There’s a classic software problem that many who use an EHR don’t understand. This was highlighted in a recent tweet by Dr. Graham Walker:
While Epic is certainly responsible for a lot of issues with its EHR, at least half of the complaints I see on social media from doctor/nurse users are actually due to poor configuration/settings from the hospital and bad workflows. Nothing to do with Epic’s software. 😒
— 𝔾𝕣𝕒𝕙𝕒𝕞 𝕎𝕒𝕝𝕜𝕖𝕣, 𝕄𝔻 (@grahamwalker) April 20, 2021
What’s Dr. Walker talking about? At the core of what he’s saying is that many people complain about Epic (or insert any EHR here) when in fact, the problem they’re complaining about is something that could be configured differently and would then not be a problem. Dr. Walker shared an example:
Perfect example I just came across https://t.co/s9X0HTqW2S
— 𝔾𝕣𝕒𝕙𝕒𝕞 𝕎𝕒𝕝𝕜𝕖𝕣, 𝕄𝔻 (@grahamwalker) April 20, 2021
Obviously, there’s a lot going on in this tweet if the person feels like Epic “judging” them, but we’ll set that aside for this article. Are these push notifications an Epic problem or is Cadie’s organization who made the decision to leave these notifications on the problem? What’s Epic supposed to do? Go and force the hospital to turn off notifications they think are valuable?
Dr. Genie offered more insight and perspective on this:
The modern day EHR configurations can not be compared to an iPhone infinitesimally smaller options. Well configured EHRs that providers are well trained on can still be annoying but not a significant cause of burnout.
— DrGenieInformaticianGeek (@geek_dr) April 21, 2021
A great example of this is would we get mad at Word for their spell checker changing EHR to HER? Ok. People do get mad over this, but do they hold Microsoft responsible? And of course, if you just add EHR to your dictionary in Word, then it won’t happen anymore. Is it Microsoft’s responsibility to let you know that there’s a feature that would prevent this pain?
The real problem is many healthcare organizations and EHR users who don’t know all the features in their EHR. Joanne Cournoyer told a classic story:
After a few days, I finally found out -they were SO happy they could see labs on their status board. That’s existed since the inception of the nursing product. BUT SOMEONE at the hospital made the decision to leave labs off the board. And they never reevaluated it. 2/2
— Joanne Cournoyer (@labtech101) April 21, 2021
Of course, that’s not to say that EHR vendors are perfect and they don’t lack responsibility. In fact, Dr. Gabe Wilson asks this great question about why a poor configuration is even possible:
One doctor’s bug is another doctor’s feature
— 𝔾𝕣𝕒𝕙𝕒𝕞 𝕎𝕒𝕝𝕜𝕖𝕣, 𝕄𝔻 (@grahamwalker) April 20, 2021
Dr. Walker’s response highlights the challenge that EHR vendors face and most users don’t appreciate. I’ve heard it over and over again from people. One doctor will describe a feature as the worst implementation ever and another doctor will describe that same feature as their favorite part of the EHR.
GruntDoc also got in on the action and shared how he often found it was the local configuration that was causing the problem.
Absolutely. Sometimes there’s a good reason why your hospital doesn’t do X but not always
— 𝔾𝕣𝕒𝕙𝕒𝕞 𝕎𝕒𝕝𝕜𝕖𝕣, 𝕄𝔻 (@grahamwalker) April 20, 2021
Matt Van Cuyk highlighted the solution that I see in most healthcare organizations. It’s the often underappreciated informatics team:
This is why I am a huge fan of informatics teams who practice still or have a great deal of practice experience.
— 💊😷Matt Van Cuyk PharmD, BCPS (@mpvancuyk) April 20, 2021
Going back to where we started, Clay Forsberg offers this perspective:
While this is true, it’s still an Epic problem. Onboarding (including properly configuring the software for the provider’s needs) and ongoing customer service (to make sure practitioners are properly using the software) MUST be an integral part of the software. Cc @grahamwalker
— clayforsberg 🦔 (@clayforsberg) April 21, 2021
He’s right that it’s still an Epic problem. Each of these “configuration” or “optimization” issues will take a toll on Epic’s EHR users and Epic will have to account for it. I recently heard Judy from Epic say that she understood at least part of this problem. To help address it, she created a grade for each of their customers for how much of their software they were actually using, were they updated to the latest version, etc. She didn’t share many details, but at least she understood that there was a problem of many healthcare organizations not being on the latest software where issues were resolved and of many organizations not using features that could make for a better user experience. No doubt, the problem above is also why the various EHR user conferences are so valuable. Meeting with users from another organization will often help an organization discover features they didn’t know about or better ways to optimize their configuration.
No doubt this is an age old enterprise software problem that’s not unique to EHR software. Whenever you have a software this complex that’s serving so many different organizations you’re going to have the challenge of whether it’s a configuration issue or a software issue. The reality with enterprise software, it’s usually both.