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

2. 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):
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):

3. 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

4. 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

5. 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

6. Step 2 | Optimize hardware and built-environment solutions
Changes that can improve patient care, workflow, and save 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. “
Simply put, the relationship is no longer a binary doctor-patient relationship but a triangle: a doctor-patient-systems relationship, with the EHR ”
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15. For additional resources, frequently asked questions and implementation support, visit stepsforward.org