EHR Optimization

Optimization with Provider and Patient Experience

After the implementation of an electronic medical record system, an optimization plan is the next key project that should take place in order to address a multitude of issues and to bring the system and its users to a more efficient and advanced state.   The concentration of these projects are usually geared towards increasing revenue and/or patient volume as the end goal but what is often overlooked are the provider and patient experiences.  By incorporating provider and patient experience with increasing revenue/patient volume as goals for optimization, a positive synergy occurs that will produce happier staff which correlates to better performance and revenue in the clinic.

 

There are several common things that most clinics struggle with post implementation; unable to get back to patient volume pre-implementation, check-in and wait times for patients are typically much longer than before, unable to close charts timely and efficiently, providers and support staff working long hours and many other issues that contributes to unsatisfactory experience for both the medical staff and patients.  In order to identify a thorough assessment of issues, these are some things that should be considered when planning an optimization project:

1.Assess the current state of workflows through shadowing the complete process from check-in to check-out. Shadowing should be done several times throughout the week to accurately capture an overview of workflows in different atmospheres. For example, the clinic may be busier on Mondays than on Fridays so both current states should be documented to understand how staff are being utilized, how long patients wait to see a provider and other useful information that can be revealed by the varying levels of patient volume.

2.Interviews with providers and support staff should be conducted on a 1 to 1 basis to identify trends of issues. Is there enough support staff to assist providers?     Are providers pushing work to the support staff? Are there enough workstations in the clinic? Are there issues with locating print jobs? This is important to allow the staff an opportunity to express issues that occur in the clinic without fear of being reprimanded. This will also give the staff a sense that their issues matter and that they are also have a stake in the improvements of processes that affect their daily jobs.

3. Surveys or other forms of metrics for patient experience should be gathered to identify issues. How was the process for registering and scheduling an appointment? Are patients leaving the clinic with meaningful office visit information? Was the communication and follow up with the clinic easy or difficult? These are some of the things that can be used to identify areas of improvement to minimize unnecessary follow up with the practice.

4.In addition to shadowing and conducting interviews, metrics from the system should be used to identify areas of improvement. There are dashboards and reports in the system that can be generated to further reveal issues. Is the build set up correctly that supports both providers and staff? Do they have the necessary tools to carry out their jobs? Are the providers’ orders-tracking and follow up manageable in their In Basket? Do patients have the ability to review their medical information and communicate with the clinic securely?

All of these steps above may seem to be an obvious way to approach optimization but most organizations jump to the conclusion that inefficiencies and the inability to increase revenue and satisfaction scores are solely due to the implementation of a new system since it was a significant and most recent change for the organization. By considering the provider and patient experience as a part of the optimization, this will create a more successful outcome.  The people who interact with the system on a daily basis  are the providers and patients so it is important that this should be considered and incorporated during an optimization plan.

 

Improving Provider Efficiency and Satisfaction through EHR Optimization

The system has been “live” now for many months or even years, millions of dollars have been invested in the system, and the physicians have attended their training on how to use the system. Yet their struggles continue long past the initial learning curve; charts not getting closed/completed for days, physicians working late hours to deal with notes, letters, follow-up results, phone calls and the list goes on. What is the solution to help your providers?

A system optimization plan may be the answer to help solve these issues and probably many more. Optimization should be a proactive venture as it is not “break-fix” or implementation of features not included with the initial system roll-out.  So, just what is optimization?  Basically, it is the act, process or methodology of making something (i.e. design, system or decisions) as fully perfect, functional or effective as possible.

There are many ways to go about the optimization and multiple tools to assist with the process. An organization should identify a few (approximately 3-4) clinics that would act as a good pilot for the project.  Workflow re-evaluation is an extremely important part of this undertaking.  Have your optimization team member focus on each step of the process from patient check in all the way through check out. Look for unnecessary steps being done.  Are there any bottle necks preventing patients from getting into an exam in a timely manner?  If there is information needed from the patient, send it to the patient thru MyChart and have it completed prior to the visit.   Are there any functions being done by the clinician that could be done by the nursing staff?  Is there anything being printed that can be eliminated?  Are those lab requisitions for the in-house lab really necessary?  Work with the providers to find out what part of the system or visit is slowing them down.  Are they having trouble placing orders, finding lab or imaging results or is the slow-down with the note creation, or is it just that never ending in-basket.

Make use of any and all productivity tools that may be available to you, such as Pulse or PEP – Provider Efficiency Profile. Pulse is the personal dashboard to measure how efficiently the clinicians are using the system.  It will also offer links to targeted training materials to help providers improve in particular areas (i.e. orders or note completion).  Also, the organizations project team can make use of the Pulse scores to pinpoint areas where additional build or training may be needed.

The Provider Efficiency Profile (PEP) offers invaluable information regarding provider usage in the system. You will be able to see how an individual provider compares to others in the same department or specialty in respects to number of number of new patients being seen, how much time spent in the In-Basket, time on notes, letters and orders and much more.  It will also show how much time is spent in the system when not actually seeing scheduled patients, so you can really drill down on the amount of time doing work after hours.

On a recent engagement we used all of the examples mentioned above to evaluate key areas that providers maybe struggling with throughout their day. After thorough evaluation of all information gathered  in person with a provider and a deep dive into the Pulse and PEP information we formed multiple deliverables to assist with provider efficiency among them:

  • Creation of education sessions for providers focusing on in-basket, ordering workflows and note creation
  • Development of tools to assist with workflow processes i.e. smart sets, standardized “speed” buttons for LOS, diagnosis
  • Learning home dashboards created for the providers with tips, short-cuts and how to for certain functions, links to standardized documentation (i.e. sports physical forms) as well as general help topics
  • Roll-out of synopsis for focused problems such as diabetes, hypertension, thyroid diseases and others

While the impact of a few of these have yet to be reported or assessed, there has been a great deal of positive provider feedback on the first several training sessions that were held. Almost all attending felt that the material presented will help with their speed in the office and with patient care and satisfaction.  Additional training sessions and expansion of the optimization initiative is currently being under taken.

If an ambulatory optimization project is in the works for your organization, don’t forget a little PEP will go a long way in helping your providers be more efficient with time in the system and ultimately lead to a more satisfied patient.