In our previous articles, we described an “as-is” exercise with the EHRA workgroup and the HIMSS Physician Committee members where one issue became the focus: the flexibility of workflows. This series of blog posts reviews the results of that exercise and describes a path forward. This article will focus on the second of the two topics: Personalizing the EHR and Understanding the Patient.
A common thread for “personalizing the system” is that while there are often tools available to personalize and configure the system, they can be difficult to discover, challenging to scale and share, and overwhelming to interact with in the clinician workflow. If it were simpler to personalize or optimize one’s own EHR experience, there would be little need for an organization to conduct optimization exercises after the initial implementation. After spending eight or more hours in formal training, and then significant time post go-live with practical EHR use, having some simple means available for self-configuration might remove additional hours of optimization, which will in turn reduce physician frustration.
Unfortunately, clinicians often figure out inconsistent “work-arounds” for the original system design as an ad-hoc means of personalization. Moreover, each EHR update, or “improvement” that is introduced can muddle those personalizations. Updates may then necessitate new workarounds and additional time and cognitive effort to both negotiate the new version, as well as to figure out how to apply prior knowledge to the new system to make it work effectively for the user. By studying these common workarounds, we can identify areas in the system that need design improvements.
Patient review and analysis is complicated by multiple challenges. Some of those challenges are related to external, or non-native, EHR data being difficult to find, and unreasonably large file sizes. Internal EHR data can be challenging when it is not optimized or summarized in a fashion that is conducive to the workflow. Charting practices developed by end-users, either through workarounds or through the use of pre-arranged templates, can result in extraneous information being incorporated into chart notes. When these factors coalesce, clinical documentation can become difficult to navigate and nearly impossible to review. Finding data in prior notes might be improved by following “best practices” like keeping notes shorter and more concise. Concise documentation recommendations have been well publicized recently.(3) However, in the absence of more concise documentation, a means of identifying critical information in a note, or finding such critical information in other reports needs to be developed.
The next article in this series will focus on challenges with Providing Care, and touch on potential solutions.