Use & Optimization News

Optimizing Clinical Workflows to Ensure Effective EHR Use

EHR technology provides a means of better documenting care as well as a means of identifying areas where providers can improve their EHR use and clinical workflows.

Clinical Workflows

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Sponsored by Nuance

- Healthcare organizations have extensive amounts of data from their current EHRs and other technologies. But how can analysis of the data provide insights into opportunities for improved utilization and help them realize the value they expected? Access to the data is only the first step. Knowing how to analyze the data to develop and execute action plans is where healthcare organizations struggle.

Proper analysis of data from core technologies in use is often the key to identifying gaps and inefficiencies. Understanding the data provides the foundation for impactful action plans and maximizes the outcomes. However, executing action plans in a targeted manner requires dedicated effort and focus by resources skilled in the EHR and other technology as well as clinical workflows.

EHRs were designed as a “one-size fits all.” However, each specialty and care team member has a different workflow that requires not only inputting patient information but also being able to retrieve information from the patient’s record. Being able to input and retrieve data remains an area where care team members struggle when using the EHR. Many have questioned whether the technology is a problem rather than a solution to clinical productivity.

Health systems, hospitals, and physician groups realize the importance of aligning the use of the EHR in a way that supports the care teams’ delivery of patient care. Optimizing clinical workflows, advancing the use of all the EHR can offer, and proper enablement of care team members are at the core of how to build competency and proficiency in the use of the EHR. Organizations are looking for ways to help their care teams utilize the technology, without impacting the quality of care. When organizations realize an optimized state, they are better able to derive value from technology investments, particularly the EHR system.

Over the past few years, Rizwan Pasha, MD, has helped organizations with Epic EHR implementations and optimizations in his role as Chief Medical Information Officer for the healthcare division of Nuance Communications, Inc. According to Pasha, educating clinical users about the new workflow and integrating technology to make a seamless experience are the toughest parts of the job.

“We start with an actual workflow that providers need to care for their patients and identify impediments,” Pasha explains. “Analytics help us identify where we can improve the physician workflow. We then redesign those workflows and retrain the physicians.”

Finding the root cause of EHR-related inefficiencies is not a simple task. Analysis of data available from all extant solutions requires rigor and thoroughness and the ability to translate the data into corrective action plans.

“Quite a few reports are available that help you identify current EHR usage, but they don't always reflect the complexity of the work being done,” says Pasha. “Maybe you have a complex patient that does deserve more time in orders. Spending more time in orders does not necessarily mean that you are inefficient as a provider. You have to take all of that reporting, understand the context, and apply some common sense.”

At Nuance, they are advancing the use of the EHR and technology such as speech recognition with data analysis from key solutions and an assessment of clinical workflows. These two steps create the story of physician skillsets, and how well the technology is integrated seamlessly into the clinical workflows. By utilizing the depth of knowledge of the technology and clinical workflow experience, the holistic assessment drives targeted approach to improvements in the workflow or an enablement approach or both

According to Pasha, making updates to the build of the EHR and retraining hold the key to building good habits for clinical documentation in the EHR system, which leads to efficiency.

“A crucial step in the process of EHR adoption is enabling physicians both an optimized workflow and the skills needed to maximize the benefits of technology. An optimized workflow that saves clicks and time provides value to physicians. However, many times we see organizations not revisiting physicians a week after initial enablement to see how they're doing and reemphasizing some of those tools,” he argues.

“One-on-one retraining of the physicians for approximately one hour is more than enough,” Pasha continues. “Retraining ranges from spending time with physicians and understanding the complex situations they face to showing them a more optimized workflow and pointing out the tips, tricks, and tools that they may not remember.”

Practice makes perfect; repetition turns competency to proficiency. Regular education will enable providers to adapt to future changes with greater ease and confidence.

“Enabling a physician with EHR and speech recognition, for example, is not a once and done activity. There are always regulatory changes coming; there are always changes coming to the workflow. Enablement must be a continual process that gets revisited and touched on periodically,” Pasha adds.

Down the road, Pasha foresees EHR technology playing a teaching role itself. It stands to reason that a learning health system would be built on intelligent health IT systems.

“We're going to see more and more use of artificial intelligence or ambient clinical intelligence within the EHRs to provide not only clinical decision support but also but insight into efficiency,” he predicts. “I hope that tools will be smart enough to recommend a slightly different workflow or shortcuts based on what a user is doing within the patient record.”

An actual smart system does not yet exist, but the concept illustrates the importance of enabling care team members and supporting them as technology advances. Providers receiving proper education and support develop familiarity with EHR technology that keeps the focus on patient care.

Healthcare organizations have committed millions of dollars to EHR technology over the past decade. While the push to purchase new systems has mostly subsided, providers are searching for opportunities to make these tools an enabler of future innovation. By ensuring that the technology is instrumental in the hands of providers, these organizations can achieve that goal.