The Five Stages of Grief in EHR Adoption for Physicians

Dr. Elisabeth Kübler-Ross wrote about the five stages of grief in her 1969 book, On Death and Dying. These stages are predictable and well accepted for processing grief of many kinds, be it the death of a loved one, the end of a marriage, or the loss of a job. So how are these emotions displayed when a physician is faced with the adoption of an Electronic Health Record (EHR)?

Denial - "This movement towards electronic medical records may be happening in the large hospitals in other cities, but it will never happen in my hospital!"

Anger - "Administration did WHAT??? I can't believe we have a new system. I'm NOT using it!"

Bargaining -"Well, I'll just go practice somewhere else then." Or maybe it isn't feasible to go somewhere else in which case the bargaining stage may sound more like, "If you absolutely make me, I'll do my orders electronically, but I'm going to keep dictating my consults and my operative notes. I'm only going to do the bare minimum electronically."

Depression - "This is really going to suck!" "Medicine just isn't what it used to be."

Acceptance - "Fine. I'll use it but that doesn't mean I like it."

While the Health Information Technology for Economic and Clinical Health (HITECH) Act is known for its mandate of EHR adoption, its bigger goal is improved patient outcomes through better documentation. I would suggest that physicians who are using a system in the Acceptance stage are not necessarily going to improve patient outcomes as is the hope of the government with this Act.

So how do we bridge the gap from mere acceptance of electronic documentation to better patient outcomes? While we can certainly hope and wish that our physicians would make the changes necessary simply for the sake of better patient outcomes, when it comes to such a drastic change in their workflow and "how it's always been done", they need more of an incentive. As with many things in life, it comes down to WIIFM (What's In It For Me).

As a physician, have you ever

• Had a patient who has been in your hospital before, whose old records would be very helpful in your decision making, but Medical Records cannot locate the old chart?
• Consulted another physician for help on your patient but the dictated report isn't available until Transcription puts it into the chart 24 hours later?
• Had to spend hours in the Medical Records department with a stack of charts that need signatures?
• Received a phone call regarding your patient while you were in your office or at home and you had to rely on someone else to look at the chart and decipher the handwritten notes and orders?

These are just a few ways the Electronic Health Record will be helpful to a physician, but to really get the most out of an EHR system, it's important to realize it is not simply a recreation of the paper chart in a digitized form. It is a dynamic, ever-changing record. And what we can retrieve and get from the system is only as good as what the user puts into the system. When physicians can see the WIIFM, they will begin to use the system differently, inputting more useful information. Only then will they be able to move from the Acceptance stage to the Improved Patient Outcome stage. That's when we will have actually achieved meaningful use with electronic health records.