2022 Clinical Workflow Flexibility Challenges in the EHR: Defining the Problem (Part Three)

In our two previous articles, we described an “as-is” exercise with the EHRA workgroup and the HIMSS Physician Committee members where one issue became the focus: the flexibility of workflows. This series of blog posts reviews the results of the exercise and describes a path forward. So far, this series has covered Learning the EHR, Personalizing the EHR and Understanding the Patient. In this article we discuss the fourth and final topic that was raised: Providing Care.

Providing Care
Providing medical care for the patient necessitates “last mile” flexibility that allows clinicians to jump in and out of the expected workflow. It has been demonstrated that a defined “workflow” that physicians agreed upon during development most commonly erodes after the first several steps. (1,2) The ability to step back into the workflow after a short detour needs to be readily available in an intuitive and simple manner. There should also be flexibility in how the EHR is used, both to conform to an individual’s working style as well as to respond to the demands of a clinical situation. Along these lines, but not limited to them, is the ability to have more than one patient record open with safeguards that ensure the correct data is always entered into the right patient’s chart.

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2022 Clinical Workflow Flexibility Challenges in the EHR: Defining the Problem (Part Two)

In our previous articles, we described an “as-is” exercise with the EHRA workgroup and the HIMSS Physician Committee members where one issue became the focus: the flexibility of workflows. This series of blog posts reviews the results of that exercise and describes a path forward. This article will focus on the second of the two topics: Personalizing the EHR and Understanding the Patient.

Personalizing the EHR
A common thread for “personalizing the system” is that while there are often tools available to personalize and configure the system, they can be difficult to discover, challenging to scale and share, and overwhelming to interact with in the clinician workflow. If it were simpler to personalize or optimize one’s own EHR experience, there would be little need for an organization to conduct optimization exercises after the initial implementation. After spending eight or more hours in formal training, and then significant time post go-live with practical EHR use, having some simple means available for self-configuration might remove additional hours of optimization, which will in turn reduce physician frustration.

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2022 Clinical Workflow Flexibility Challenges in the EHR: Defining the Problem (Part One)

Defining the Problem: Flexible Workflows in the Electronic Health Record (EHR)

The Electronic Health Record Association (EHRA) Clinician Experience Workgroup met with the HIMSS Physician Committee shortly after HIMSS 2021 to discuss areas of shared focus and create plans for collaboration over the next year. Our groups already agree on the quality, safety and efficiency-of-care benefits, to both providers and patients, that EHRs have brought. We also agree that there is more work to be done to improve and deepen the impact of these tools on care delivery, documentation and clinician satisfaction. The focus of our meeting was to decide where action was most urgently needed to raise the bar for EHRs. One topic that was of interest was the sense that EHRs lacked flexibility within clinical workflows. This series will provide a summary of our discussion, the areas of focus we agreed upon, as well as some of the promising solutions we discussed.

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Enhanced EHR Usability Starts With Understanding Users’ Needs and Challenges

By the EHRA Clinician Experience Workgroup

EHR utilization places a number of burdens on clinicians that can impact decision-making, workflow and satisfaction. This has been confirmed by recent studies, including one published earlier this year by the Journal of Biomedical Informatics which found that clinicians face numerous cognitive demands when using EHRs. The study concluded that the management of those demands ultimately limits clinicians’ agency to work individually and collaboratively while failing to help them develop awareness of, or reason about, the big picture or their patients’ current and future states, including effects of potential treatments. 

A study in Journal of the American Medical Informatics Association (JAMIA) found that when goal-based decision-making, sense-making, and agency/autonomy are overlooked in EHR design, it results in increased cognitive load, emotional distress, and unfulfilling workplace environments. And a study from Mayo Clinic and the American Medical Association (AMA) and published in Mayo Clinical Proceedings, gave EHR usability a grade of F, which is “markedly lower” than for most other technologies. Researchers further noted a strong relationship between usability and risk for physician burnout.  

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State of the Note Summit 2021 from ACP and EHRA

By EHRA Clinician Experience Workgroup

In January of this year, CMS adopted new billing guidelines from the American Medical Association (AMA) regarding E&M coding. The new guidelines include a wide variety of much-needed changes focused on streamlining billing processes and reducing clinical documentation burdens.

Seeing this as a watershed moment for clinical documentation and an opportunity to produce shorter, more clinically focused notes, the American College of Physicians (ACP) partnered with the Electronic Health Record (EHR) Association. Together, we examined the practical impacts of the coding changes with our community of vendors and clinical stakeholders, specifically:

  1. What consensus about documentation burden exists across vendors, healthcare organizations, and specialist societies when interpreting the guidelines?
  2. What questions, if any, exist around the guidelines?
  3. How can we effectively educate the community about the impact of the guidelines?
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Five Ways EHRs Are Helping CDC Track COVID-19 Vaccinations

By the EHR Association COVID-19 Task Force

In December, two COVID-19 vaccines received authorization from the FDA, and the federal government began distribution to the states almost immediately. Millions of Americans have already received their first dose – many their second – and millions more will be vaccinated in the coming weeks and months. While social distancing, frequent hand washing, and face masks remain vital tools in limiting spread of coronavirus, we can increasingly see our way to a full return to hugs and handshakes, in-person meetings, travel, pubs and parties, concerts and classrooms.

As we anxiously await a return to our old way of life, public health experts, policymakers, and the public are watching the CDC vaccine data tracker, updated every evening with the latest numbers, including: 

  • How many vaccine doses have been distributed to-date? 
  • How many vaccines have been administered?
  • How many people have received their first dose? 
  • How many people have gotten a second dose?
  • Which vaccine is being administered?

But how does the CDC get all that data? The answer varies, but it’s made possible by technology, and electronic health records (EHRs) have been a key player from the beginning. 

Here are five ways that EHRs and the EHR Association are playing important roles in vaccine administration and data collection in the United States.

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