Technology adoption is iterative. Here are some suggestions that can help you adopt and morph EHR techniques and processes to fit into your own practice’s workflow.
When it comes right down to it, some are basic learning techniques that can apply to any new situation in the office.
And remember, everyone has something to learn.
Don’t get stuck in your own routine, if a physician finds a work-around that improves a system function or someone figures out a better way, get out of your box and make the change.
Set up a buddy system. Pair up doctors and nurses with a peer who is using a particular function or has developed a workflow, template, or process. Note that it may be optimal to invite one doctor to serve as a model for one process or task and others for different “tricks”.
Round on physicians who may be struggling. “Be available” so they will ask questions rather than waiting for them to come and ask for help. If you’re not the one who’s rounding, appoint someone else who will.
Physicians get too busy, or, at the end of the day, they just want to finish up and go home, or they don’t want to bother staff. So the designated trainer for your practice needs to go to the physicians and “hang out.” Set up a rounding schedule so that each physician is rounded on for one hour every two weeks.
Query the EHR (or practice management system) to identify the top 10 diagnoses for each physician and use those to build protocols and templates rather than waiting for the physicians to provide a list.
Introduce a new feature once every two weeks (one-on-one with each physician/nurse team). Everything cannot be assimilated at once. This will require careful tracking and monitoring of each individual’s needs because one user may need more support using a function or process that another user has conquered.
The adoption of technology is a very iterative process; there is always the next step that can be taken by learning something new, or changing a workflow.
Pre-chart on the EHR before entering the exam room helps prepare for the visit efficiently and stages the tasks.
Give new physicians extra time to “clean up” the charts. Just as it took about a year after the practice adopted the EHR before patient charts were caught up and tidy with all the data necessary, it may take that much time for a new doctor to get the charts of patients seen by his predecessor in a shape that will allow him to work most efficiently with them.
Use nurses to do more for the physicians. For example, the physician might order a change to Coumadin, but the nurse would actually enter it into the EHR and all the physician would need to do is approve the entry.
Remind and retrain nurses and physicians on how to filter the orders queues.
Train nurses to print labs as visit prep so the physician can discuss and deliver to the patient during the visit.
Let Dragon fit the personal style of each physician. If your practice uses voice recognition software, remember that everyone uses it differently. For some it is used to supplement their visit note, others use it to comment on labs. Rounding will provide examples in your practice for physicians to model as it fits their personal style.
Have enough workstations. There should be terminals in hallways outside exam rooms and extra workstations at nursing stations for physicians to use. It is possible to maintain an “empty” or near-empty inbox by working the list between patients.
Try to have dual monitors at each workstation so physicians can review documents in their work list/in box on one monitor and open a patient chart on the other. This will ease the review process for items such as EKGs and labs.
Investigate use of tablets or signature capture pads for patients’ informed consent for things like CT scans. Creating an electronic form that the patient can sign electronically eliminates additional paper to route and scan.
One key mantra to keep in mind: One size does not fit all.
Some physicians are more comfortable moving through the system in the exam room. Some are more comfortable using a headset and dictating, which is clunky for others. Some are fast on the keyboard (trained typists and hunt-and-peck pointers, alike).
Everyone is at a different stage with different “wants”.
The key to optimization is personalization — get out into the patient care area and find the trick that works for each individual!
You can reasonably expect continued iteration and effort as the integration of the EHR tool into the operational workflow progresses within each physician’s practice.
And remember the medical model for teaching also works for learning new EHR tricks: see one, do one, teach one.
Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.