The ongoing transformation in terms of competition, consolidations, and disinvestments necessitate a prompt, short implementation process for electronic health record (EHR) systems to adjust accordingly.
This is a difficult task, yet it offers various possibilities for perfecting electronic health records, chances to perfect their operational systems for superior medical quality and economic savings.
In this case, the phrase “optimization” usually implies various types of advancement after the launch of a product or service. EHR optimization should have its own designated approach, which is unrelated to the everyday tasks like system advancements, system servicing, and platform upkeep.
The goal of EHR optimization should be treated as a continuous process of improvement, with the intent of getting the greatest possible reward out of an organization’s EHR expense.
These are the optimal techniques and advice for optimizing Electronic Health Records to guarantee that healthcare providers are receiving the precise healthcare data services they demand.
Optimizing the Electronic Health Record: Strategies and Approaches to Address Well-Being
Thankfully, there are interventions that can help address the burnout that clinicians experience due to the use of electronic health records. Certain techniques can be employed right away, and others can be used at a later point–the closeness of the approach to being put into action is pointed out beneath the name of the activity in each of the subsequent sections.
First, Know What Optimization Means
Dan Kinsella, managing director at Deloitte in the healthcare and life science departments, proposed that finding a common definition of terms should be the primary focus of EHR optimization.
He expounded that optimization involves customizing the installed software tools to suit the needs of a particular person or purpose. Optimizing is different from continually fixing issues and should not be considered the same as blindly carrying out orders from higher-ups without them being checked first.
Sadly, a big chunk (25-50%) of numerous healthcare providers’ IT capacity is absorbed in dealing with inquiries from customers that reach the help desk or ticketing system.
Kinsella suggested that the user departments, customer groups, and business partners from IT all work together to come up with the optimum solutions.
He clarified that optimization endeavors fundamentally comprise of undertakings that start, progress forward, and reach a resolution. Optimizing is successful when it leads to technology improvements based on how it affects corporate processes, operations and people. Optimization then takes some time.
“It also takes a village,” said Kinsella. The hybrid agile POD needs to have people with a knowledge of the business and the right to make decisions to create a solution that fits with the usual processes of the organization, as well as people with technical and application skills.
He noted that utilizing change management strategies, such as mapping out the path of how tasks will be handled once the streamlining process is finished, are the top-notch practice.
Key Sources of Information
Laurie King, a managing director at Accenture and leader of the North America health and public services industry group, suggests utilizing the employees who have to face the troubles of the organization first-hand to provide sources of information in order to optimize the EHR most efficiently. This is seen as the best practice, particularly whether a wide-reaching or restricted timeline project is pursued.
She suggested turning to other entities like tech vendors, consulting companies with broad customer bases and in-depth tech knowledge, and alike health services for potential ideas.
Clients look toward information to help address individual issues through the analysis of pertinent metrics, searching through data, and recognizing then fixing any issues. Issues that could range from single, isolated incidents to recurring issues can all be addressed through well-thought-out, data-driven plans geared toward pinpointing and addressing the root cause of the problem.
At the core of every successful Electronic Health Record is a powerful and precise system made to store, sustain and manage data relevant to the most vital aspects of someone’s health, according to King.
She elucidated that a huge array of healthcare workers take advantage of various technological methods to manage the piece of the patient’s file that they are responsible for, contributing to that set of data. It is necessary to coordinate multiple sets of data as part of the overall EHR optimization process, with the basic electronic health information for an individual patient derived from various technology systems.
An EHR that has been set up effectively should have the capacity to join and have data exchange between the different parts of data into one cohesive, organized, and meaningfully related entirety that can be acquired wherever and whenever the patient report is required, she continued.
She warned that more and more information systems that could have, or need to get, data about a patient are located in multiple businesses. This is a movement that is being encouraged by recent ONC and CMS regulations, which we believe will shape the landscape of medical care in the United States and around the world in the years to come.
Governance should be a pivotal factor in order to ensure this works accurately; the CIO, CTO, and CDO should all encourage a sense of collaboration rather than working alone, according to King.
She suggested that a team should be made up of people with various skills, such as people in leadership roles; individuals with product knowledge; people who know what the business requires; and those who focus on how best to implement change and ensure people can change easily.
It is essential to determine how much money and resources to allocate for EHR optimization in order to avoid any conflicts with other strategic initiatives that require attention.
Identify Data Quality Gaps
Luis Sayago, the supervisor of the healthcare technology practice at consultancy agency Dacarba, claims that by having access to the normal interfaces for an electronic health record, it would allow a medical organization to have a better idea of their data either directly or through connected applications.
He suggested that a great chance to optimize occurs by having the capability to swiftly recognize where data quality is not up to par in the Electronic Health Record, such as the documentation of doctors, or the upkeep of the list with problems and medications. Although it can be done in several ways, improving the grade of the data in the electronic health record can now be done more efficiently through technological solutions that have been made possible through standard FHIR interoperability.
He suggested that with the help of HL7 FHIR, healthcare provider organizations can quickly allow applications to get ahold of both clinical and financial data, which can be examined instantly and result in some useful recommendations to current procedures.
He indicated that a FHIR application is able to achieve this aim by obtaining EHR patient information through FHIR and joining to notification notifications specified by the CDS Hooks protocol which would be visible in the EHR. For instance, an app with a more comprehensive and up to date medication decision support system could be substituted for the existing EHR programs, which would lead to more accurate documentation of medications.
He also mentioned that healthcare facilities are able to boost the precision of their patient demographic and record information by deploying FHIR applications.
Sayago mentioned the use of scheduling applications as a way to connect patients to their upcoming visits and to have them fill out paperwork electronically, as a means of eliminating transcription mistakes. Also, there are increasing numbers of applications available that let patients view and investigate their electronic health records via FHIR, so that they can spot any mistakes that may have been made.
EHR Optimization “Sprints” and Work Design Approaches
At the University of Colorado Health in Aurora, Colorado, they completed an intensive and short team-based intervention called an EHR optimization “Sprint” which had majorly successful results. Clinicians reported significantly improved EHR satisfaction, with their Net Promoter Score going up from -15 to +12, and they also decreased the time it took to complete their documentation.
The Sprint group was made up of 11 employees who conducted a three-part project: (1) teaching healthcare providers to operate the Electronic Health Record method more productively, (2) improving the workflow of multidisciplinary medical care, and (3) building new Electronic Health Record instruments tailored to particular fields. The team got together with medical and office personnel three, two, and one month before the Sprint began in order to comprehend the suffering points of care providers and everyday office practices, and to make specialized apparatus.
The length of the sprints varied depending on the practice size from 5 to 20 days, and included on-site introductory meetings, individual observations and courses on EHR efficiency, and putting new clinic workflows into action utilizing devoted clinician time.
Erlanger Health System, located in Chattanooga, Tennessee, was successful in expediting the completion of paperwork and documentation of office visits within 24 hours thanks to new protocols linked to the EHR. Additionally, the time it took for refill authorizations for medications was reduced to 1.2 days. Primary care (PC) physicians have implemented EHR-based protocols to transfer the responsibility of medication refills to registered nurses or medical assistants (MAs).
It was critical for the health system to appoint extra staff during the EHR optimization phase to consult with EHR “super users” — namely, clinicians who actually practice – to guarantee that problems related to actual processes were addressed. Erlanger worked on getting rid of documentation requirements seen as having very little or no value by practitioners, as part of their overall mission to ease up on the administrative burden placed on electronic health records.
Hawaii Pacific Health in Honolulu, Hawaii, launched a promotion titled “Getting Rid of Stupid Stuff”. Senior management asked doctors and nurses in the health organization to identify anything in the electronic health records they found inefficient, unnecessary, or simply idiotic. Ashton (2018) found that the majority of requests from nurses were for measures such as eliminating unnecessary documentation, streamlining task processes, and introducing better methods for recording information.
By November 2018, over half of the proposed transformations had been accomplished or were in progress. No official analysis was done to determine the effect of the initiative on paperwork requirements or physician stress, however, Ashton said the employees responded positively to it.
It appears that many healthcare organizations, such as Nemours Children’s Health System, Oregon Health & Science University, and Allina Health, are striving to improve the efficiency of their digital records. This indicates that it is possible to do so without delay, and is seen as critical inside healthcare facilities and for those providing care.
In-Basket Management Techniques
At Reliant Medical Group in Worcester, Massachusetts, a change was implemented that sent particular in-basket notifications to the correct clinical team members as opposed to going to physicians first, leading to a 25 percent decrease in the physician in-basket load. Reliant developed rules for employees to limit the amount of emails sent and make sure that each message included what the receiver should do in response.
The Department of Veterans Affairs (VA) health system enacted a policy in which EHR notifications have been systematized and restricted to certain types of alerts according to a suggested evidence-based list. They have additionally provided trainers to assist practitioners on personalizing and handling notifications produced by the EHR. The program resulted in the daily notifications from each PC doctor declining from an average of 128 to 116, prompting an estimated one and a half hour weekly saving in the process, and having beneficial side effects such as reduced notification volumes and administrative strain, which were noted in the paper just before.
The American Medical Association (AMA) has created an instructional program with a six-stage outline for reorganizing EHR in-basket messages centered around team-based care (TBC). This plan necessitates that each doctor be assigned two or three Medical Assistants (MAs) or nurses.
This module offers guidance not only on how to reach optimization by shifting electronic health record messages to the proper team member, but also on other ways to lower a doctor’s inbox load, such as having multiple team members share a single inbox.
Documentation Strategies and Team-Based Workflow
Non-physician staff members, often known as medical scribes, are employed to type and document patient data into Electronic Health Records in real-time while the clinician works. This has the positive side effect of taking a large burden off of the physician’s time allotted for documentation but also provides further advantages.
A research project that implemented scribes in doctor’s offices revealed a significant boost in the doctors’ efficiency and contentment with their jobs. There are some potential downsides to hiring scribes, such as the expense of hiring them, their tendency to change positions often, and the cost of training them. However, these cons can be overshadowed by the increased capacity of clinicians to provide care to more patients in the same time frame. A handful of studies indicate a favorable response to using scribes from patients; however, more research into this area is needed. TBC is also a mechanism to address EHR inefficiencies.
EHR Training
Educating medical personnel on how to work with the electronic health record system both prior to the introduction and intermittently thereafter is essential for optimizing productivity and thwarting the possibility of exhaustion. A study conducted in 156 different health care organizations found that doctors who were given inadequate training were 3.5 times more likely to allege that their Electronic Health Records were not useful in providing the best possible care. Major impediments to training include an absence of allocated time for healthcare professionals, resources tailored to the specific role and specialization, and agreement on an accepted method of determining quality Electronic Health Record utilization.
As with other forms of clinical training, having someone standing by during a dedicated time period is possibly more advantageous to clinicians, since it allows an individual to receive immediate feedback to address particular necessities and learn from other people.
Beginners can be shown how to implement the ideal techniques right away instead of having to replace bad habits. Learners should receive training that is comprehensive, with precise rules on their duties for work related to electronic health records, provide well-defined note pattern templates, and get education that is structured to enhance their note writing capabilities. A curriculum for training students in Electronic Health Records is desirable, but one currently does not exist.
In 2018, the American Medical Association (AMA) started a collective of 32 medical schools with the purpose of upgrading medical education, including a computerised patient record (EHR) training curriculum that had enrolled more than 19,000 people.
Though it’s very important for patient safety and clinician well-being, graduate medical training programs have not concentrated on educating trainees on how to access and pull together clinical information quickly and have not honestly dealt with the undiscussed agenda that leads to note excess due to coding and accounting requests.