- Most healthcare organizations can expect some slowdowns in clinical efficiency as providers and administrators acclimate to the changes that accompany new EHR system implementations or EHR optimization efforts.
While these upgrades help to streamline EHR use in the long-term, providers often run into snags immediately following the changes.
But a dedicated IT services department can help healthcare organizations resolve problems as they arise and ensure EHR upgrades and optimization efforts run smoothly.
New Hampshire-based Dartmouth-Hitchcock Medical Center (DHMC) first went live with its Epic EHR implementation in 2011. The academic medical center completed its most recent system upgrade in early October.
Along with the EHR system changes, DHMC also invested in bulking up its IT support team with a new IT service management platform to ensure clinicians and administrators had the specialty support necessary to navigate the more than 20 applications built into the medical center’s Epic EHR.
DHMC Director of Information Systems Bill Weyrick and his team leveraged the IT service management platform to address trouble tickets submitted after the upgrade went live.
“Since we went live on Sunday, there were 509 incidents that were created all related to the upgrade, and 356 that've already been resolved,” Weyrick told EHRIntelligence.com on October 15. “The providers have recorded what they would like or need in the Epic 2018 configuration.”
In addition to changes associated with the 2018 Epic upgrade, the IT services team is also working through 1,000 trouble tickets and 1,400 active change requests submitted before the upgrade went live.
DHMC uses an Epic EHR-integrated Cherwell platform to address trouble tickets as they crop up.
“We created a dashboard so we can see everything that’s Epic related,” explained Weyrick. “Epic is very prescriptive in its processes.”
The IT services dashboard is divided into five task-based categories: incident, problem, change, release, and management.
“If something is broken, that would be considered an incident,” Weyrick said. “If two things are broken the same way, then we have something systemic going on and that's escalated into a problem.”
Sorting incidents under the larger umbrellas of problems helps the IT services team identify the root issues that may be causing incidents for several providers in different departments or care settings across the medical center.
“Management is all about the tracking and closing of the specific incidents,” said Weyrick. “Problem management is identifying the cause, identifying a workaround, and escalating the fix to the change management process.”
“As the fix is then escalated to a change for approval, we schedule for the release, identify backup, and identify a communication plan for once the change is released,” he added.
The IT team notifies all affected care teams once a problem has been resolved. The team then documents workarounds and completes a root cause analysis after resolving systemic problems to ensure users have the tools necessary to address the problem in the future.
Prioritization for effective IT services management
In addition to trouble tickets, the team also has a dashboard to facilitate change requests. Trouble tickets and change requests can be sorted by priority to indicate which tasks the team should focus on first.
“A lot of these changes are high-impact,” said Weyrick. “Enhance efficiency. Add physical therapy processing in documentation. Order tools. They’re workflow-specific.”
A prioritization algorithm built into the dashboard allows users to flag particularly pressing incidents and requests.
“The algorithm is a little bit different for changes versus tickets,” clarified Weyrick. “For changes, the system allows the person entering it to make the determination, as well as the analyst that is working on it and the team.
“One of the biggest values of this dashboard is that it allows so many of the operational versus technical people to get access to what's going on in the environment, and contribute to the prioritization.”
Members of the medical center’s operational or IT support teams can identify the urgency and impact of the change, as well as whether a change will affect the medical center on a departmental or individual level.
“That is very similar to but not identical to the prioritization that we use for problems and incidents,” said Weyrick.
Clinicians can also submit requests for new features or EHR system customizations they would like to see implemented into their clinical workflows, such as improved integration.
“With our dashboard, it’s easy to just escalate through the process with the clinician’s documentation,” said Weyrick. “They say, ‘This is what my problem is. This is what I want.’ And we can then create a change from that request or that incident.”
“That way, the change request attaches the original incident based on who on the team took it, and everything just attaches that to the change request or that problem,” he continued. “You have full tracking of the whole history of that request, right down to the initial call.”
Increasing documentation to boost EHR usability
While allowing providers to document problems for the IT team helps to streamline and improve the process of resolving changes and trouble tickets, it can add administrative burden to the provider workday in the short-term.
EHR optimization can also increase administrative burden as providers are required to complete more thorough clinical documentation.
“Anytime you want to mature your processes, it requires more documentation and more field definition,” Weyrick said. “It’s that additional work that tends to be the obstacle in general with the EHR, just like it is with other major systems.”
“We want to mature, we need better and more documentation, and that's work,” he added.
Enabling improvements in clinical efficiency and EHR usability also means more work on the IT side.
“Epic focuses on reducing the number of clicks for providers and being user-friendly on the provider side,” said Weyrick. “As a result, it’s extremely complicated on the technical side.”
“If you want to reduce the number of clicks, you need to make decisions in advance and bake them into the application or system,” he added. “By doing that, you make it more complicated.”
Implementing an efficient IT services management platform is crucial for allowing the IT team to address complex system problems in the back-end, said Weyrick.
“It lets us crack all of those complicated relationships accurately and address any problems that people have with their specific workflows,” he said. “We have all the information in one place.”
For other health systems looking to improve EHR usability and problem management, Weyrick recommends investing in an IT services management tool that offers built-in Information Technology Infrastructure Library (ITIL) best practices.
“I’m a real fan of ITIL best practices,” said Weyrick. “Having a tool that can be flexible enough to include all of those best practices will save time in the long run. But it will be more work upfront.”
Ensuring providers and IT teams thoroughly document any incidents, requests, and fixes is also imperative to improving efficiency during EHR optimization or upgrades.
“If you want to be robust and agile, you need to have the whole configuration documented well so that when you do have a problem or a change request, you know exactly what you need to change to optimize the system.”
“It does take a lot of documentation, but that's what will make you more agile and reliable for the end-users,” he concluded.