End User Experience – Part 1
How many hours are spent each day clicking the necessary buttons to document patient notes? How much is this costing your organization in both time and money?
There is a certain level of documentation that providers and staff must complete to meet the organizations needs for insurance audits, quality improvement programs, medical compliance, etc. However, is the EHR helping with this documentation or making it more difficult? I will review these points in this blog. I will also discuss the importance of customizing your system or workflows to gain the most efficiency out of this very expensive software program that you have implemented.
As I discussed in previous blogs, the end user experience is critical to the success of the EHR within your practice. If end users (providers, nurses, and support staff) find the EHR an obstacle to complete their work rather than something to help with their work, then the EHR needs to be adjusted to change this perception. It is sometimes difficult to determine if the users are just adjusting to the change or if there are issues with the implementation of the EHR in your environment. Having both subjective and objective metrics to measure the success of an optimization project will assist you in determining high priority areas to focus on.
Many providers are not happy with the EHR system they are using currently and organizations are reviewing the possibility of switching systems to ease the frustration of their providers. However, changing the entire system may not be the ultimate solution. There is always the “grass is greener” approach but before a group makes such a drastic decision they should consider doing an detailed review of their current workflow and system setup to determine if a much more cost effective optimization process could achieve a higher level of satisfaction.
In today’s blog, I will be focusing on the objective measure of “Click Counts”. I have been implementing EHR systems for well over 15 years and I do not believe I have ever done an implementation without at least one user telling me it takes xx number of clicks to perform a function. What better way to prove the system is better after an optimization project is completed then to show “Saved Clicks”? It’s pretty simple actually, show the exact number of clicks to perform various common workflows.
- Identify Top 25 “painful” workflows
- Document step by step, click by click the current workflow
- Develop a summary of clicks
- Engage development staff and users to improve the system
- Document step by step, click by click the improved workflow
- Calculate Clicks Saved
The video in this blog reviews one workflow and the clicks saved.
Time Savings Per Function Per Provider
|Function||Original Clicks||Optimized Clicks||Click Delta||Time Difference in Seconds (assuming 1 second per click)||Average # of Patients Seen Per Day Per Provider||Total Time Per Day in Minutes Saved|
Time Savings with Total Optimization
The above is just one workflow that could be improved. I am going to expand this and assume that during an improvement process we could identify 20 areas within a typical patient encounter that could be improved similar to the example above. You can take this formula and modify to reflect your practice’s information and current state.
|Time Difference in Seconds|
(assuming 1 second per click)
|Number of Functions Improved||Average # of Patients Seen Per Day Per Provider||Total Time Savings Per Provider in Minutes|
(time saved X number of functions improved X average number of patients)
Dollar Savings / Revenue Potential
The total time saved could now be put into dollar amounts by calculating the potential of additional patients added to the schedule. Practices could also give the above time back to providers and staff to perform other functions that are needed for the daily workflow. Either way, optimizing your workflow and your systems gives time or money back to the practice.
|Total Time Savings Per Provider in Minutes||Potential Additional Patients Seen Per Day|
(assume new patient 45 min. appt.)
|Average Reimbursement per Visit per 2015 Medicare Fee Schedule of 99204||Average Monthly Office Days Per Primary Care Provider||Total Potential Revenue Per Provider Per Month||Total Potential Revenue Per Provider Per Year|
As you can see, developing a plan to take a serious look at your systems may not only allow for an improved end user experience and job satisfaction, but it could also mean a great deal of increased revenue for your practice.
How to Improve Your Click Count
The clinical documentation tools (forms) represents the primary point of data entry into the patient’s record and also has the largest workflow impact on providers and staff. Effectively the forms are the EHR to most providers. Insufficient clinical content development necessary to accommodate the organizations workflows and not an out of the box workflow, will cause dissatisfaction and frustration with the end users.
Many EHR systems provide an “out of the box solution”. This content has been used by clinicians for many years and provides new implementations a quick and standard method of implementation. While this solution does provide a consistent standard of implementation, it does not allow for many customizations and can create major inefficiencies in the clinical workflow by not allowing a practice to customize to their needs. There may be state regulations, special programs, provider preferences, business decisions, etc. that cause the organization to need content that is specific to their business.
Some EHR’s do not have tools to customize the content within their system. These types of systems may require a more detailed review of the workflow of the practice to determine if there are changes that can help to gain some productivity. There are also systems such as GE Centricity that have tools available such as the Visual Form Editor, which allows for very robust customization of clinical forms used by the organization. This option will allow a group to provide very efficient and customized content utilizing GE Centricity’s robust programming language but will also require more maintenance and support.
Engage with Someone Who Knows the Functionality of Your EHR
Just as a primary care physician doesn’t typically treat a broken bone, you should not engage with resources that do not have expertise in the specific area that you want to improve. If you are looking to specifically focus on the tools used to document a visit then you should be certain that the resources, either internally or externally, have a great deal of experience in the system and its full potential and limitations. A very knowledgeable resource will be able to most drastically improve your processes.
You can also leverage what other groups have done. If a group has made some significant modifications to their system and the practice is similar to yours, then leverage that experience and that knowledge. In my experience, most healthcare environments are very collaborative and would be happy to share what they have learned/developed. Networking can be very beneficial to understand options that you may not even be aware are available to you.
Lastly, don’t be afraid to think outside of the box and ask for things that seem impossible. Technology is a very powerful tool. Many systems have flexibility that isn’t openly discussed because many times the EHR vendors just don’t have the resources to implement or more important support “out of the box” workflows. They design, build and implement their systems in a standard method. Practices and individual providers simply do not know the details of the technology behind this powerful tool. They don’t care if it has a SQL, Oracle, Unix, etc. platform, they just want it to do what makes sense to their workflow. Software vendors struggle, for good reason, on how to give so many customizations to their clients while still being able to support these customizations.
The best implementation of software is done when the end users collaborate closely with developers. This promotes the best end user experience and is critical to the implementation of any software platform. If you are considering an optimization project for your organization, begin to identify individuals who could work with developers to design a system that will work for you instead of your providers and staff being forced to just click the buttons……