Healthcare Technology: the role of habits in EHR adoption

How smart can a product be? How smart can a system be? There ought to be a limit. And trust me, there is. No matter what product or service or app is being built, it relies on the role of ‘users’. Without users putting in the necessary effort, no product can be smart enough.

The same applies to Electronic Health Records (EHR), with the ‘users’ being physicians. If you are a physician reading this blog, I am assuming that you yourself have decided or have been pushed at the front line for adopting a new ‘software’, ‘EHR’, or a ‘product’. Something that is going to improve your hospital’s performance and get you granular details of your patients in a strategic manner to improve your marketing, functionality or some other aspect of your existence.

Having assumed the previous, please allow me to also assume that you are struggling to use or implement it or use it to its fullest. You could categorize these struggles as problems. Hospitals that have successfully implemented EHRs would agree with me in considering a major portion of these problems to be excuses. This blog will help you identify if you are struggling with problems or excuses, and how your ‘habits’ can change it.

First and foremost, do decide if you want to go digital or not. Although as an organization, a hospital may choose to invest and implement a particular EHR tool, you as a ‘user’ must also align with their ideology. It is imperative that you also share their perspective, and they respect your ideas and suggestions.

Going digital in healthcare can mean anything from this spectrum and beyond:

1. To be ready for insurance and billing as per norms in your country.
2. To solely achieve compliance with government regulations.
3. To experiment a popular tool that other hospitals are using.
4. To market yourself better and use patients’ data for designing marketing endeavours.
5. To schedule and manage appointments.
6. To be able to share patient’s clinical details within and outside your organisation.
7. To be efficient in managing inventory, HR, etc.
8. To study your local population in terms of epidemiology and statistics for creating original research.
9. To utilise data from your organisation for research.
10. To predict disease patterns.
11. To allow for clinical research within your premises.
12. To showcase the results your hospital is achieving in a scientific manner, ready for publication.

While many physicians and hospital owners find the above mentioned points lucrative, they have a huge list of tangible and intangible excuses that become a barrier in this process. The most common excuses that consume a physician’s willpower in attempting to use a new EHR can be listed as the following:

1. I cannot type fast. Intra-appointment typing consumes a lot of my time!
2. I can type, but I don’t want to!
3. Intra-appointment typing compromises the doctor-patient rapport.
4. The EHR is difficult-to-use because it has too many fields and aspects.
5. I want to use it, but no one else wants to.
6. I wish there was voice controlled typing to make it a lot easier.
7. Patients visit my practice because they are seeking treatment! Not to see me type.
8. I do not see enough value in this endeavour. Nothing gets compromised if I do not record patient details in the tool.
9. I am comfortable recording patient details with pen and paper.
10. I do not have appropriate technology in place.

You may feel free to rationalize the existence of these problems in your organisation, but once you decide to open your mind and view the success so many hospitals around the world have achieved in adopting EHRs from scratch, you will definitely find a newer perspective to your problems. They are more ‘in the air’ than in reality. But still there are some problems. Most importantly, all problems have solutions. There is only one solution for physicians aligned to adopt a new EHR — Make new habits!

Adoption of a new tool for your hospital is in no way related to your clinical or surgical acumen, or even your knowledge. It is a simple task that you are expected to do and your next generation (most probably) will be compelled to do. Considering the future of healthcare, which is towards complete digitization, sooner or later you will have to learn this habit of documenting patient interaction in a systematic manner so that research, analytics, and reliable prediction models actually become a part of your everyday professional enthusiasm.

While there are many books intended to help you inculcate new habits and eradicate bad ones, I am referring to a recent publication by James Clear. I heard him discuss the concept of his book in “The Productivity Show” podcast by Asian Efficiency.

Atomic Habits: 4 Laws for Changing Your Identity w/ James Clear

When you repeat 1% slacked attitude each day, soon it accumulates into this huge behavioural problem, to the extent that adjusting to something new becomes impossible. On the contrary, if you decide for 1% improvement on a daily or weekly basis, you end up gaining this huge momentum that takes with it any new possibility or activity in its stride. Consider typing. If you decide to work on your typing skills on a weekly basis, you certainly can improve it. No doubt about it. And you know it!

The only question you will have after reading the previous paragraph would be — Why? Why should I? That is a personal question, to be honest. One thing is a common truth though —

Success is a product of daily habits — not once in a lifetime transformations.

If you are somebody who relates to the benefits of digitisation in healthcare as I mentioned earlier, you will find a reason that suits your needs. We need logic to go on. At times when ‘going on’ is important, it is reasonable to choose a ‘logic’ that suits you. While at that, you must also understand that your outcomes are a lagging measure of your current habits.

If today you decide to improve your habits, you will achieve success, but with some certain lag. This has been explained beautifully by James in the book:

“In the early and middle stages of any quest, there is often a Valley of Disappointment. You expect to make progress in a linear fashion and it is frustrating how ineffective changes can seem during the first days, weeks, and even months. It doesn’t feel like you are going anywhere. It is a hallmark of any compounding process: the most powerful outcomes are delayed.”

So what new habits are we actually talking about?

Improving typing skills.

Understanding and exploring your tool in depth.

Sharing your success and problems with your peers.

Maintaining direct communications with the tool provider.

Acknowledging the problems that your team faces, and attempting to find solutions.

Monthly meetings for sharing your progress.

Asking the right clinical questions based on your data.

Reading analytical reports at least once in a week.

James Clear further elaborates on the 4 laws of habits. Here is an interpretation of those laws as they apply to adoption of a Healthcare Knowledge System such as SmartHealth.AI.

1. Make it obvious — Let your doctors know that they are pivotal in making the implementation a success. Of course, a part of making it obvious is to make it mandatory, but if the tool does not interest the doctors, they end up taking the minimalistic approach and enter the minimum mandatory fields. This leads to incomplete records and leads to a partial failure. Only if the tool excites and supports doctors enough, will they use it. Making the same effort becomes obvious in our tool because it generates clinical insights, and keeps doctors excited about the act of capturing data, for there is data analysis at the end of the tunnel.
2. Make it attractive — The tool has to be attractive, in function, in design as well in terms of a Clinical Decision Support System. Clinically the tool has to represent the needs of the specialty of varied physicians. We have ensured that we make a basic framework to all hospitals and accept any and all customisations according to specialisations so that its doctors are not alienated by the structure, rather feel that they themselves have designed it.
3. Make it easy — What makes the act of capturing a patient’s data during consultation easy? Quick retrieval of suggestions based on individual doctor’s usage (AI and Machine Learning based), and ability to add favourites and have them a click away certainly makes it easy. But it is the motivation (that their efforts will reap benefits in terms of publication-ready data, CDSS, analytic reports, smart timelines, trending in lab insights and much more) that actually makes the task easy in their minds.
4. Make it satisfying — The moment we show a doctor his dashboard, which converts his patients’ data into meaningful charts ready for interpretation and publication, they find satisfaction. Considering that respective government regulations will soon encroach all hospitals and clinics, it will be a huge relief that your doctors are already aligned with those regulations. Far more exciting are the cross-correlations that show statistical associations between different aspects of the patient population.

The purpose of this blog was to address the first-time users adopting an Electronic Health Record (EHR). Physicians planning to shift to a new platform can use my next blog which I will publish the next week. Stay tuned.

The author is the GM Operations and Clinical Officer at SmartHealth.AI, a company dedicated to creating Healthcare Knowledge Intelligence Systems using AI and Deep Learning.

Please feel free to drop an e-mail to Dr Uday with feedback and suggestions at uday.singh@smarthealth.ai