- Clinical efficiency and provider satisfaction often suffer after hospitals and health systems go live with new EHR implementations.
Disruptions to clinicians’ daily routines can sour providers and administrators against EHR technology and overshadow the potential benefits of new systems.
Launching an EHR optimization project after implementation can help to restore clinical efficiency, improve physician satisfaction, and reduce administrative burden on providers. Effective EHR optimization activities can also save healthcare organizations from investing in costly, time-consuming EHR replacements by resolving persistent problems with usability.
To be effective, EHR optimization activities need to be geared toward helping providers spend less time interacting with EHR systems — not more. Low-value alerts and nonessential health IT modules that add clicks for providers without offering much benefit to users or patients can further frustrate clinicians.
With the following five EHR optimization activities, healthcare organizations can boost the usability and effectiveness of their existing EHR systems and get more out of health IT investments.
Reduce Information Overload in Physician Notes
Healthcare stakeholders and health IT developers are working steadily to give clinicians access to more and more health data and clinical decision support at the point of care. But how much information is too much?
Information overload can overwhelm clinicians and negatively effect efficiency by requiring that providers spend time sifting through large quantities of clinical data to find the specific information they need.
Redesigning EHR note templates to display less data to clinicians may help to cut through the clutter and reduce information overload.
A 2017 JABFM study by Beldon et al. found collapsible EHR note designs that temporarily hide portions of physician notes may have a positive impact on clinical efficiency.
Researchers in the study devised four physician note designs and tested the designs on 16 primary care physicians. Study participants were prompted to locate key information in EHR notes while completing timed tasks.
Physicians also gave each note a usability rating and new feature preference rating. Ultimately, the collapsible note design that displayed assessment, plan, subjective, and objective (APSO) information to patients received the highest usability rating. Physicians also performed tasks faster and with greater accuracy when using the new collapsible note design.
“Users strongly endorsed all the new note features incorporated into the new note prototypes,” stated researchers. “Previously expressed concerns about temporarily hiding parts of the note (using the accordion display design pattern) were allayed.”
Researchers also suggested using colored and bold text to highlight abnormal information as ways to further optimize EHR note design for maximum clinical efficiency.
Incorporating new EHR note designs into commercial EHR systems can help to improve EHR usability without requiring that physicians learn to use additional health IT tools.
Specialize Clinical Workflows
Some EHR vendors are willing to work with healthcare organizations to specialize clinical workflows to meet the unique needs of certain specialties, care settings, hospitals, and health systems.
Specializing clinical workflows to prominently display the information or functionality most commonly used by providers part of certain specialties or care settings can help users more easily navigate EHRs.
When Pennsylvania-based Uniontown Hospital integrated a new health IT tool into their existing Cerner EHR, the hospital’s IT team worked directly with Cerner to specialize clinical workflows as part of an optimization project.
The team created four specialized workflows to save time for clinicians across specialties and ensure the new tool was a boon rather than a hindrance to clinical efficiency.
The IT team invited clinicians to assist with workflow design to ensure all changes met providers’ needs for improved user satisfaction.
“We divided physicians into four specialty groups, and we brought in physician champions for each specialty,” Uniontown Clinical Informatics Integration Analyst Jennifer Abraham told EHRIntelligence.com.
“These physician champions were the drivers,” she continued. “They were the voice of that group of doctors. They gave us input and designed their own systems. We very much took the approach that this was their system, and we’re just helping them build it.”
Uniontown developed workflows for inpatient medicine, surgery, cardiology, and pediatric care.
“Whenever the physician logged in — say the physician was a surgeon. They would have their specific labs,” said Abraham. “The workflow is specific to what each department needs.”
The team at Uniontown plans to extend this EHR optimization activity to include other specialties in the future.
Creating individualized workflows that are representative of the needs of specific clinicians allows providers to quickly access relevant information in patient EHRs.
Adopt Health IT Tools That Improve Usability
Integrating new health IT tools and modules into commercial EHR systems can improve clinical processes and care delivery. But adding functionality providers will need to learn and utilize in day-to-day operations can also augment administrative burden and divert attention away from patients.
Prioritizing usability when selecting and implementing a new health IT tool is critical for healthcare organizations looking to yield clinical efficiency improvements.
When Vanderbilt University Medical Center (VUMC) needed a new way to streamline care coordination and provider communication, the academic health system selected an Epic EHR-integrated tool clinicians could easily access through their phones.
VUMC implemented Mobile Heartbeat’s MH-CURE platform to give providers a way to relay admission, discharge, and transfer (ADT) information and close the communication loop between providers.
The solution also included a provider directory to give clinicians insight into what different care teams are doing, which patients they are caring for, and what their availability looks like.
“Providers can communicate with the appropriate colleagues — such as specialists or pharmacists or case mangers — very quickly, and without having to leave the patient’s bedside, or go search for that information at the nursing unit or in the EHR,” Mobile Heartbeat Vice President Jamie Brasseal told EHRIntelligence.com.
Selecting a health IT solution that providers can access through their phones rather than through the desktop EHR system accommodates the needs of mobile care teams. Providers can use the tool when they are bedside with patients.
The Mobile Heartbeat platform also integrates with Epic apps including Epic Rover and Epic Haiku. Users can access these apps within Mobile Heartbeat and avoid the administrative burden of multiple log-ins.
Health IT tools that require minimal log-ins and are easily accessible for providers on the go can help to boost care coordination and usability.
Involve Nurse Informaticists in EHR Optimization
To ensure EHR optimization projects accurately address providers’ usability needs, healthcare organizations should consider inviting nurse informaticists to make system adjustments.
Nurse informaticists serve a dual role as both EHR system users and experts in technical design and data analytics. They are uniquely positioned to optimize EHR systems for quality and workflow improvements that cater to the needs of clinical staff.
“Nursing informaticists transform the usability of health IT systems in their facilities and practices,” ONC Chief Nursing Officer Rebecca Freeman, PhD, RN, said in a 2017 blog post on HealthITBuzz.
“Trained with a diverse set of tools to expertly triage and correct any system, workflow, training, and accountability issues, they lead the partnerships between their frontline clinicians, super users (i.e., bedside clinicians who receive additional health IT training), and IT clinical analysts and builders,” wrote Freeman.
Nurses can triage EHR usability problems that center on number of clicks, time inefficiencies, and data display.
“When called to address an issue with health IT, one must first triage the problem and determine if there is a true break/fix situation at hand (e.g., a button that doesn’t work or an order that displays incorrectly),” wrote Freeman. “I am certain I will not surprise any clinical informatics professionals when I say that most issues are not break/fix and won’t be addressed by tweaking a setting or a bit of code.”
Involving nurse informaticists in EHR optimization projects can help healthcare organizations keep clinicians needs at the forefront.
Integrate PDMP data into EHR systems
Offering providers direct access to external databases such as prescription drug monitoring programs (PDMPs) through EHR-integrated links can reduce the number of log-ins for providers and streamline health data viewing.
PDMPs provide clinicians with complete patient prescription drug histories to help prescribers more easily identify patients who may be visiting multiple doctors for several prescriptions.
It is increasingly important that providers can easily access PDMP data as federal entities push healthcare organizations to query PDMPs prior to prescribing in an effort to curb the opioid crisis.
While PDMP queries can help to promote safer prescribing practices, healthcare organizations without EHR-integrated access to state-run PDMP databases must spend additional time logging into and out of different systems to access the information they need.
According to a 2018 JAMA Surgery study, these extra steps can add an average of 7 minutes in administrative burden per patient for providers prescribing opioids for elective surgery.
Researchers observed Dartmouth-Hitchcock providers who had access to a PDMP link through a hyperlink embedded in their EHR system. The hyperlink led users to an external website, which required a separate log-in and password. These extra clicks added up to slow clinical efficiency and delay prescribing.
“An additional median time of 6 minutes (range, 4-15 minutes) was required to complete our institutional informed consent process,” stated researchers. “Together, these additional mandatory requirements for prescribing opioid medication to patients who underwent surgical procedures took 13 minutes for each patient.”
Implementing EHR-integrated PDMP access into provider systems that do not require additional logins can help to streamline PDMP queries.
Overall, cutting down on the amount of time providers spend logging into or out of different systems, searching through patient EHRs for specific data, and interacting with EHR systems can help to boost clinical efficiency and reduce provider frustrations with EHR technology.