- The EHR-integrated SKN system is designed to encourage clinicians to report problems with EHR functionality on a regular basis using the system’s reporting tool.
- Researchers found many providers were unsure who was responsible for completing certain tasks related to medication histories and admission processes.
Researchers at AU Health used a provider communication tool to identify and address problems with clinician EHR use.
Implementing an EHR-integrated provider communication tool may help health systems improve clinician EHR use, according to researchers at the Augusta University College of Allied Health Sciences.
Researchers implemented a social knowledge networking system to allow clinicians to more easily report and discuss problems with EHR medication reconciliatio tools.
As part of a two-year project funded by the Agency for Healthcare Research and Quality, Rangachari et al. aim to improve clinician engagement with EHR MedRec technology by encouraging medical staff to share best practices about EHR use across the health system.
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The team is currently working to complete the three-phase project comprising a six-month development phase, a year-long SKN implementation phase, and a six-month analysis phase.
The EHR-integrated SKN system is designed to encourage clinicians to report problems with EHR functionality on a regular basis using the system’s reporting tool. After clinicians report a problem, a group of moderators can view and respond to specified issues using a discussion tool. The discussion tool enables clinicians to share knowledge about best practices across a diverse group of practitioners.
AU Health integrated the SKN system into its Cerner EHR in June 2017. Approximately 60 health system staff members including physicians, nurses, and pharmacists signed on to participate as SKN users responsible for reporting problems related to EHR MedRec.
At the same time, a group of five senior administrators including AU Health’s Chief Medical Officer (CMO), Chief Medical Information Officer (CMIO), and senior physicians signed on to become designated SKN moderators in charge of addressing reported problems using the system’s discussion tool.
“The first step in Phase 1 was to identify a comprehensive set of issues related to EHR MedRec from multiple practitioner subgroups involved in the MedRec process, i.e., physicians, nurses, and pharmacists, based in the inpatient and outpatient medicine service at AU Health,” clarified Rangachari in the report.
Researchers conducted 15 individual interviews with participating physicians, nurses, and pharmacists and identified 55 problems with EHR MedRec. Researchers then sorted all 55 reported problems into nine categories and conducted a survey with a larger group of AU Health medical staff to identify which problems were viewed by clinicians as the most significant.
A total of 127 AU medical staff members submitted survey responses. Problems with care coordination were deemed by clinicians as the most important, with 89 percent of respondents rating care coordination problems as either important or extremely important. Patient education-related problems were seen as the second-most pressing (84 percent), while workflow issues were seen as the third-most significant (83 percent).
“A central theme that emerged from Phase 1 was the absence of shared understanding across multiple practitioner groups,” noted Rangachari.
Researchers found many providers were unsure who was responsible for completing certain tasks related to medication histories and admission processes. Additionally, many providers were unsure of how other clinicians use the EHR MedRec system.
“For example, outpatient subspecialists are not convinced that MedRec marked as complete in the system at the time of hospital discharge translates to a complete and accurate medication list,” she wrote.
Furthermore, clinicians were generally uncertain about the value of EHR MedRec in improving patient safety.
“For example, outpatient providers expressed the concern that inpatient clinicians may not realize the importance of ensuring a medication list that is free of discrepancies at discharge, to enable patients to effectively transition into the community,” Rangachari explained.
Clinician skepticism surrounding the value of EHR MedRec lead to EHR workarounds at AU Health and limited clinician engagement with the EHR-integrated tool. By encouraging use of the reporting tool among clinicians, researchers were able to identify significant problems related to EHR use and foster discussion among medical staff about ways to resolve these problems.
“Results of Phase 1 provide insights into best practices for meaningful use and successful implementation of EHR MedRec,” maintained Rangachari.
“In effect, the results suggest that meaningful use of EHR MedRec could be facilitated by creating shared understanding of the process for MedRec and responsibilities for each step of the process among all practitioner groups involved in the EHR MedRec process,” she continued.
After completing phase 1 of the study, researchers developed and implemented the SKN system into AU Health clinician workflows. The reporting tool and discussion tool were each imbedded into the health system’s Cerner EHR.
Phase 2 of the study is currently underway. Researchers plan to leverage the results of phase 2 to develop evidence-based management strategies for encouraging increased use of EHR MedRec throughout the health system.
The potential for SKN systems to improve clinician engagement with EHR functionality could help to boost physician EHR use, reduce physician dissatisfaction with health IT, and streamline the process of reporting and resolving EHR-related problems.
“To this effect, EHR vendors could also be encouraged to incorporate SKN features into EHR systems,” Rangachari concluded.
Through EHR-integrated tools such as the SKN system, health systems can help to improve provider communication and promote more effective EHR use.
Date: Mar 27, 2018