Working with software might not be the first thing that comes to mind when a physician thinks about coming out of retirement, but it will likely be a part of what they'll be asked to do.
As the number of patients diagnosed with the novel coronavirus surges across the country, retired doctors are being called on to return to the healthcare system. It's a big ask that requires taking on clinical tasks and brushing up on day-to-day minutiae—like documenting in the electronic health record.
"If they're not familiar with an electronic health record, that's going to be a learning curve," said Tammy Combs, a director of health information management practice excellence at the American Health Information Management Association.
Northwell Health in New Hyde Park, N.Y., has already had a "small number" of physicians come out of retirement to support its COVID-19 response, said Joseph Moscola, the system's chief people officer. Some have been assigned to the system's hospitals and others are staffing call centers to triage patients to other sites as capacity changes.
Moscola said retirees receive an orientation within the service line they'll be in, which would include going over how they'll be interacting with Northwell's EHR, a system from Allscripts Healthcare Solutions. For those who need more support, Northwell also has video tutorials it can share with retirees, meant to serve as a refresher on how to navigate the EHR.
A core part of the process is pairing retirees with a practicing physician in the same service line who can go over processes that might have changed, set expectations and serve as a point of contact.
It's "more of a buddy system, where people know who they have available to them," Moscola said.
New York was one of the earliest states to call on retired workers to support healthcare organizations facing staffing shortages due to COVID-19, with Gov. Andrew Cuomo asking recent retirees to sign up to volunteer as "reserve staff." Governors in Illinois and Colorado have made similar calls to action.
At the national level, the Veterans Affairs Department is also urging retired health workers to consider rejoining the system to bolster medical staffs in the wake of the pandemic.
Many recent retirees will have used an EHR before—the technology is used by most acute-care hospitals and office-based physicians—but they might not be familiar with the specific version in use at a facility.
In 2019, just over half of the acute-care hospital market used an EHR from either Epic Systems Corp. or Cerner Corp., according to a report from KLAS Research, with about a half dozen other companies making up most of the remainder.
"EHRs are far more ubiquitous than they were three or four years ago," said Dr. George Reynolds, a clinical informatics executive adviser at the College of Healthcare Information Management Executives and a retired healthcare chief information officer. "Somebody who's two years out, they can use an EHR—they're not that far out of the game, and they'll catch on real fast."
But even EHR systems from the same company can contain differences, based on customizations by the healthcare organization or updates made to the software.
Hospitals should prepare an orientation for retirees to get up-to-speed on their EHR version, including not only how to maneuver the software, but also what to document, said Combs from AHIMA. That could be different than what they're familiar with, particularly if working with COVID-19 cases, where they need to include whether a patient is suspected or confirmed, and what their exposure was.
Combs cautioned not to "throw too much at a provider."
"Be very careful to not build up this big administrative burden … they have to have time to take care of the patient," she said. "What are the key elements we need to capture? Make sure providers understand this is what we really need included in the documentation."
NYC Health & Hospitals has been reaching out to retired physicians, nurses and respiratory therapists who have recently retired from the system for support. Aside from calling on retired health workers, the New York City-based system's already brought on more 500 supplemental staff, too.
Kim Mendez, chief health informatics officer at NYC Health & Hospitals, said she's mindful that clinicians, "particularly those who have not been in active service for quite some time," could vary in their ability to quickly get acquainted with the EHR and other computer systems.
Even recent retirees could need training. NYC Health & Hospitals last month completed a multi-year rollout of a new EHR system from Epic Systems Corp., which replaced a patchwork of disparate EHRs across the system's 11 acute-care hospitals and dozens of ambulatory sites.
To train clinicians on how to use its EHR, staff at NYC Health & Hospitals host about five online classes a day, mainly focused on functions needed to document care in emergency departments and intensive care units. The classes are live—not pre-recorded—so that clinicians have an opportunity to send in questions during the session.
The online classes are designed to replace in-person trainings that NYC Health & Hospitals would have used prior to the COVID-19 outbreak.
"We're aware of social distancing," Mendez said. "We no longer have 30 or 40 people in a classroom."
