EHR Optimization: Strategies for Thriving Strategies to help health care organizations maximize the benefits and minimize the burdens of the EHR.

Physicians spend nearly 2 hours on EHR and deskwork for every 1 hour of direct face time with patients. On top of this, physicians take 1-2 hours of inbox and documentation work home every night. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Ann Intern Med. 2016;165(11):753-760. http://annals.org/aim/fullarticle/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med. 2017;15(5):419-426. http://www.annfammed.org/content/15/5/419.long

What is EHR Optimization? Decisions in the following areas contribute to the benefits and challenges of EHR use: Design Regulation Implementation Individual use Goal: Maximize the benefits Minimize the burdens

Eight steps to optimize your EHR Align the goals of leadership and clinician EHR users Optimize hardware solutions Optimize software solutions Reduce the burden of order entry and documentation Optimize teamwork Optimize provider use of EHR Optimize information flow throughout the health system Leverage EHR-use data

Step 1| Align leadership and clinician EHR users EHR implementation is most successful when leadership and end users are working together toward the same goal. The following organizational strategies can be helpful: The institute shares accountability Conduct a regular measure on overall clinician satisfaction/burnout Include EHR-use metrics on the organization’s data dashboard Consider time trade-offs Include practicing physicians and other health professionals in all decisions regarding implementation, training, and metrics Train and support a core team of clinician informaticists Value the users’ training time

Step 2 | Optimize hardware and built-environment solutions Changes that can improve patient care, workflow, and save 12-30 minutes per staff person per day include: Implement flow stations where clinical support staff and physicians are seated side-by-side Installing widescreen monitors Having networked printers in every exam room Optimizing user sign-in process with technology such as radiofrequency identification

Step 3 | Optimize software solutions Software Functions within the EHR Improve Workflow and Efficiency Physician e-prescribing of controlled substances – instead of printing prescriptions Capturing patient photos – facilitates recognition of the patient and their story on opening the record Using the after visit summary – records patient education* *Check state and local regulations

STEP 4 | Reduce burden of order entry and documentation Solutions include: Team order entry Team documentation Dictation to transcriptionist Speech recognition software Templates and auto-text Information overload contributes to cognitive workloads, work after work, and a hazardous environment for medical decision making

STEP 5 | Optimize Teamwork Methods Description Inbox Management Try to reduce the volume by empowering teamwork, using standing orders, and using verbal messaging Medication Reconciliation This can be performed by a pharmacy technician, pharmacist, medical assistant, or nurse before the physician sees the patients Patient Portal Improve the efficiency of results reporting and other communication with the patient Update the Rooming Protocols Empower clinical support staff in expanded roles for medication reconciliation, agenda setting, care gap closure, quality metric documentation Print Select Information for Each Visit Print out a few key sources of information, helps with efficiency and reduces the cognitive workload of medical decision making

STEP 6 | Optimize user skills with the EHR To train team members on EHR use it is helpful to do the following: Facilitate peer-to-peer learning (a time to share tips and tricks) Train the practice unit as a whole Offer intensive training

STEP 7 | Optimize information flow throughout the health system Information overload contributes to cognitive workloads, work after work, and a hazardous environment for medical decision making It is important to remember that not every element of care needs to flow through the EHR and not every element of care in the EHR needs to be performed by the physician

STEP 8 | Leverage EHR-use data Measure EHR-use data and track these metrics on the institution’s data dashboard. EHR-use metrics include: Work after work: identifying the hours the physician is logged into the EHR on nights, weekends, and while on vacation Click counts: clicks per task or clicks per day Teamwork: percentage of total keystrokes for a patient visit that are performed by the physician

How is it Working at Other Practices? Eau Claire, WI Boston, MA Denver, CO Virginia North Carolina South Carolina Georgia Southern California Steps in Practice Summary = Location Featured Here Summarize the description of the steps in practice section in a bulleted format Keep it concise and straight to the point Think about what information would be helpful to a practice manager that is presenting this information Review other module pitch decks for examples

“ Simply put, the relationship is no longer a binary doctor-patient relationship but a triangle: a doctor-patient-systems relationship, with the EHR ” embed video

For additional resources, frequently asked questions and implementation support, visit stepsforward.org