Healthcare IT New Year’s Resolutions

Craig Joseph, MD
By: Craig Joseph, MD
Date: January 03, 2019

With New Year’s Day in our very recent past, I thought it appropriate to propose some resolutions for those of us in the healthcare IT trenches. These are in no particular order, and like all resolutions, I make no commitment to following any of them myself.

  • Just say no to electronic health record (EHR) hard stops

Depending on which EHR you use, hard stops are often represented by a stop sign. They indicate a field or choice that must be acted upon before the desired outcome can be achieved. Stop signs are evil. Before you click the comment button, I realize that hard stops are a necessary evil, yet they are still evil! In medicine, we are blessed – and cursed – with choices, so when an EHR tells us we must make a choice or we cannot proceed, many of us physicians become . . . unhappy. Sure, sure a med order must have a dose and a route, we get that. But if we just entered a discrete indication for an imaging study, why must we see a stop sign next to a field called Reason for Study?

  • Use documentation templates when they make sense, and don’t use them when they don’t make sense

There are certain aspects of medical practice in the United States that lend themselves to templated documentation. (Pro tip: these are usually the parts of the note that most doctors don’t routinely read, but keep that on the down low, please.) Which aspects, you ask; I’m thinking sometimes the history of present illness, always the review of systems, and often the physical exam. Procedure or operative notes can often be templated because surgeons typically try to do the same thing in the same way every time whenever they can. What can rarely be successfully templated? The assessment and plan comes to mind! The most important part of medical documentation, at least from this physician’s viewpoint, is what the doctor is thinking. That’s what we want to know! Why did you rule this out? What are you trying to determine with this lab and that x-ray study? When do you think the patient will be getting better? Why are you not ordering the specialist consult? Most of this goodness won’t ever be found in a documentation template, so please don’t use one inappropriately.

  • Don’t be too polite when it comes to secure messaging in the hospital

Judy Faulkner, founder and CEO of Epic which is based in Madison, Wisconsin, often tells her employees that many of them suffer from a malady called “Midwest Nice.” I don’t believe that she wants her staff to use vulgarities in email, but rather to be aware some customers in other parts of the country (hello Boston and New York City) or world might be a tad more direct and confrontational than they’re used to. Along these lines, I’m seeing doctors want to throw their phones across the room because they’re getting way too many “thank you” or “:-)” messages from nurses and techs. This is fine when sending personal texts to your friends and family, but . . . it’s a nicety that’s gone bad in the hospital. Every time that phone buzzes, the physician needs to check the secure messaging app. If half the time it’s not an urgent message, unhappiness abounds. It’s not good for the patients, it’s not good for the doctors, and it’s not good for the support staff. Create a messaging etiquette guide and encourage your doctors and nurses to minimize non-essential texts at work.

  • Send your IT staff to educational conferences

Nowadays, everyone in healthcare IT is tasked with doing more with less. More implementations, more upgrades, more clinics, more hospitals, just more! Oh, and no, don’t hire more people. Do you know how expensive good IT people are? What’s a healthcare IT leader to do? One thing you might be able to do is send your folks to good educational conferences. In my experience, look to your key software vendors first. They often host great meetings that ideally focus both on where the software is going and what current customers like yourselves are doing with the code that’s out there now. There are local, regional, and national meetings that groups such as HIMSS host. There are meetings like CHiME for your IT leaders, AMDIS for your physician IT executives, and even AMIA for those with an academic bent. Your IT staff will have a good time, learn a lot, and hopefully network with others who have solved problems that are perplexing you now.

Do you have other healthcare IT resolutions that you’re hoping to keep? Leave me a note and share them!

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