By Doug Cusick

Browsing through trade and even consumer media, it is easy to become pessimistic about the state of electronic health records (EHRs). One article may describe how a health system is spending hundreds of millions, if not more than a billion dollars, ripping out and replacing a new EHR platform. While no one will argue with the need for EHRs, countless articles have focused on how the technology is contributing to physician burnout.

For example, survey results published in JAMA Network in August 2019 stated: “The adoption of the electronic health record (EHR) has occurred alongside the dramatic and troubling rise in clinician stress and burnout.” The article goes on to describe how survey participants cited factors such as excessive data entry requirements, long cut-and-pasted notes, inaccessibility of information from multiple institutions and interference with work-life balance, as among the many challenges physicians face with EHRs.

More such research and commentary can be expected in the coming years, but what hasn’t been reported enough is how EHR satisfaction is improving across many health systems. Ironically, while EHRs are one form of health IT that has disrupted physician workflows, other types of health IT are addressing the issues with EHRs that aren’t working, so that clinicians can enjoy practicing medicine again. For example, third-party applications that are customized to physicians’ workflows and specialties can be embedded into EHRs to improve functionality and to accomplish important tasks such as improved patient hand-offs without having to duplicate efforts when there’s a shift change at the hospital.

The transition from paper to electronic records has been difficult, and we’re not at the end of the tunnel yet for many hospitals and health systems. Thanks to the emergence of innovative and powerful integrated technologies within EHRs, some organizations are seeing the light. This technology is changing physicians’ and clinicians’ experiences with their EHR — from frustration to satisfaction — enabling teams to deliver safer, more efficient care that supports optimal outcomes.

One EHR, hundreds of teams
Across a typical health system, there could be hundreds of care teams comprising physicians, consultants, nurses, technicians, social workers and others, each with their own unique workflow and information needs. EHR workflows were not designed with each team member’s needs in mind. They were actually built to address common financial and coding needs across an entire healthcare system — which means they may actually be disruptive to specific workflows.

Care teams can be quite large and include clinicians inside and outside the facility, flowing in and out of the hospital all day and night. Although the faces may change, they all access the same EHR system with the same generic workflow and general information. They must search to find the relevant information they need to safely deliver care and then move on to the next patient on their rounds.

For example, an overnight RN may start his shift with a patient admitted for a heart condition who appears to be decompensating. He searches the EHR for the hospitalist’s and/or on-call cardiologist’s clinical notes, which were not shared during the patient handoff — but is unable to find that critical information. That means the nurse must start calling or asking around about the right physicians who need to be contacted.

If the EHR were optimized with an embedded application, the first information the nurse would see is those team members’ names, along with the rest of the team for that patient at the bedside. In addition, their clinical notes would be readily accessible. Viewing immediate and accurate contact information for all clinicians saves many cumulative hours each week of searching, calling and waiting for answers. When this critical information is readily accessible within the EHR, clinicians starting their shift have the EHR context that they need to ensure care continuity and enable them to act quickly if an intervention may be needed.

When the EHR information is juxtaposed with the active patient list and action items in a highly intuitive and workflow-focused design, EHRs support workflows rather than disrupting them. Such a list can include real-time updates on patients’ conditions, medications, last rounding information and other relevant data. If the nurse decides that some needed data on that first screen is missing, they can leverage the integrated technologies within the EHR to easily customize it for maximum relevance. This data also can be synchronized between users and across the various modules of the EHRs so all care team members have the same, up-to-date information, which saves time at the point of care and during documentation, and protects patient safety.

Having these capabilities available through an easily integrated application — with no rip and replace — is in stark contrast to traditional EHR customization that is done by the vendor, which could take weeks or months of waiting and countless dollars for the vendor to perform a change order.

Standardize workflows by condition
While flexibility is essential, providers often use standardized information sets to manage the most common conditions they treat, such as diabetes. Within the EHR, however, context-building data is often scattered, making it difficult for clinicians to identify trends to drive their decision-making. These conditions also frequently have common orders that need to be entered, requiring the physician to perform repetitive data entry throughout the day.

An embedded optimization application can standardize the workflow for such chronic conditions while offering opportunities for customization. Data can be organized and visually presented so that providers can quickly assess trends and glean the insights needed to deliver evidence-based care while advance order sets reduce data entry. Embedding the technology within the EHR saves care teams from redundant typing, searching for data, and toggling between screens.

Following such protocols is backed by research. The University of Washington, for example, implemented a standardized handoff process called IPASS, which was supported by an EHR-integrated application, and found it reduced communication errors by a significant 3% while 73% of clinicians reported that the process improved team communication and patient safety. A separate randomized, crossover study published in Academic Medicine found residents who utilized standardized and integrated rounding and sign-out software reported fewer medical errors and adverse drug events than the control group, who used the EHR and separate lists. The rounding and sign-out application also alleviated residents from 30 to 45 minutes per day of menial copying and recopying patient information onto rounding lists, progress notes, and sign-out sheets without risking patient safety.

Mobile care requires mobile data
Clinical teams aren’t stationary, and it can impede workflows to search for an open computer workstation, log in, and then access patient information or respond to a secure text message from a colleague. In addition, most EHRs were not designed at a time when there was near-universal adoption of smartphones among clinicians. This resulted in vendors playing catch-up to deliver apps that often contained the same usability challenges as their desktop counterparts.

EHR optimization technology has addressed this mobile demand by offering companion smartphone and tablet apps that are intuitively designed for clinicians’ workflows, delivering specialty-customized data and functions they need during rounds, in meetings, away from the office, or elsewhere. Providers can access clinical data, including medications, labs, vitals, allergies, I&O, TLD, notes, cultures, radiology and others specifically organized for their specialty. From mobile, they can also perform important functions such as updating the assessment and plan, managing their patient list and signing out of on-call coverage, which ensures the right provider is contacted by the on-shift clinicians at the hospital.

Providers can also securely text with the care team and link their messages to the relevant patient for maximum context and to protect patient safety. To prevent alert fatigue, advanced EHR optimization technology apps offer greater control so clinicians can subscribe to alerts that are most important to them, such as when a patient spikes a fever or when a consult is available.

Putting the flow back in workflow
When the EHR works like physicians and other clinicians want to work both at a computer workstation and through mobile devices, training is rarely necessary. Clinicians simply follow their intuition and inevitably find the relevant and actionable information they need and deliver the care needed for that moment.

Such a scenario calls to mind a joint paper issued by Harvard Global Health Institute, Massachusetts Medical Society, which found that improving physician satisfaction and giving them a sense of efficacy in their work hinges on improving workflows, managing distracting or unhelpful alerts, and alleviating burdensome documentation processes.

Embedded EHR optimization technology restores the control over the workflow called for in that joint paper. By delivering the right information about the right patient at the right time and the right place, the technology itself becomes invisible, allowing physicians and other clinicians to instead focus on productivity, efficient care delivery, and helping their patients achieve optimal outcomes.

About the author: Doug Cusick is president and CEO of TransformativeMed which makes EHRs easier to use.