Craig Joseph, MD, is Chief Medical Officer at Avaap where he works with healthcare leaders to implement and optimize EHRs in order to increase physician satisfaction, improve efficiency, and ensure full value of the technology.
Avaap acquired Falcon Consulting (now Avaap EHR) in 2016 to provide healthcare customers with a single source for two of the industry’s largest technology investment areas, EHR and ERP. As Avaap’s first CMO, what is your role?
My main role is to provide peer-to-peer insight and an outside clinical perspective to help healthcare organizations implement and optimize the EHR, ensuring it is secure, easier to use, and interoperable across the continuum of care. I can add value in the ability to go beyond clinical knowledge to truly understand the pain points of implementing, using, and optimizing the EHR through real-world experiences gleaned from years of private practice and as an Epic employee, customer, and consultant.
I plan to help Avaap customers leverage my expertise to uncover additional quality and efficiency improvement opportunities and realize the cost savings and improved patient care EHRs deliver.
Can you share a highlight from your time at Epic?
As anyone familiar with Epic knows, the software can be tailored to each hospital’s requirements to support streamlined, integrated workflows. In its nascent days, Epic implementations commenced with discovery sessions where doctors, nurses, and other healthcare professionals described their current-state workflows. Then, Epic analysts and project team members would try to replicate those current-state workflows inside the EHR. While this may sound like a great idea, it often resulted in broken and inefficient workflows being cemented into a modern software system.
Working with a team of physicians, nurses, revenue cycle experts, and workflow specialists who helped implement Epic software across the United States, we created the first version of a model system to give new Epic customers a strong base on which they could build. Now called Epic’s Foundation System, this set of configuration recommendations has allowed new Epic customers to implement the software faster and, I think, better. If new and existing Epic customers leverage the Foundation System to bake best practices into their software where appropriate, they usually end up with better outcomes and less implementation or optimization cost.
What are your early observations from your first 90 days at Avaap?
I see a lot of opportunity for customers using Infor and Epic to gain access to experienced, certified resources who understand the software, underlying technology, and gamut of IT requirements for a large hospital system. With ERP and EHR the most significant technology investments for most health systems, an integrated approach can establish streamlined processes on the clinical as well as the business side, providing greater visibility across the organization for more strategic decisions.
We recognize our ERP customers may run an EHR such as Cerner and our Epic customers may run a different ERP than Infor. While Avaap has a strategic focus on Infor ERP and Epic EHR, we bring customers a collaborative approach that helps them achieve the greatest value from ERP and EHR investments regardless of software vendor.
You recently gave a lecture on the unintended consequences of computerized physician order entry and the electronic health record. What are some of the unintended consequences of CPOE?
When computerized physician order entry (CPOE) decreased the need for paper, clerks no longer routinely entered medical orders, leaving physicians responsible for the task. The change in communication flow from free-text clinical orders to CPOE illuminated how much physicians were reliant on others and as a result, it introduced new errors. Gone were problems with historically poor handwriting and transcription mistakes when a clerk typed in something different than the physician intended. In their place, new errors arose, such as not properly entering order details or allowing default order choices to remain even if the defaults were not optimal.
Some other unintended consequences of CPOE include errors such as selecting the wrong medication or dosage because screens are small or text is too close together. Others include the ordering of wrong tests due to limited choices or because clinical orders were reworded or made into an acronym in effort to standardize and physicians suddenly found ordering unclear.
As with any technology, overdependence on CPOE is not good. Physicians are still the final arbiters of what happens to the patient in the hospital or in the ambulatory clinic, and while CPOE can enhance the physician’s efficiency and the patient’s outcome, we have to keep guard to minimize the deleterious effects that CPOE can bring.
Interested in learning more about optimizing the EHR for greater physician efficiency and satisfaction? Connect with Craig!