I have been asked many times on what is the most efficient and best workflow for documenting a patient visit in the exam room, when quite commonly the PC in the room is used by both the nurses and the providers. This has been a challenge since day one of EHR adoption because we do not want to slow down oir interrupt the typical workflow and patient experience wherever possible. For many, the solution is to have two instances of EEHR open in two separate browsing sessions, one for the nurse and one for the provider. This is a perfectly viable option, however I would like to present an alternative that may prove to be more efficient for your organization’s workflow.
There is a preference built into EEHR which makes it possible for multiple users to perform their respective documentation functions for each patient within the context of one session. This preference is: “SwitchUser”. In essence what it does is makes it possible for one user to continue where the last user left off before locking their session.
If this preference is set to Yes, it can prove to be very efficient for some organizations when applying it to the nurse/provider workflow where the nurse would typically lock their session after performing the intake workflow such as entering the vitals, chief complaint, reconciling the med list, etc. Upon locking, the nurse would hypothetically still have been working within the patient’s record who is currently being seen in the exam room. When the provider comes in and continues the session under their own username, upon logging in they would be directed to the exact location in the patient’s chart where the nurse left off.
Here you can see the addition of the “Change” button on the lock screen. Once the Change button is clicked, a field presents which prompts the next user to enter their username and pasword to continue where the “Current User” left off:
There are a number of advantages to adopting such an approach:
- Increases efficiency by providing the option to continue where the current user left off, eliminating the steps of navigating to the correct patient chart before continuing the visit documentation process.
- Prevents confusion as to whose browser session belongs to whom, which can be a risk if user A is actually unknowingly documenting under user B’s session.
- Eliminates unecessary navigation time within the EHR so more quality time can be spent with the patient.
As with any solution, there are a number of drawbacks that need to be taken under consideration as well:
- Auto-timeout preference settings as well as interaction within a Citrix environment have been known to cause unwanted issues.
- If your users have unique workplaces assigned, this can cause problems because the new user will be directed to the last place the current user left off, which will in fact lead the new user to the same workplace component, even if that component does not exist in the new user’s workplace. Fortunately, at least in the nurse/provider example, many components are shared across their workplaces, such as Clinical Desktop, Tasks and Schedule to name a few. That being said, in most cases this would not be an issue and when it does occur the new user would just have to navigate somewhere than where they are directed upon login to refresh the workplace differences between the two users and continue from there.
In summary, this preference is one to take into consideration if it will help your organizations overall efficiency and provide a better patient experience. Thoroughly testing with your workflows is recommended before implementing this feature.
For more information, please visit the Galen wiki or contact your Galen consultant for additional details.