What an EHR troubleshooter knows

What an EHR troubleshooter knows

March 31, 2020
Health IT

This is no exaggeration: my teams have discovered and cleared queues with over $1.2 million in charges waiting to be processed. Sometimes there’s a system issue that prevents faster discovery of these errors. But an even more common reason is no IT or business unit was assigned ownership of monitoring certain queues. Bridging these costly gaps between process and technology begins with clear, open communication. Another requirement: solid testing when changes are made; whether to a system, to a business process, or with the introduction of a new or revised regulatory requirement.

With every EHR upgrade, something gets broken. Let’s take a closer look at testing in the wake of EHR changes and upgrades. The reality is most hospitals and provider organizations customize their systems according to their unique patient mix, service lines and clinician workflow preferences. They also apply custom interfaces with other systems, such as those used in the pharmacy and lab.

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For a while, these custom features work as intended—until the next vendor upgrade. Suddenly, a custom alert that nurses relied on has stopped alerting, or custom orders aren’t being processed by the lab information system. The longer it takes to discover and fix the root causes, the more frustrated system users will become.

Vendors do test their upgrades, but they’re testing their standard features. It’s simply not possible for a vendor to test the impact of an upgrade on all the countless customized features in thousands of hospitals’ EHRs. The solution resides in frequent, thorough testing on the user end. However, in my experience this is another area where hospitals strain to find the time and resources, including mastering use of automated tools that perform enterprise-scale testing.

Certification does not mean experience. I recognize that training and certification on an EHR are not easy feats. Nothing, however, can replace the experience gained from working with EHRs in multiple healthcare environments. That’s why an analyst who has supported an EHR for years at one hospital may know the system build and history very well, yet not have the knowledge required to introduce new functionality requested by users.

One example that comes to mind is a hospital that manually verified seasonal vaccine history for patients by reviewing previous visits. This process wasn’t just time-consuming; it had a high probability of error. My teams were able to replace it with a vaccination history panel accessible with a simple mouse click, based on knowledge gleaned from other projects.

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