2022 Clinical Workflow Flexibility Challenges in the EHR: Defining the Problem (Part One)

nurse reading a chart

Defining the Problem: Flexible Workflows in the Electronic Health Record (EHR)

The Electronic Health Record Association (EHRA) Clinician Experience Workgroup met with the HIMSS Physician Committee shortly after HIMSS 2021 to discuss areas of shared focus and create plans for collaboration over the next year. Our groups already agree on the quality, safety and efficiency-of-care benefits, to both providers and patients, that EHRs have brought. We also agree that there is more work to be done to improve and deepen the impact of these tools on care delivery, documentation and clinician satisfaction. The focus of our meeting was to decide where action was most urgently needed to raise the bar for EHRs. One topic that was of interest was the sense that EHRs lacked flexibility within clinical workflows. This series will provide a summary of our discussion, the areas of focus we agreed upon, as well as some of the promising solutions we discussed.

The two groups collaborated on a brainstorming exercise to clarify the problem space. They modified IBM’s ‘As-Is Scenario Map’ to allow physician stakeholders to share specific points where they had hit the ‘limit’ of EHR flexibility. The exercise asked physicians to add virtual post-it notes to a personal whiteboard as they reflected on what they were doing, thinking, or feeling when they last experienced inflexibility in the EHR. Those various boards were then brought together, and facilitators did an initial affinity grouping of the ideas that had been shared. The goal of the affinity grouping was to discover the ‘phases’ or ‘facets’ of flexibility that seemed to be concurrent across the participants. This affinity grouping was brought back to the group for a second session of discussion and clarification.

After clarifying and refining the ideas that had been shared, four categories of concerns were identified:

  • Learning about the EHR
  • Personalizing the EHR
  • Understanding the patient
  • Providing care

Learning about the EHR

As noted in two recent studies, training and optimization are the biggest predictors of provider satisfaction and wellbeing (1,2). Surprisingly, this category had the least consensus and fewest urgent issues during the exercise. Our interpretation of this is that while training and mastery of the EHR are clearly important for success, there are significant variations in organizational and EHR vendor recommended training and optimization methods. As a result, there is not a clear path forward. Having a system that is intuitive to learn, with training and flexibility built in, might offer a very attractive alternative to current “change management” mandates. The concept of a teaching and learning system is a challenge being tackled throughout the software industry. EHR vendors are an important part of solving this complex challenge. 

Our next post will focus on Personalizing the EHR and Understanding the Patient. We’ll wrap up the series with thoughts on Providing Care in the EHR and solutions.



  1.  Longhurst, CA, et al.  Local Investment in Training Drives Electronic Health Record User Satisfaction.  Appl Clin Inform 2019;10:331-5.
  2. Shah, T, et al.  Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action.  National Academy of Medicine 2020;