The fallout from COVID-19 provided a perfect case study in why physicians must always look toward optimizing their electronic health records (EHRs), says Ogechika Alozie, MD, chair of the Texas Medical Association’s Committee on Health Information Technology.
Put simply, EHR optimization is the process of tailoring a system for a physician’s individual needs.
Before the pandemic reached Texas in March 2020, EHRs paid little attention to telemedicine information because so few practices were able to provide that service, Dr. Alozie says. Filling in telemedicine information typically happened outside the normal EHR experience.
But EHR companies quickly switched gears during the pandemic, he says. Suddenly, physicians demanded to have the telemedicine screen automatically show up on the EHR screen so they could document a visit and talk to the patient at the same time.
“There were a host of [EHR] companies that did that” once telemedicine became more common, Dr. Alozie said. “They were able to pivot to that relatively quickly during the pandemic. That’s a huge example of how people changed their workflow to make EHRs more intuitive and user-friendly.”
But it shouldn’t take a natural disaster for physicians to find other ways to make their own EHR experience more intuitive and user-friendly, says Matt Murray, MD, a pediatric emergency medicine physician at Cook Children’s Health Care System in Fort Worth and the system’s former chief medical information officer.
Physicians use the basic EHR functions to do day-to-day tasks, such as documenting patient encounters, ordering tests, prescribing medications, and managing bills and payments.
“What’s harder is fine-tuning the EHR to meet your individual needs and streamline workflow,” he said. “For example, if I’m a pediatrician, I will see a lot of well-child checks at certain intervals, such as at 6 months of age. When the 6-month-old comes in, I would want my EHR configured to pull in a documentation template designed for that specific age in order to streamline my documentation and help guide me through important discussion topics typical for that stage of child development.”
Physician’s often express frustration with EHR capabilities, and that can be seen in TMA’s 2020 Survey of Texas Physicians, says Joseph Schneider, MD, a pediatrician and informaticist in Dallas. (See “EHR Survey Says ...,” pages 30-31.)
For instance, when asked why they were dissatisfied with their EHR a majority of physicians say it lacked needed functions, or was too slow or difficult to use.
“Optimization can partly resolve some of these problems,” Dr. Schneider said.
For instance, physicians may speed up the EHR by adding computer memory, he says. But there’s not much they can do about an EHR that’s missing needed functions, like pediatric growth charts.
EHRs also directly impact patient care, Dr. Schneider says. In TMA’s survey, 30% report adverse patient outcomes with EHR use.
“While many of the root causes of these issues can’t be fixed by physician or staff optimization, you should do as much as you can to improve what you have,” he said.
How to optimize
Physicians first should realize that EHR optimization is a team activity, Dr. Alozie says.
“Wherever you’re getting your EHR from [the vendor should] think of you as a partner and not just someone they sold something to, because you’re going to be in contact with them a lot, he said. “You’re going to be asking them, “Can I do X? Or is it possible to do Y?’ And if they’re not relationship-building, if they’re not communicative, you’re going to get really frustrated.”
Physicians and their staff should work with the EHR vendor to become familiar with the system, Dr. Murray adds. In medical practices with multiple partners, it helps to designate physician and staff “champions” who can serve as liaisons with the EHR vendor. At least one person should become familiar with technical aspects of the EHR and keep up with technical updates, he says.
Before EHRs, physician practices continually analyzed and improved their manual workflow processes to become more efficient, Dr. Murray says. EHR optimization is a similar process. Physicians should continually analyze workflow and identify whether there are underused EHR functions.
For instance, if there is a bottleneck in patient flow caused by a delay in getting patients from the waiting room to an open exam room, the practice might review the problem with the EHR vendor, Dr. Murray says. The vendor may identify an unused capability of the EHR that could address the issue, or they may know how other practices using the same EHR have solved this problem.
Optimizing an EHR can be especially difficult for practices that are converting from paper records because they also have to re-think all of their paper-based workflows.
“When I was a [chief medical information officer] on a site visit to evaluate an EHR, I looked for physicians or staff writing on paper and listened for the humming of a printer or fax machine,” he said. “Those were visual and audible clues to paper-based processes that might need refining, or possibly even elimination by optimizing EHR use.”
In the past, optimizing an EHR usually meant reducing the number of “clicks” a physician makes during a clinical visit going from task to task. But with improvements in voice-recognition software, it more often means getting rid of the keyboard altogether, Dr. Alozie says.
He now uses software on his phone that is tied to the laptops he designates for patient visits. Speaking into his phone brings up the appropriate prompts during a visit. He then uses verbal commands throughout the visit without ever touching a keyboard.
“You can talk faster than you can type, always,” Dr. Alozie said.
The TMA survey shows that about 30% of Texas physicians use voice-recognition software. (See “More Intelligent Care?” page 36.)
Improvements in this technology indicate how EHRs are finally meeting physician needs, Dr. Schneider says. Yet current EHRs are – to put it in automobile terms – a Model A from the 1920s when physicians need a modern Ferrari, he says.
“No matter what I do to my Model A, I can’t make it a Ferrari,” Dr. Schneider said. “But physicians also can’t just wait and sit back and say, ‘One say they’ll deliver a Ferrari to me.’ Physicians across the nation need to get involved and speak loudly and make it crystal clear to EHR companies that we need Ferraris.”
Leveraging your EHR
Until those souped-up machines arrive, current EHRs can streamline business operations and improve how patient charges are captured, Dr. Murray says. More importantly, they can track patient data in ways that improve care.
For instance, he co-authored a study for the Winter 2019 Texas Public Health Journal in which practices were shown how to track patients with chronic illnesses. At the beginning of the study, most of the practices used EHRs simply for clinical documentation and billing.
“By showing them how to collect, analyze, and develop reports [using their EHRs] that were focused on measures related to hypertension and diabetes, the practices improved their ability to track these disease conditions across their patient population,” the study said.
Finding the time and resources to develop these reports – and for all other types of EHR optimization – can be an obstacle for practices, Dr. Murray says. Many practices don’t have a technical person on staff who can produce reports in their EHR.
“Vendors may end up charging physicians to create reports if a practice doesn’t have somebody in house with the technical skill to do so,” he said.
Physicians should view EHR optimization as an ongoing improvement project, Dr. Murray says. One practice he studied started holding weekly meetings specifically to discuss EHR problems and identify solutions.
“They knew they had to communicate better,” he said. “But the EHR implementation basically forced them to hold weekly meetings to promptly problem-solve. They subsequently decided to continue these weekly meetings because they really valued the open discussions on how to improve their EHR use.”
Physicians and everyone in an office using an EHR should take advantage of the training offered by the vendor, Dr. Schneider says. They also should periodically review their training for updates and take part in user forums with the vendor.
“This is a good way to not only learn from other users, but to provide valuable feedback to the vendor on how the product can be improved,” he said.
Physicians looking to optimize their EHR, start using an EHR, or switch EHR companies should start by looking over TMA’s numerous EHR tools, Dr. Alozie says.
“Other than that, it’s a lot of word of mouth – talking to your colleagues about what experiences they’ve had and what they would do differently,” he said. “Everybody has a different level of need for their EHR.”
Tex Med. 2021;117(7):27-29
July 2021 Texas Medicine Contents
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