- Healthcare organizations looking to dramatically improve their clinical and administrative processes through health IT use can choose one of two options: EHR optimization or EHR replacement.
Some healthcare organizations opt to invest in EHR replacements due to problems with inefficient clinical workflows, limited EHR functionality, or a lack of interoperability, according to a 2018 AHIMA’s Perspectives in Health Information Management study.
However, EHR replacements are expensive, time-consuming projects. Investing in a new, commercial EHR system can cost health systems millions.
To avoid the costs and disruptions associated with implementing an entirely new EHR system, many healthcare organizations instead focus their efforts on improving existing health IT by redesigning physician note templates, specializing clinical workflows, integrating new health IT tools into the EHR interface, and launching other EHR optimization activities.
When Florida-based Gastro Health needed a way to streamline clinical documentation and enable providers to spend more time interacting face-to-face with patients, the medical group teamed up with its EHR vendor to launch an EHR optimization project.
Gastro Health President James Leavitt, MD, recently spoke to EHRIntelligence.com about how the gastroenterologist medical group improved rates of provider satisfaction and reduced time spent on clinical documentation by significantly improving the usability of its eClinicalWorks EHR.
Gastro Health first made an effort to reduce the amount of time providers spend on clinical documentation in spring 2017 by implementing eClinicalWorks’ free-form dictation tool, Scribe.
“We went live in April, and that was just the implementation,” Leavitt told EHRIntelligence.com. “This is a multi-step process.”
The health IT tool leverages Dragon Medical Practice Edition 4 to allow providers to dictate patient narratives directly into their eClinicalWorks EHR systems.
“Some providers took to it right away,” said Leavitt. “Now we’re using Scribe to create templates so providers can not only fill out patient health histories, but other parts of documentation. We’re starting to build that out also.”
Gastro Health and eClinicalWorks formed an ECW Optimization Team to continuously build out Scribe and allow clinicians to utilize the dictation tool for a variety of different aspects of clinical documentation.
“It’s made up of our IT people, or health informatics managers, and a core group of physicians,” explained Leavitt. “We roll out new templates and show them to some docs. We get feedback from docs, and they tell us what parts of it they like.”
While Gastro Health and eClinicalWorks value clinician feedback, Leavitt said medical group executives also prioritized standardization when developing templates.
“We don’t let everyone just do their own thing,” clarified Leavitt. “Then it becomes unusable. It gets so big that it becomes cumbersome.”
“We have one template for colon cancer screening, for example,” Leavitt added. “Maybe nine doctors want nine different templates, but that doesn’t make sense. We try to develop the most common templates that are used the most first.”
Promoting health data standardization in clinical documentation can help streamline health data exchange and interoperability with other providers, hospitals, and health systems.
Enabling clinicians to use templates that require providers to enter information into standardized data fields also helps to ensure patient health records are complete and consistent.
For Gastro Health, standardizing data fields across templates has also proven to be a boon to clinical efficiency.
When using the dictation tool, clinicians can say key words indicating different data fields and dictate the information they’d like to enter into patient health records.
“We’ve standardized components of our health records, so the system knows to put information in the appropriate location within the note without me having to go in and use a mouse to click and click,” said Leavitt. “It’s much faster and much more intuitive to use.”
“You can say, ‘okay, history of present illness’, and then dictate that information,” Leavitt continued. “Or you can say physical exam, and it’ll go to that box in the EHR, and you can speak information directly into that box.”
Cutting down on the number of clicks per day for providers by adopting speech recognition-enabled health IT tools and standardizing health record templates is part of Gastro Health’s overall strategy to reduce administrative burden on providers.
While provider satisfaction with clinical documentation has improved significantly at Gastro Health over the past year, Leavitt emphasized that these improvements were gradual.
“What’s at the core of the EMR is workflow and content,” said Leavitt. “We’ve spent a lot of time developing our workflow and content components since we’ve gone live. And as we get used to the program, our providers are less stressed.”
Allowing providers time to get accustomed to new health IT tools and EHR configurations is key to realizing improvements in clinical efficiency, Leavitt said.
“Number one, some of the stress goes away from just perfecting the content and workflow so it fits what a gastroenterologist does,” said Leavitt. “Then, gaining familiarity with the program, where to click, and what to do reduces stress.”
“Finally, using Scribe, et cetera, is another way to reduce stress and burnout from EMR use,” Leavitt added.
At Gastro Health, keeping lines of communication open between IT leaders and eClinicalWorks has also been imperative to enabling more effective EHR optimization.
“Every other Friday, we have a meeting of the ECW optimization team,” said Leavitt. “There are regularly scheduled calls, and then there’s ad hoc stuff.”
“We need to keep up and understand what they’re doing now and in the future, so we have frequent conversations with them,” Leavitt continued. “We hope to drive their prioritization, too, by telling them what we think is important. We’ve had good conversations to address things we think should be improved in the future.”
Ultimately, Leavitt underscored the importance of selecting an EHR vendor that is dedicated to continuous improvement.
“There is no perfect EMR,” said Leavitt. “It's always a process. If anyone's EMR vendor says it's perfect, I don't want that one, because there won’t be improvement. It's an improvement process for us, and it should always be an improvement process for the EHR vendor.”