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Practice Wise 3/13/14

March 13, 2014 News 4 Comments

Open letter to EHR users

Now I know for sure this is going to put in me in the unpopular kids group, but I have to say it! EHR users are costing vendors excessive amounts of support time and resources supporting users who refuse to admit they might actually be causing the problem.

I’m not saying this as a rebuke to users who truly have EHR problems and vendors who won’t/don’t address them effectively. However, as an organization that provides both consulting services and direct support, we see this scenario way too often and I think it’s time to address it head on!

For example, a customer complains that the system keeps doing something nefarious and is out to ruin their practice. Vendor asks typical level one support questions such as ‘are you sure you have not hit the (any) key?’ Customer insists they are not hitting that key, and is not shy in stating how offended they are that the vendor would even consider that ‘they’ might be causing their own problem. After hours of support, escalation and development time spent on this issue, customer is audited on site, they hit the key they swear they never hit, and sheepishly say, ‘oh, I guess I sometimes do hit that key’. And instead of swallowing a little humble pie and offering an apology, they deflect by saying something else like ‘but the system does this other thing that is really ruining my practice!’

Seriously, what EHR users really need to understand is that most software vendors have the same goals as they do: to have a successful implementation with expert users who fully utilize the system for optimum use. There are certainly vendors who have badly designed products and poor support. Let’s just assume we are not talking about any of them here.

This behavior is top down in most practices. The most successful implementations and ongoing adoption of all things EHR are in practices where the doctors themselves display a positive attitude about the change, are engaged in the process, and are supportive of their team as they all struggle to grasp the new program and develop the muscle memory that leads to mastery. There are fewer of these practices overall. The general experience is that doctors believe EHR is being forced on them, that no vendor could ever make a product that doesn’t slow them down, that it doesn’t print out documents that sound like they would speak, etc. And when the project starts at that level of negativity, it permeates the whole team.

What happens in an EHR implementation is that a magnifying glass is held over all your processes and procedures. If you are a well-developed process-based organization, this is a good thing, your shining moment. If you are an organization that has just always done things on the fly or ‘this way because that’s how it’s always been done’ and not open to new processes that might actually improve your practice, you will have a hard time hearing valuable recommendations from your consultants and implementation team.

When the internal practice attitude towards the project is negative, the doctors become abusive to their team and to the vendors who support them. I don’t use this word lightly. Talk to any implementation person and they can rattle off a litany of horror stories of doctors throwing fits, calling them idiots, throwing laptops across the room, etc. Here’s my theory (not very scientific, purely observational): doctors are used to being smart and good at what they do. This process unmoors them to some extent. Once they accept the process and decide to move forward, they generally do well the first week of go-live because they believe they shouldn’t know the system, so they don’t typically get snarky that week. However, week two rolls around and they assume that since they are smart and quick learners, that they should have mastered the darn thing, and then the snarky, rude behavior comes out. When the staff sees/hears the doctors abusing the vendors, they do the same when they are frustrated because they believe it’s how to get things done in the practice.

I’ve worked in other industries besides healthcare, and never in my professional life have I experienced this kind of rude abuse by a customer to a vendor as I have in this field.

Here’s my message to providers: we are here to help you. If your practice succeeds, we succeed. Your implementation failure is our failure. We want you to be the best users you can be, and we want you to master the system to the fullest. However, when you don’t speak nicely to us, call us names, make threats etc., we are less likely to want to go that extra mile to hold your hand in your time of need.

I had an IT vendor tell me on the phone the other day that he doesn’t care that the darn doctor can’t access the VPN from home and fixing it is low on his priority list because the doctor is so rude to him and always hangs up on him when he doesn’t get the answer that he wants.

That’s what happens when you’re rude to your support vendors: we tend to put you at the bottom of our priority list. Here are a few ideas of ways you can navigate through this difficult transition, with everyone pulling for your team and working towards your success:

  1. Accept that you are changing your processes and getting an EHR. Doesn’t matter why, it just is, so accept it and get over it.
  2. Project a positive attitude within your organization, encourage your partners and staff to do the same. Be the champion!
  3. Buy the hardware as recommended by your EHR vendor. Don’t try and cut corners and save money buying your own computers and equipment at discount sales if you really don’t understand the hardware specifications. Your IT vendor is not a magician; if you don’t buy what’s recommended, he can’t make it do what you need it to do, and you’ll be frustrated and likely blame the IT vendor and the software vendor.
  4. Take advantage of ALL training opportunities offered by your vendor. The more effort you put into your training, the less frustrated you’ll be. This is one area that frustrates the vendors; doctors are ‘too busy’ to do the training, yet want to be masters of the system. It’s not magic; it’s learning. You had to go to med school to become a doctor – they didn’t just hand you a degree. Same theory here!
  5. Put effort into doing the customizations offered to tailor the system to your practice. Many systems have great malleability and trainers who can help you design your workflows in a way that helps you document in your comfort zone. This effort on the front end will reduce your stress on the back end.
  6. Create a position for an EHR super user in practice. The person’s sole responsibility is to make sure your needs are getting met, your changes are addressed quickly, and is dedicated to you. Treat that person nicely even when they can’t give you exactly what you want. You cannot expect your vendors to drop everything and meet your demands all the time, especially when you make demands and don’t ask nicely for help.
  7. BE NICE to everyone. We are all doing the best we can at any given moment to support you! We all have the same goals – your successful implementation and continued success in your practice.

I love working in healthcare and supporting doctors. Some call me crazy! However, I think most doctors really do have the best intentions and just need to know that in the end, it will all work out fine. At least we’re not asking you to work 100 hour/week rotations. You survived residency, you’ll survive this too!


Julie McGovern is CEO of Practice Wise, LLC.

Comments 4
  • A visiting HR professional in my MBA program once said something that I think applies tenfold in our industry: People don’t really fear change, what they want is someone to acknowledge their loss. Their loss of comfort, loss of expertise, loss of being at ease at work- basically the loss of everything that they felt secure with in their job. As change leaders it is often our job to listen more than direct, but at some point, the five stages of grief must end and progress must be made- honestly, openly, and with a nod that the past is the past. We do not forget our scars, but we must allow our wounds to heal. Question what you want about a “vendor’s” motives, but the front line staff really are there to make a difference and try to help when/where possible. If you don’t believe them, try and find a 3rd party to facilitate. Success really is everyone’s goal. Tough article to write, but a great discussion to have. Thanks!

  • Thank you, Julie. This paragraph:

    What happens in an EHR implementation is that a magnifying glass is held over all your processes and procedures. If you are a well-developed process-based organization, this is a good thing, your shining moment. If you are an organization that has just always done things on the fly or ‘this way because that’s how it’s always been done’ and not open to new processes that might actually improve your practice, you will have a hard time hearing valuable recommendations from your consultants and implementation team.

    rings so true with me. As a software implementer with over 25 years of experience in multiple industries (the most recent 1/2 of that in healthcare) I share your views 100%.

    What gives providers ( or anyone) the right to be rude to the very people who are trying to help them provide the best patient care they can? Or for that matter, the collector/registrar/payment poster? Not only is it counter-productive but it is just plain wrong.

    There is good software out there. There is bad software out there. There are good people to help you use it to its fullest. There are support staff who really don’t give a damn. Just remember that maybe it was you (or your colleague) who made them feel that way. Even if you didn’t, do you want to continue the downward spiral?

    #7 says it all: BE NICE.

    I vaguely remember hearing that advice in pre-school…seems like we need to re-train this “golden rule” in higher education as well…

  • This was great, Julie, and it’s about time someone said it! I agree with and have shared your observations that many physicians don’t make the time to watch the available learning videos (not quite sure how that worked out for them in medical school), nor do they want to pay their staff to do the same or give them time away from their normal daily duties. I’ve also noticed that there doesn’t seem to be a whole lot of actual thought and discussion given to “what is our work flow and does it make sense or need changing” prior to Go Live. I would think you’d want to have a LONG list of questions ready when the vendor implementation team is on site. Don’t wait until go home! As you said, have your paper forms gathered and ask if they can be customized as such in the EMR.
    I remember in the early days of selling EMRs there were dozens of webinars offered on readiness and change management, yet I have rarely seen many practices that actually do that stuff. Sigh. Yes, BE NICE!

  • Thanks for having the courage to say some of the unspoken truths about vendor/client relationships and the importance of both parties being good partners in order to achieve a common goal. Most of these things should “go without saying”, but every once in a while… they need to be said.

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