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.
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.
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