Improving Your EHR

We recently did a presentation at the Allscripts conference titled “Your EHR is Live.  What’s next?”  To me it seems like a fairly simple concept, but I am amazed at the applicability to most groups using an EHR.

The simple concept is around optimization.  The initial push of the implementation is to meet all of the vendor milestones and accomplish all of the things that were decided way back when.  This often seems to leave some low-hanging fruit.  There are varying reasons these exist.

Often, the reason is what we know now, doesn’t quite line up with what we thought we knew or understood then.  It may have been a lack of understanding or possibly that some additional people weren’t in the decision process.

Another reason is the learning curve is limited by the “go-live” timeframe.  Some of the users aren’t as quick as others and they learned what was required but nothing beyond.  The EHR might be just one of the changes the users are currently absorbing.

The number of reasons could go on and on.  The reasons aren’t as important if you are already using a system.  If you aren’t you might want to ask others what they might have done differently.  The next step is what’s important.

I was introduced to the term “process re-engineering” some time ago and have been continually process re-engineering my life since that time.  When going through the implementation process to bring up an EHR, we often duplicate bad processes in the EHR because we don’t see the opportunity to improve other than the technology.  When I say we don’t see the opportunity, it could mean a couple of things.  One might be that the build team asked “How do you do it now?” and never examined if that was the best process.  The other side is that those answering the question don’t understand the technology available to know how to improve the process.

I recently came across a group where everyone is “e-prescribing.”  Interestingly there are several flavors of how “everyone” is accomplishing this.  There are some who are writing everything on paper as they always have done but now also entering the information into the computer.  There are some who are writing all of the prescriptions in the computer and printing them all out.  Both of these have missed some of the efficiencies of e-prescribing.  Among the efficiencies, are the medication list and allergy/DUR reconciliation that these two examples are gaining.  However, they are missing out on the delivery efficiencies available, as well as not using paper and incurring those costs.

I would suggest that groups schedule periodic process improvement evaluations that look at utilization, efficiencies and priorities from a technical and clinical perspective.  The main focus should be to get the most out of the systems in the most efficient manner.  Here is a list of some of the questions that should be asked?

How are you using the EHR?
What are your challenges with the EHR?
What are possible solutions to the challenges?
What would make the EHR most valuable to you?
Has the EHR made you more efficient?

Work with those that are having challenges, often the learning curve is what is holding them back.  They want things that are already there, they just need education on how to use the features.

Additionally study some individuals to see how they are accomplishing what they are doing in the system.  Use this to compare it to “best-practice” not as a tool to reprimand but as a way to show them the easier way.

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