The Tyranny of “Time” – EHR Efficiency Has a Lifecycle

I love when you can find a picture, chart or graph that describes an important concept. I saw that during a CHIME Fall Forum focus group that was led by Heather Haugen from The Breakaway Group. During the focus group, Heather put up the following slide to describe the level of optimization a hospital experiences during the lifecycle of an EHR.

EHR Adoption Optimization Lifecycle

The key element in the above graph is the trough that happens after the initial adoption. I think the slide into that trough of EHR inefficiency is as steep as what’s shown on the graph, but the dip in efficiency definitely occurs. In fact, I think that the path to inefficient EHR use is slow and that’s why many healthcare leaders don’t notice when it happens.

The solution to this problem is to create a program in your organization that manages upgrades, provides ongoing training, and regular workflow assessment and optimization. I imagine most organizations weren’t worried about this when they slapped in their EHR to meet meaningful use. However, now they’re all going to have to take a deep look into solving this long term problem.

Full Disclosure: The Breakaway Group is a sponsor of the Breakaway Thinking series of blog posts on EMR and HIPAA.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

6 Comments

  • The reason healthcare leaders don’t notice the slide to inefficiency is because they generally don’t know what they are looking at/for.

    What are the efficiencies in a hospital setting?

    What are we measuring here? Staff interaction? Patient visit quality? Patient stay time?

    That graph almost looks like something a consultant made up to ensure they have a reason to be around.
    Unless there are major interface changes or complete vendor changes, I have a hard time believing that the trough drops below fluency.

  • John,
    Very true. We don’t have a great system to measure how we’re doing with EHR proficiency. Interesting to think about how you would measure it.

    I agree that the dip in efficiency is probably not as deep as is shown in the graph, but there’s definitely a dip. How deep depends on the organization as well.

  • The more I think about this dip, the less it makes sense.
    Has your word processor efficiency slipped over time?
    Has your spreadsheet efficiency slipped over time?

    No. In fact, it is when there are upgrades and the GUI is changed when efficiency drops.

    Think about how long legal secretaries clung onto WordPerfect for DOS. They knew all the keyboard shortcuts and could function much more efficiently in that world vs. the mouse driven versions today.

    Without any metrics to judge this “drop”…I call shenanigans.

  • John,
    You’re looking at it too much from a specific person perspective. I think the graph is from an organizational perspective. There are 2 reasons why I think this is the case. First, staff turnover. The new staff don’t get trained as well as previous staff and so the EHR user becomes less than optimal as staff turns over. Second, when there are upgrades to the software it lead to a user working at a less than optimal level. If they have new features that could benefit you as a user and you don’t know about them or don’t integrate them into your workflow, then your working at a less than fluent level on that EHR system.

  • True, my perspective is purely private practice.

    I agree with your staff turnover remark – which actually points out an implementation flaw: the lack of ongoing and new employee training. After initial implementation, nobody wants to spend the money to properly train either new people or active staff on new features.

    I’m sure this is an area that is not budgeted as that would increase the cost of the system and make it a tougher sell.

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