A common concern among physicians virtually everywhere is that there isn’t enough time in the day. Not enough time to spend with patients; not enough time for administrative tasks; and not enough personal time.
But a project started by Atlanta-based Emory Healthcare has targeted a reduction in EHR clicks through customized workflow as a means to, at the very least, make the use of technology more efficient. “We started with a pilot in cardiology in June,” says Julie Hollberg, MD, CMIO of Emory Healthcare. “But now we’ve actually rolled it out throughout the entire clinic.” With significant results. Eight weeks after the new workflow launched, physicians’ Pajama Time—the time Emory physicians are in the EHR system at night and on the weekend—dropped by 36%. And according to Hollberg, this is only the beginning. “Our thought is this needs to be a continuous improvement cycle by which we look for efficiencies and ways to improve provider workflows so that patients and providers have better experiences.”
Hollberg says that the project is strongly linked to ICD-10 preparation. The rationale was that if being ICD-10 compliant was going to increase physician workload, it was important to figure out how to cut work in other places. Thus Emory began collaborating with its EHR vendor, Cerner, a supplier of health information technology solutions. “In our current electronic medical record, you have to click on a lot of different places to find the information that you need,” Hollberg says. “So, you have to click on the lab tab to see lab results, the vital signs tab for that, the radiology tab; you have to click through the different sort of file folders to find all of your notes.”
With the workflow tools Cerner supplied, Emory designed a single page where each specialty could decide what it wanted to see on a single screen. The idea is that what a neurologist wants to see is different from what a primary care physician wants to see. These specialty-specific views on the electronic medical record reduced how long it takes physicians to navigate their charts by about one-third.
“The way we measure that is we use a tool from Cerner where you can basically video what’s happening within the screen without being over the physician’s shoulder,” Hollberg explains. “And so you can see, within the workflow, what’s happening.”
Support and Surprise
Hollberg says physicians were receptive to this benchmarking approach because, “We’re all scientists.” She explains that physicians have been given a wide assortment of technology tools, or been told to use different platforms, with the hypothetical promise that it would make their lives better. That promise has not materialized. “But the potential to actually have data to access is appealing because it moves things from a subjective conversation to a really objective conversation,” Hollberg says. “You want to give the right information to the right person at the right time. By having these provider specialty views of the chart, we brought the right information to the right person, and much faster than we did before.”
Hollberg admits she was pleasantly surprised by the results. Even physicians who work quickly don’t often realize how many clicks it takes for them to perform a specific action. And now using advanced tools from Cerner, the ability exists to measure how much time physicians spend on different parts of the workflow. Or how long they spend doing documentation. That data is being used in the next phase of the project which is targeted coaching.
“Our goal is for them to be able to spend more time with patients, more time with their families, and less time working within the electronic medical record,” Hollberg says.
Making Life Better
Hollberg says she’s not ready to make the connection between reducing EHR clicks and the healthcare provider’s bottom line. But Emory is making strides where it wants. “We’ve kind of talked some of them (physicians) off the brink of burnout and losing it, with the window of, wow, this tool actually could make my life better,” Hollberg says. “So we’re peeling back the frustration and starting to show people how we can use the tools to make things better.”
For healthcare providers looking to emulate Emory’s results, Hollberg says they need a partner. And that partner should be their electronic medical record vendor.
“We would not have been able to do what we did without Cerner’s help,” she says. “But Cerner’s not the only electronic medical record vendor hearing that what a primary care doctor needs to see is different than an anesthesiologist. Talk to your vendors about what specialty-specific windows into the chart are being offered.”
This article originally appeared here.