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Clinically responsive workflows are the key to EHR usability

2 months ago 31


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Clinicians are among the most highly trained knowledge workers in the world, yet the systems they use to care for patients hinder their ability to deliver care. Electronic health records (EHRs) require clinical users to spend far too much time searching for clinically relevant information for a given patient and, once that information is located, to go through too many disconnected processes to complete their work. EHRs need to be more of a tool for patient care, and less of a burden.

Clinicians know what they want to do but cannot easily find the information they need without clicking through multiple screens. Patient data is divided between different silos: diagnoses, labs, medications, symptoms, history, and orders are typically stored in distinct sections of the EHR.

If a physician wants to evaluate the status of a condition, such as diabetes, they need to see what actions were taken previously, along with the status and recent trends of key clinical indicators (such as A1C levels). This information is also needed to complete documentation, ensure compliance with quality measures, place orders, and any other actions required.

In a clinically efficient EHR, each interaction with the system should provide usable, actionable, diagnostically connected data to the user at the point of care. By selecting a problem from a problem list, a user should be presented with a profile of the key indicators for the given problem, including relevant medications, lab orders and results including trendlines, related history and physical exam indicators, and therapeutic interventions for the problem. The status of quality measures related to the problem and appropriateness of diagnostic coding is also essential.

Displaying this relevant information is crucial, but to make the system a viable tool for patient care, users must be presented options to complete their work. If a key quality measure must be completed, the system should present the information required to complete it without forcing the clinician to search throughout the EHR. If additional documentation is required to meet value-based care requirements, the system should present that to the user proactively, without request.

The bottom line: Clinical users must be able to focus on the patient––and not spend so much valuable time grappling with the EHR. 

Some providers have recognized this issue and are taking action. An Arizona hospital has taken this approach to diagnostic connectivity to another level. They met with their ambulatory providers in each department and developed clinically specific dashboards for each specialty. Part of their design approach involved meeting with doctors, nurses, patient care coordinators, and other therapists to determine what specific information was needed at-a-glance, and how to connect that to the provider workflows so that everything could be completed at the point of care. The results have been impressive. The dashboards have improved clinical outcomes, increased throughput, and achieved higher patient and clinician satisfaction.

While EHRs are often viewed as essential clinical tools, most were originally designed to facilitate billing operations. By incorporating clinically responsive workflows that readily present the right information to clinicians at the point of care, EHRs can finally fulfill their destiny – to drive better patient care.

Photo: Filograph, Getty Images

David Lareau is Chief Executive Officer of Medicomp. Lareau joined Medicomp in 1995 and has responsibility for operations and product management, including customer relations and marketing. Prior to joining Medicomp, Lareau founded a company that installed management communication networks in large enterprises such as The World Bank, DuPont and Sinai Hospital in Baltimore. The Sinai Hospital project, one of the first PC-based LAN systems using email and groupware, was widely acknowledged as one of the largest and most successful implementations of this technology.

Lareau’s work at Sinai led to the founding of a medical billing company that led, in turn, to his partnership with Medicomp. Realizing that the healthcare industry made less use of information technology than almost any other industry, particularly in the area of clinical care, Lareau immediately saw the potential for Medicomp’s powerful technologies and joined the company to help fulfill Peter Goltra’s vision.

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