As a healthcare organization, innovation and change can be a challenge. And while many changes are forced, either by government mandate, financial incentive, or patient care necessity, each organization must make a series of decisions that will dictate their technological, financial and cultural future. Though the EHR journey, from selection and implementation to maintenance and upgrades, is not easy. It is necessary. In this series, we reached out to Terri Couts, VP of Epic Application Programs at Guthrie Clinic, for her thoughts on the end-to-end EHR journey.
A major part of any EHR installation is workflow analysis. Every organization practices, functions, and cares for patients a little differently largely due to training, culture, and patient demographics that they serve. Knowing all of this, there is still an unrealistic expectation that healthcare technology is plug-and-play. Being trapped in this misconception can lead to end-user frustration, delays in care for patients, delayed revenue or revenue loss, and an overall mistrust of the product and the IT implementation team.
Workflow analysis should start the day you sign your vendor contract. Of course, during the implementation, each vendor will have suggested workflows but most only consider the technological use of their product. They do not address any policies or procedures established by your institution. They do not include any State or local regulatory requirements that your organization is bound to. Finally, they do not consider the culture of your organization including the providers’ independence of practice. When I state providers’ independence of practice, I am not suggesting that standard tools and workflows should not be implemented and encouraged. What I am suggesting is that identifying workflows at your organization and having the tools to support those workflows is the first step to a successful go live and sustainability.
To accurately collect and document workflows, your IT team will need to heavily engage the subject matter experts. These include registration staff, transporters, nursing, physicians, surgeons, back office staff, medical records, pharmacists, radiologists, and the list goes on. Once the analyst understands how each of the users practice within the organization, they can start to configure the technology to support the workflow.
Technology should never define the workflow. But it should support and enhance the work, drive patient outcomes, and increase patient safety.
Terri Couts | VP Epic Program Applications, The Guthrie Clinic
While performing workflow analysis, ease of use and best practices should always be considered. Most electronic health record (EHR) early adopters implemented their systems with the driving desire to fill the Meaningful Use agenda to ultimately receive incentives and avoiding penalties. Thankfully, those days are behind us and there have been many lessons learned. Physician burnout is one effect stated to be caused by EHR requirements and we have all heard the complaint about “too many clicks”. The role of the provider should not be defined by the number of clicks in the EHR. Be careful to design technology for ease of use, clean and intuitive workspaces, and to not take away from the patient experience.
In my opinion, users should not only be involved in the definition of the workflows and design of the product, but also the testing of the design. Usability testing is just as important as the initial workflow analysis. This gives us the chance to identify gaps in the design and user adoption before implementation.
The product and documentation that comes from the workflow analysis should also serve as the foundation of training for the system. I have found that EHR training cannot just be about the technical aspects of the system. It should also include relevant scenario-based training to include policies, and procedures held at the organization. End users want to know how this affects them personally. They also need to know the effect of not completing or performing a particular workflow. For example, if the system is built to drop a high dollar charge only if a particular box is clicked, how would the clinician know the downstream impact of revenue loss if they are not educated on the entire workflow. Finally, build the scenario training to include scenarios that the providers can relate to. If something does not seem realistic to a provider, he or she will be lost in that concept and not focused on learning the system.
The EHR journey can span years and effectively dictates, at least in part, the healthcare organization’s path and culture. This series examines the experiences of healthcare leaders that have been through it. Whether you’re selecting an EHR for the first time or replacing an existing system, the EHR journey is a daunting one. These lessons learned could be priceless to you and your organization.
Check back soon as the next post in this series will cover change management and governance and their importance throughout your EHR Journey.
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Terri Couts is the VP of Clinical Systems and Epic Program at The Guthrie Clinic which serves the Twin Tiers region of Northern Pennsylvania and Southern New York. She has a proven track record of excellent service in healthcare IT and EHR implementation.