Between June and October 2021, members of Marshall University's Department of Family and Community Health collaborated with their school's Information Technology (IT) team to conduct a four-month, department-wide optimization project to improve their usage of the Electronic Health Record (EHR) software. The software was implemented across their institution nine months prior. In this paper, they analyze their attempt to enhance EHR usability within their department as well as the impact of their efforts on departmental productivity.
At the outset, eight work groups were created to identify workflow problems. Each work group was related to a specific critical area within the department's daily workflow: care coordination, communication, front desk, medication, notes, nursing, orders/referrals, and revenue. The groups included a multidisciplinary mix of junior- and senior-level department members. In one-hour monthly meetings, they analyzed the efficiency of problematic tasks and processes, determined best practices for handling them, and created new workflow policies. Each of the 124 EHR-related optimizations that emerged from these groups was tracked under one of four categories: Accommodation (workflow adjusted outside the EHR by the department), Discovery (workflow found inside the EHR by the department), Creation (workflow added to the EHR by IT), and Modification (workflow changed within the EHR by IT). Just over 20% were Creation or Modification optimizations, falling under the domain of IT. Nearly 80% did not require IT fixes, with 43.5% deemed Discovery optimizations, in which solutions were already in the EHR, but users didn't know the functionality was available.
What We Know: The majority of health care practices now use an EHR. The large-scale adoption of EHRs was expected to improve communication among clinical and administrative staff and ensure the standardization, quality, and safety of care. However, EHR usage is often associated with problems including increased administrative burdens, negative clinician emotions, attenuated workflow communication, clinician burnout, and medical errors. Physicians and other practice staff may not receive much training in how to engage with the EHR interface during its implementation.
What This Study Adds: Current literature on EHR optimization is limited and largely details organization-wide initiatives. This is the first study to demonstrate that successful EHR workflow optimization is possible at the departmental level. Ongoing collaboration between EHR users and their IT colleagues is essential to improving user experience. Many EHR difficulties stem from users' insufficient knowledge of how the interface works. On the technology side, greater understanding of clinicians' needs could inform upgrades to EHR interfaces and functionality.
Optimization of Electronic Health Record Usability Through a Department-Led Quality Improvement Process
Adam M. Franks, MD, et al
Department of Family and Community Health, Marshall University, Huntington, West Virginia
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