Physician Assistants Are Ideal Leaders for EHR Implementation (Part II)

In part one of this blog, Peter Igneri explained his own experience as a physician assistant taking a leading role in his health system’s EHR implementation. This week, he explains why a PA might be the right person to help your office conduct the same exercise.

So why might you look for a physician assistant in your organization to help with your EHR planning? One of the best reasons is that a PA is neither nurse nor doctor. Nurses and doctors can have a love-hate relationship. Pushing their influence too far in either direction is probably not healthy for your organization. It is one of the most difficult jobs to balance the needs of these two large groups. Balancing their sometimes equally important but at times conflicting viewpoints is something that a PA does all day, every day. To know the needs of both groups and speak the language of both is something I find myself doing every day.

There are also financial impacts. One obstacle facing hospitals and clinics is the need to have a robust product built using direct clinic input from the providers. At the same time almost all EHR companies will tell you that in order to facilitate adoption you must cut back on clinic schedules at the time of implementations. Physicians are also called upon to give up their time to assist with design and validation activities. Administrators often have no problem in an academic center to add this to the pile on the plate of most physicians. Why burn out your doctors and take the financial hit by paying them at a much higher rate for the non-productive time in the pre-go live phase when you can utilize their trusted PA colleagues? An average PA in the U.S. makes between $80,000 and $100,000 a year. Compare this to physicians who across specialties start above $100,000 with some reaching into the $600,000 mark depending on training and experience. So it is clear that using a PA for their clinical knowledge is going to cost you less than a physician.

There are places where it may be more cost effective than your nursing costs too. In areas of the country that are traditionally low paying for physicians, the nursing shortage has seen salaries of the nursing staff go above that of mid-level providers. In these locations it can be more cost effective to use a PA than a nurse for a clinical informaticist in your organization.

Around 18 months ago, I joined the team at my organization. During that time I have learned the culture and methods of our information systems/technology group. I have seen the change reaction occur around me. I have witnessed frustrated physicians and nurse come to tears or tantrums. For me, their context was real. I was able to see the ones with true concerns about their ability to provide the care they desired and the ones that just feared change for change sake.

All in all it has been an amazing experience to see the evolution of EHR implementation. The working knowledge of what the clinicians were thinking and feeling allowed me to put myself in a position to imagine what they needed to do their job. It was incredible motivation to learn the EHR product we were using and ensure that it was built in a way that minimized redundancy and found the simplest solution for work flows. I experienced some pitfalls in this process. By no means was my project flawless. I can tell you that the external consultants and the software vendor were impressed with the outcomes. When those that you have come to trust for their advice and guidance tell you the outcomes were great, I have to give them some credence.

I attribute much of my success on the skills I learned as a PA. To be able to speak the languages of those who were most fearful of the EHR and make it more translatable is something that some have a hard time doing. Information systems/technology employees often have no concept of the pragmatic needs of the clinic. Joining the technical and operational needs of patient care is a job a PA can tackle. Bring a PA to the team and you can often find someone that can translate for all of the team.

Clinically a physician assistant in family medicine and now trauma and burn surgery, Peter Igneri now works for both in the Simulation Center at University of Vermont’s College of Medicine. He is also the former medical director of a family physician office, president of the PA Academy of Vermont, and sometimes consultant in the area of EHR and PA utilization.