A Phrase No Medical Provider Should Be Forced To Use

Any nurse can tell you they are burdened by seemingly endless documentation that interferes with their ability to provide competent, high quality patient care. Recently, I overheard one nurse telling a new overwhelmed nurse “Oh, you'll get used to it…” when referring to the documentation. But that's a shame. Rather than being something one “gets used to”, documentation should be sensible and performed for the purpose of meaningful communication and record keeping.

Nurses are not the only providers burdened by EHR systems. In fact, many physicians refuse to implement EHRs citing safety concerns, a decrease in quality of care, and interference with the ability to engage with the patient.

This is not to say that EHR use is bad, but rather, that important changes should be made to existing systems. I truly believe it's possible to develop a logical, high-quality system that actually improves work-flow processes. But IT organizations, thus far, have apparently done a poor job of collecting data for use throughout their EHR development phase.

Lean process is a term that is thrown around in healthcare. The objective of lean process is to cut out any step in a procedure or process that does not add value to the outcome. I'd venture to guess that 75% of nursing documentation does absolutely nothing to improve patient outcomes or to facilitate communication. For example, no one uses a care plan to determine what care to provide to a patient. In fact, I asked one nurse, “Did you do all of the interventions on the care plan?” She answered a truthful, “No.” I do not fault the nurse for not performing the interventions. Some are inappropriate or unnecessary, and while others might be a nice idea (e.g., sitting down and talking to someone with hypertension about lifestyle changes), they are impossible to perform in the acute care setting due to prioritization of care. While quality “experts” stress the importance of individualization of care, they neglect to realize that “care plan” and check box documentation provides for just the opposite.

Federally mandated meaningful use guidelines are the most likely culprit of the disconnect between the reality of care and the documentation of care. The truth is, organizations are concerned about the documentation because it is tied to their reimbursement. The result is that patients are getting less care, but more is being documented. Essentially, a great deal of the documentation is false documentation. Frankly, that's illegal but it doesn't appear anyone is having a discussion about that .... yet.

I am mystified that a company has not developed an EHR platform that facilitates documentation quickly and accurately. I can only assume that the right kind of bedside medical professionals are not involved with planning and development. Any professional will not do. The professionals must understand the concept of lean process and its application to nursing documentation, physician documentation, ordering, and the work-flow processes of multiple types of providers. They must also understand the regulatory requirements imposed upon the organization, and how documentation impacts reimbursement. And from a quality and safety aspect, the professional must be familiar with problem areas (e.g., nurse physician communication), and be capable of assessing systems and soliciting input from front end users with excellent critical thinking skills before planning and development take place.

I've spoken to quite a few business people who wish to break into the field of Healthcare IT as it is expected to be a long booming business, but have found they often lack useful perspective. When EVERY front-end provider sites some issue with EHR use, it's time for regulators, developers, and organizations to listen, and to do something about it.

In any event, a dysfunctional and burdensome platform is not something any provider should report “getting used to.”