AUG 7, 2013 10:33pm ET

Simple Steps to Reduce EHR Clicks

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Mastering electronic health record technology is a difficult process and it demands an ongoing commitment from ambulatory practices and their EHR users. No matter how few ‘clicks’ it takes providers to prescribe a medication, review lab results, or document a visit in their EHR system, most think it is too many.

Many ambulatory practices become complacent and feel resigned to accept their EHR system after the ‘go-live’ phase. They fail to develop an ongoing process to refine and optimize the system to better suit their evolving patterns of use. This static approach often leads to frustration, complaints, and a feeling that users have to cater to the system’s needs.

The reality can be quite the opposite. Frustrated providers who invest the time and energy to better understand the advanced capabilities and opportunities for ongoing software customization will see benefits in increased efficiency and streamlined workflows, all of which can contribute to productivity gains and improved profitability.

Providers often feel helpless, constrained by their EHR technology and dependent on programmers to make improvements. While most major changes do require vendor intervention, there are some relatively simple steps providers can take to ensure they maximize efficiency and reduce clicks.

* Update Administrative Settings

Independent ambulatory practices often retain significant administrative control of their EHR system. This enables practices to review all the available settings in the administrative area to confirm they are set to maximize operational efficiency. Once they are more familiar with the EHR system and its associated workflows, providers usually discover that the initial go-live settings no longer meet their needs. Vendors also regularly enhance the options via software updates, providing new administrative settings that could improve a specific workflow. For instance:

o Most EHRs allow users to select defaults for specific fields, eliminating the need to pick an option each time.

o Administrative settings often allow users to re-order items on various screens such as the patient summary or vitals sign input screen. Selecting the correct layout could eliminate the need to scroll to critical fields or information.

o There may be options to eliminate certain pop-ups, such as confirmation screens, which can become unnecessary speed bumps for seasoned users.

* Creative System Configuration

Critical pain points may not be identified until months after go-live. EHR workflows can be very different than their paper-based counterparts. Reviewing the system-build periodically may yield creative timesaving revisions. Consider these approaches:

o Develop logical ways to order pick-lists to allow the most commonly selected items to appear at the top. In many systems, placing a character, like an asterisk or dash, in front of an item may move it to the top of the list, though it might not read as well. Forcing common items to the top of the list can eliminate the need to scroll (one less click), which can lead to compelling efficiency gains over time.  

o Review the layout and end-user appearance of all forms to identify opportunities for improvement. For example, enter dummy diagnosis codes on the bottom of the encounter form so that the real codes all appear on the top part of the form. This can eliminate scrolling and one potential click per patient.

o Research the availability of user-defined or custom fields. If users are forced to navigate through to a distant screen to enter or view a common piece of information, there is likely to be a more accessible user-defined or custom field available that could be used instead.

* Implement Additional EHR Features

During initial EHR system training, most practices and users are only able to grasp the basics. Six to twelve months after going live, most users are ready to creatively evaluate and implement more advanced features. Consider, for instance, how a template, flow sheet, or order-set feature could save clicks. Look for system features that reduce the need to type the same standard phrases repeatedly, and it will likely unlock new time and cost efficiencies.

* Schedule Regular Training

Ongoing training is an integral part of system and workflow optimization. Many EHR system contracts come with free training resources, including webinars, live chat sessions, recorded videos, or customer service calls. Use them!  Consider these tips to maximize training time:

o Pre-schedule an hour a week or every other week to have a call with the vendor. Support staff in setting aside training time as well.

o Keep a running list of questions to be prepared with specific topics to discuss during training sessions.

o Write down the name of any good service representative and try to schedule direct sessions with them in the future.

o Ask the representative to get creative or to problem solve. Explain the big picture goal or problem and then brainstorm.

o Ask to have the vendor demonstrate popular new features or options.

o Software updates are a regular occurrence; don’t take any answer as final. Ask again in a few months or try a different representative to get a better or more complete answer.

In Conclusion

To improve efficiency and overall satisfaction with an EHR system, ambulatory practices should focus on where they have control and actively work to make custom improvements to their software. Even small changes can have a big impact over time. EHR users should also regularly communicate with their vendors about larger system problems in order to set expectations for improved solutions in future software updates.

Katherine Redmond is a consultant at Freed Associates in Kensington, Calif.

Comments (2)
Although your article provides excellent suggestions from the perspective of speeding up care, it fails to recognize that uncontrolled speed has uncontrolled dangers, and speed is NOT the same concept as efficiency (which is performing all tasks OPTIMALLY without undue waste of effort. EHRs have successfully depersonalized most patient-physician interactions. The required clicks in a well-designed system SHOULD prompt physician/clinician engagement and thinking about each patient's individualized concerns. By reducing clicks, systems disengage the clinician's active thinking about their patient (the medical diagnostic process). Analysis indicates that reducing functions to a single click moves automated information from one portion of the software program directly to another, without significant involvement of active understanding or thinking. After a week or two, the clinician will know only what buttons to click to achieve speed, with almost no awareness of what information is being moved around. This also creates "cloned" documentation, which CMS and Medicare Administrative Contractors have identified as failing to support Medical Necessity and therefore failing to support claims for medical services. Audited medical practices have paid fines in excess of $175,000 per physician for claims based on this type of EHR documentation. In other words, "automation is not documentation." Further, as observed by Peter Drucker, the noted management consultant, educator, and author, "Nothing is less productive than to make more efficient that which should not be done in the first place." There is a productive place for clicks, and even for certain selective (and currently improperly used) macros in medical records, but eliminating physician engagement in patient care by speeding up the care and documentation processes is disruptive to quality care, disruptive to quality documentation, and disruptive to goals for individualized patient care.
Posted by Stephen L | Friday, August 23 2013 at 12:01PM ET
There is a way that physicians can totally eliminate the need for them to click...or to spend any time at all on EHR documentation. It's by deploying a remote scribe. Their productivity (and net income) increases, and medicine is a joy to practice again. This approach is outlined in an article at http://www.fortherecordmag.com/archives/0913bonusp6.shtml
Posted by Joe W | Saturday, September 28 2013 at 9:08AM ET
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