by Allison VanLue
Now that most health systems have implemented enterprise-wide electronic health records (EHRs), most are looking to tailor the EHR to better suit their business practices, clinical workflows, and staff needs. These improvement projects are often labeled ‘optimization’. One mistake I often see, is too much focus on what needs to change in the EHR rather than examining how the EHR works in conjunction with business processes.
The software is just one piece of the puzzle. The rest of the puzzle involves looking at factors such as the level of autonomy of individual departments in making EHR changes, device utilization, patient insights, and overall organizational structure. When using the term optimization, it should refer to how software configuration and operational processes can produce the most optimal outcome. Below are four questions you should ask yourself next time you are planning an optimization project to help you step away from this common trap.
Decentralize: Can you put optimization ownership in the hands of the experts?
When looking to improve department or specialty clinical workflows, delegate the optimization analysis and planning to the people who know the department best. Empower the clinicians who work in the department to identify what is not working and to be part of the solution. I recommend identifying at least one person per department to be a clinical EHR liaison. Call them what you will – provider innovation group happens to be my favorite label – but their role is to understand department workflows, staff frustrations, performance metrics, and the EHR, and to combine that knowledge to come up with suggested improvements. Pair the provider innovators with an EHR team member for optimal results. By pairing a clinical expert with an EHR expert, you will be able to couple changes in clinical practice with changes to the EHR to get more effective EHR optimization. Lastly, when I suggest one person per department, I am not only speaking about medical or surgical departments. Include therapists, specialty nurses, technicians, or care coordinators.
Can hardware or devices help?
In addition to identifying business or workflow inefficiencies, ensure your hardware and devices are working optimally with the EHR. If patient satisfaction surveys return complaints about wait times in the ED, put up large-screen monitors to display wait time information. If the EHR has increased clinic visit time due to data entry, use iPads in the waiting room for patients to complete medical history. If you are seeing a large amount of data being back-entered from inpatient wards, ensure there are enough mobile workstations for nurses to do their documentation in real-time or physicians have mobile devices to complete rounds. In each case of a proven inefficiency, figure out if investing in new hardware or devices is the correct solution to the problem.
Can you better leverage patient insights in optimization?
During each optimization project, you should be asking how you can engage patients more. What tools does your EHR have that transfer responsibility from staff to patient? Patients have both the desire and the expertise to contribute to their medical record and take ownership in managing their health. Consider creating a patient advisory board for your optimization projects. Ask patients directly what level of engagement they desire in their care and how they want to interact with the EHR online or with mobile devices. As you transfer more responsibility to the patient, you’ll see patient care outcomes and staff happiness improve.
Centralize: Is there an organization-wide change that makes sense?
EHRs enable health systems to standardize workflows across the organization and to take advantage of resource sharing through centralized services. These centralized services include call centers, central scheduling, telehealth centers, and care coordinators. I worked with one organization where years after implementing the EHR they saw significant inefficiencies and errors in their outpatient scheduling processes. We recommended the consolidation of 20+ specialty scheduling desks into a centralized scheduling center. This organizational change required significant planning and change management but allowed them to quickly realize the benefits of resource sharing. When coupling this large organizational change with the correct EHR tools, you streamline workflows and reduce errors for both staff and patients.
While planning your next optimization project, consider these four simple questions to improve the effectiveness of EHR optimization. If you would like to discuss how Divurgent can help you pair EHR and operational optimization, please reach out.
