damages for medical negligence starting on January 1, 2023 – with gradual increases over the next 10 years and a 2.0% annual inflationary adjustment thereafter. Other important guardrails of MICRA will continue unchanged, including advance notice of a claim, the one-year statute of limitations to file a case, the option of binding arbitration, early offers of proof for making punitive damages allegations and allowing other sources of compensation to be considered in award determinations. Critical MICRA guardrails that will remain in place with modest updates include the ability to pay awards of future damages over time and limits on plaintiff’s attorney’s contingency fees. “This compromise will help to ensure that community health centers across California that serve some of our state’s most vulnerable patients will have continued access to safe, affordable health care,” said Jodi Hicks, Planned Parenthood Affiliates of California President and CEO. “It was important for Planned Parenthood to have a voice in this process because the proposed initiative would have caused significant harm to California’s safety net. We’re pleased to see a solution that creates long-term stability and protects access to care for those who need it most.” CAPP reached the agreement with the initiative’s proponent, Nick Rowley, and the Consumer Attorneys of California, the state’s largest organization representing plaintiffs’ attorneys.
Changes to the MICRA Cap
Current law limits recovery of non-economic damages to $250,000, regardless of the number of defendants. The modernized framework would increase the existing limit to $350,000 for non-death cases and $500,000 for wrongful death cases on the effective date of January 1, 2023, followed by incremental increases over 10 years to $750,000 for non-death cases and $1,000,000 for wrongful death cases, after which a 2.0% annual inflationary adjustment will apply. The proposal will also create three separate categories of caps, which could apply depending on the facts of each case:
+ One cap for health care providers (regardless of the number of providers or causes of action) + One cap for health care institutions (regardless of the number of providers or causes of action) + One cap for unaffiliated health care institutions or providers at that institution that commit a separate and independent negligent act A health care provider or health care institution can only be held liable for damages under one category, regardless of how the categories are applied or combined.
New Protections for Benevolent Gestures and Statements of Fault
Often, a patient’s decision to file a medical malpractice lawsuit is triggered by a failure in communication, not negligence. The modernized framework establishes new evidentiary protection for all pre-litigation expressions of sympathy, regret or benevolence, including statements of fault, by a health care provider. Allowing physicians and patients to have full and open conversations about adverse events and unexpected health care outcomes will foster greater trust and accountability, while facilitating improved patient safety.
Next Steps
The proposal reflected in this legislation strikes a prudent and patient-focused balance between fair compensation to injured patients and the need for universal, high-quality and cost-effective health care. More significantly, in the shadow of the most sweeping public health crisis in a century, it demonstrates a unifying willingness to put the interests of California patients ahead of divisive political positions. Our broad and diverse coalition of physicians, community health centers, dentists, hospitals, nurses and hundreds of other organizations dedicated to affordable, accessible health care will be working closely with the Newsom Administration and the California Legislature to ensure this updated approach to medical negligence cases is enacted and signed into law. CMA and the provider community remain united and committed to the principle of high-quality health care that is accessible and affordable to all Californians.
Californians Allied for Patient Protection (CAPP) is the large and diverse coalition working to protect access to health care through the Medical Injury Compensation Reform Act (MICRA). Its membership includes the California Medical Association (CMA), California Hospital Association, California Dental Association, CMA’s component medical societies, medical malpractice insurance carriers, community clinics, Planned Parenthood Affiliates of California and many more. (You can see the full membership at micra.org.) CAPP and its members also made up the core of Californians to Protect Patients and Contain Health Care Costs, the campaign CMA has been leading to defeat this dangerous ballot measure. CAPP reached the agreement with the initiative’s proponent, Nick Rowley, and the Consumer Attorneys of California, the state’s largest organization representing plaintiffs’ attorneys.
Singular Quality is Something to Care About
BY BRADLEY KNOX, MD; NIHAL NACCASHA, MD; AND STEVEN VAN SCOY, MD
Health care is an important concern for all citizens, and we must demand both the highest and safest level of quality care. Fortunately, Tenet Health Central Coast is one of the nation’s safest and elite hospitals (from nationally-recognized independent sources, such as The Joint Commission, Health Grades, The Leapfrog Group, to name a few), an amazing honor that lends even more significance to living in such a breathtaking region.
As physicians that have practices at Sierra Vista Regional Medical Center, we are privileged to offer high-quality care to all residents. But the quality of the County’s outstanding health care is in danger of diminishing if we don’t stand up together as physicians to oppose dangerous duplication of specialized services.
While we agree that competition is good in most cases, this type of duplicative competition in a county as small as San Luis Obispo will be detrimental to patients and the community.
Here are some important facts to consider:
• Numerous studies show that more care is not necessarily beneficial: along with the increased likelihood of medical errors, it can make care less affordable and accessible (Asian Bio Ethics Review,
August 2020).
• The more a hospital performs a surgical procedure, the safer it is. Many reports dating as far back as 1979 identify a link between higher mortality rates (more deaths) and low surgical volume (less experience with a particular operation). (JAMA Pediatrics, August 2015).
• Having a highly-honored hospital helps with the recruitment and retention of highly trained and skilled physicians of all disciplines. Studies show that physicians seek areas that strive for quality and provide outstanding opportunities.
As SLO County’s Trauma Center and only hospital with 24/7/365 Pediatric and Obstetrics (OB) Physician Hospitalists, Sierra Vista Regional Medical Center is directly accountable to the community it serves. Volunteers and patient advocates make up Sierra Vista’s Board of Directors, along with physicians, and promote patient safety to ensure that Sierra Vista provides the highest quality care possible. This is evident in the hospital’s more than 50 awards in patient safety and satisfaction and in recognition of excellent outcomes for quality patient care.
Sierra Vista provides cutting-edge, nationally-acclaimed innovations such as the NicView, Ion Robotic-Bronchoscopy, Transcarotid Artery Revascularization (TCAR) and has been recognized with the IBCLC Award for maternity care and support, putting Sierra Vista in the top two percent of community hospitals in the nation.
Sierra Vista Regional Medical Center’s Level III NICU has given advanced newborn intensive care to the tiniest, most vulnerable patients – a level of care rarely found in communities the size of San Luis Obispo County. To have the safest outcomes and not put babies at risk, it must have a high volume of babies. In addition to the NICU, Sierra Vista specializes in high-risk pregnancy and offers the County’s only Obstetric Hospitalist Program. Since opening its Neonatal Intensive Care Unit (NICU) in 1986, Sierra Vista has taken care of about 7,000 highrisk newborn babies. This high volume has created an experienced, well-educated, local team that is prepared for any newborn crisis.
As physicians, we need to advocate for best practices over more places to practice.
What are we risking by duplication of specialized services?
• We risk increasing health care costs locally.
Duplication of services means a duplication of costly, highly specialized equipment and staff, resulting in increased health care costs for the patient. • We risk mediocre care and higher mortality rates.
No one can be the expert if volume for any program goes down. National data indicates mediocre care contributes to poorer outcomes in general and ultimately higher mortality (death) rates.
• We risk losing our physicians. If overall quality care decreases or there is a loss of opportunity, physicians across disciplines might leave the area entirely.
• We risk losing quality programs. Sierra Vista Regional
Medical Center has worked hard to become an elite center for care; it is not something that happens overnight, and the community already has too much of a vested interest in the quality services, such as with a NICU, to let it fail now.
Dr. Knox is a volunteer Board Member and the Medical Chief of Staff. Dr. Van Scoy is the NICU Medical Director. Dr. Naccasha is a Perinatologist (Maternal/Fetal Medicine) and the Medical Director for Obstetrix Medical Group of the Central Coast.
Wellness
The History of Wellness
BY DOUGLAS MURPHY, MD
Though considered by many a newer concept, the tenets of wellness date back to antiquity. Long before recorded history, human drive for survival and exposure to the ubiquity of physical suffering and death must have elicited a desire to escape or at least defer that inevitability. And with that desire, a search for the means by which do so. This is perhaps the most basic human drive: to live longer, healthier, and better.
Wellness as an Ancient Concept By most accounts, ancient concepts of wellness are attributed to Ayurveda, originating as an oral tradition in approximately 3,000 B.C. Ayurveda was a holistic system which aimed to create harmony between body, mind, and spirit and were tailored to individual constitution (their nutritional, exercise, social interaction, and hygiene needs) – with the goal of maintaining a balance that prevents illness. Yoga and meditation are critical to this tradition. Ancient Hebrew concepts of health and wholeness are less clearly defined in texts but also have ancient origins. Hebrew scholars have argued that though there is no Hebrew word for “health,” the whole of Hebrew scripture is about health. The word nephesh, commonly translated “soul”, implies all the functions of man: spiritual, mental, emotional, and physical. According to some Hebrew scholars, health is the first mitzvah of the Jew and of anyone who believes in God and that the Hebrew word Shalom means “complete,” “whole,” mostly with the connotation of health. Early Christian concepts defined health as a gift of God but emphasized service to one another “in health, sickness, and suffering.” An overview of these principles defines life itself as a gift emphasizing stewardship
over one’s health, not overindulging in food or drink, seeking spiritual health, being kind to others and praying. Similarly, for Muslims, health is a state of physical, psychological, spiritual, and social well-being and is considered the greatest blessing God has given humankind. Muslims are to receive illness with patience, prayers, and meditation. The ancient cultures of China, India, Greece, and Rome had a very sophisticated understanding of how to maintain health, and they tended to emphasize a “whole person” or “harmonious” approach to staying well.
Ancient Systems of Medicine Traditional Chinese medicine is one of the oldest systems of medicine in the world. Influenced by Taoism and Buddhism, it applies a holistic perspective to achieving health and wellbeing through the cultivation of harmony within one’s life. Therapies that evolve out of traditional Chinese medicine, such as acupuncture and herbal medicine, are notably still in practice and increasingly being integrated into Western medical practices. The ancient Greek physician Hippocrates, considered to be the father of Western medicine, is possibly the first physician to focus on preventing sickness instead of just treating disease. Hippocrates was credited with separating the discipline of medicine from religion, arguing that disease was not punishment by the gods, but that illness came from poor lifestyle choices. He argued that disease is a product of lifestyle and environmental factors, diet, and living habits. Ancient Roman medicine emphasizes the prevention of disease over curing disease, and it adopted the Greek believe that diseases
are a product of diet and lifestyle. They had a highly developed public health system with a system of aqueducts, sewers, and public baths, which helped prevent the spread of germs and maintain the health of the population.
Though the earliest western mention of the term wellness can be found in 1654 in a diary entry by Sir Archibald Johnston, a modern concept of wellness derived from a diverse set of intellectual, religious, and medical movements in the 19th century, being refined in the 1950s through 1970s, and coming to the forefront of healthcare consciousness and policy over the last 25 years. Hence, the concept of wellness is not modern at all, but ancient, deriving from the most basic human drive: to live longer, healthier, and better. Let us hope we with the vast resources we possess in modern society, we can achieve more broadly effective application of wellness principles - better nutrition, exercise, stress management, and restorative sleep - in our own lives as physicians, while teaching and modeling this for our patients.
In the next installment of this series, we will consider modern concepts of wellness and more specifically how these are being applied.
About the AMA STEPS Forward™ Playbook series
This Playbook is part of the AMA STEPS Forward™ interactive practice transformation program. Each Playbook in the series highlights key messages and links to free online toolkits, videos, podcasts, and practical tools to start creating change today. The objective of the Playbook series is to offer you a high-level overview of an area that you can choose to dive deeper into at your own pace.
The AMA STEPS Forward program offers practice innovation strategies that allow physicians and their teams to thrive in the evolving health care environment by working smarter, not harder. Physicians looking to refocus their practice can turn to AMA STEPS Forward for proven, physician-developed strategies for confronting common challenges in busy medical settings and devoting more time to caring for patients. This collection offers more than 70 online toolkits and other resources that help physicians and medical teams make transformative changes to their practices, including in the areas of managing stress, preventing burnout, and improving practice workflow.
The AMA STEPS Forward™ Innovation Academy expands on the program to give participants the flexibility to customize their practice transformation journey. The Innovation Academy offers a spectrum of opportunities to learn from peers and experts, including webinars, telementoring, virtual panel discussions, bootcamps, and immersion programs.
Learn more at www.stepsforward.org.
Taming the Electronic Health Record Playbook authors: Jill Jin, MD, MPH; Jessica Reimer, PhD; Marie Brown, MD, MACP; Christine Sinsky, MD, MACP
AMA STEPS Forward also acknowledges the authors of the individual toolkits referenced in the Taming the EHR Playbook for their contributions: Melinda Ashton, MD (Getting Rid of Stupid Stuff); Peter Basch, MD, MACP (EHR Optimization); John Bulger, DO, FACOI, FACP (Choosing Wisely); Catherine DesRoches, DrPH (Sharing Clinical Notes With Patients); Jane F. Fogg, MD, MPH (EHR Optimization); Matt Handley, MD (Choosing Wisely); Kevin Hopkins, MD (Patient Portal Optimization); James Jerzak, MD (EHR Inbox Management); Christopher Joseph (EHR Optimization); CT Lin, MD, FACP (EHR Optimization); Margaret Lozovatsky, MD (Patient Portal Optimization, EHR Optimization); Paola Miralles (Sharing Clinical Notes With Patients); Wendy K. Nickel, MPH (Choosing Wisely); James Rice, MD, MHA (Patient Portal Optimization).
© 2022 American Medical Association https://www.ama-assn.org/terms-use
Introduction
50% of the physician’s day spent on EHR and desk work1
37% of visit time with patients spent on non-clinical tasks1
1 to 2 hours
of extra work each day, including long hours before and after clinic completing “between visit” work1 TAMING THE EHR
1. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165(11): 753-760. doi:10.7326/M16-0961
The EHR Problem: How Did We Get Here?
The electronic health record (EHR) has profoundly changed the practice of medicine and is perceived as both a blessing and a burden by clinicians who use it. Most physicians who did not begin their training and enter practice using a sophisticated EHR only learned enough to “get by.” Younger physicians who did go through medical training using a modern-day EHR typically did not have the bandwidth to focus on mastering the EHR along with their medical knowledge. Furthermore, the near-universal adoption of virtual care and telehealth during the COVID-19 pandemic has TAMING THE EHRincreased patient expectations and awareness about EHR-based communication tools, resulting in increased physician time spent on the EHR.2 Meanwhile, the EHR has evolved dramatically, in both positive and negative ways. While most EHRs now have customizable tools that, if used optimally, can save physicians time, there are also many more unnecessary “clicks” and automated messages clogging up inboxes. The EHR burden is a major contributor to physician burnout, and it has become a problem that individual physicians cannot fix on their own. It is imperative for organizations to learn how to “tame” the EHR by implementing effective team-based care principles and responding to feedback for continuous system-level improvement.
Physicians don’t quit their jobs, their patients, or their bosses; they quit their inboxes.
—CT Lin, MD, FACP, FAMIA; Chief Medical Information Officer, UCHealth-Colorado
2. Holmgren AJ, Downing NL, Tang M, Sharp C, Longhurst C, Huckman RS. Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use. J Am Med Inform Assoc. 2021;ocab268. doi:10.1093/jamia/ocab268
How Can We Tackle This Problem? What’s In Your Control?
The EHR problem can be thought of as encompassing a few buckets:
•the volume of unnecessary work that is being done (eg, extra clicks and mental bandwidth spent on filtering signal from noise, patient questions and requests that could have been avoided with better teamwork and workflow re-engineering)
•the volume of necessary work that needs to be done, but can be shared by nonphysician team members (eg, chart review, order entry, documentation, inbox management) To accomplish any of these changes, it is imperative to work with leadership. Some changes will be easy to make, others will be more difficult. Some changes may be institution- or organization-specific, while others may be governed by federal regulations. Having a shared understanding between leaders and practicing clinicians of “what’s in your control” helps overcome inertia (or resistance to change) while building trust and transparency (Table 1).
•the technology itself
Who Is This Playbook for?
This Taming the EHR Playbook is for:
•Daily EHR users (eg, physicians, physician assistants, nurse practitioners, nurses, medical assistants)
•Organizational leaders (eg, Chief Medical
Information Officers [CMIOs] and Chief
Compliance Officers [CCOs])
•Medical directors
•Practice managers
•Operations leaders
This Playbook will focus on addressing each of these buckets so that individual clinicians and their TAMING THE EHRpractices can: 1. Minimize the unnecessary work by deimplementing nonessential rules and looking upstream to stop irrelevant notifications and results from entering the inbox 2. Manage the necessary work by utilizing team-based care principles to offload inbox management, order entry, and documentation from physicians alone 3. Become more personally proficient at using EHR technology Anyone interested in maximizing the benefits and minimizing the burdens of the EHR can learn from the content outlined and linked to within this Playbook.
This Playbook contains highlights from 11 AMA STEPS Forward™ toolkits.
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