In the first of this two-part series, Lee Milligan, VP & CMIO at Asante, identified the reasons why, rather than helping to increase efficiency and improve care delivery, EHRs often leave clinicians feel “unsafe.” This part will discuss how the challenge can be addressed, both in the short-term and long-term.
Lee Milligan, MD, VP & CMIO, Asante
When it comes to EHRs, the ultimate fix may take many forms. Still, one design philosophy will need to reign supreme: simplicity.
We should consider both immediate and long-term solutions. For immediate improvements, a consensus is building that there are three core components. First, providers should insist on an IT governance structure led by physicians and nurses. At Asante, we have a physician advisory council, an ambulatory physician advisory council, and a nursing advisory council. These councils enable clinical leadership to rip out the garbage that doesn’t belong within the workflow, leading to a more intuitive EHR navigation design. Without these critical governance structures in place, ITS and operations will default to making decisions on behalf of clinicians.
Second, training needs to be overhauled at many institutions — both initial and ongoing training are frequently abysmal. There are a lot of great ideas for how to improve training, but at the end of the day, you need to have buy-in from operational and ITS leadership to provide resources. Third, along with ongoing training, clinicians should be given ample opportunity to deepen their adoption of EHR personalization tools — something proven to increase both satisfaction and efficiency.
The long-term fix, in my opinion, is taking clinician engagement to the next level: clinicians should fully lead the way on (a) intuitive and simplified EHR design, (b) smart, gamification-based training, and (c) rapid feedback loops. Let’s talk about design.
The EHR vendor that ultimately wins this EHR race is the vendor that can mirror what the physicians see on the screen to their actual clinical workflows, without gratuitous distractions. I liken it to doing your own taxes with TurboTax. Without sounding like an endorsement, TurboTax is pretty straightforward.
The software has two tabs at the top — the simple tab and the full-view tab. The simple tab streamlines the workflow into a basic question-and-answer format; you input your data, and it spits out your numbers. On the full-view tab, you get a behind-the-scenes look at all the long forms. You’re free to walk through the software using either view.
Most of the time, you’ll find yourself working within with the simple tab because it corresponds to the main workflow. An EHR designed in a similar fashion could be equally effective. It could be set up in a format where the physicians pick their tab; if a patient comes in for abdominal pain, the system could automatically open the abdominal pain tab, thus presenting the view based on that particular clinical scenario.
Conversely, if you find yourself in a scenario where you want to check on a non-typical result — for example, a head CT scan in addition to abdominal pain — you can quickly adjust to a long-form view of the patient record by clicking the full-view tab.
How close are we to making game-changing improvements in the industry? Although I can’t say for sure, it does feel like we are approaching a tipping point. Provider frustration combined with clear, hard-dollar ROI around improved efficiencies are aligning the planets on this topic.
Nonetheless, it’s a big lift for vendors and clinicians. Until now, this level of investment hasn’t been considered urgent due to cost constraints. In addition, this level of workflow intuition would require a cadre of clinicians spending hundreds or thousands of hours designing appropriate clinical scenarios.
On the other hand, can you imagine an EHR scenario where the physicians efficiently find what they need, are confident in their EHR navigation, and do not make errors of commission or omission? Think about how much safer physicians would feel in that environment, navigating the EHR as an augmentation tool to patient care and not a distraction — a vision of an EHR which relieves clinicians of the mundane burdens of healthcare instead of compounding the chaos.
The time has come for physicians to demand it.
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