EHR Usage Studies Should Be Based on Optimized EHRs
A recent report cited by the US House Ways and Means Committee referenced the impact of EHRs on physician performance. The report results indicate that during the office day, physicians spent 27% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37% on EHR and desk work.
The “elephant in the room” question is whether the EHRs being used in this study were first evaluated to ensure that the EHR workflows of the study clinicians had been optimized. The Arch Collaborative has been studying the impact of EHR personalization tool use for over 18 months, and the findings show that higher EHR personalization results in higher EHR satisfaction.
Provider organizations that focus on EHR training and education related to physician workflows, by specialty, have higher Net EMR Experience Scores (NEES). Physician satisfaction is directly related to higher EHR efficiency and usability. Would the results of the above cited study have improved if the EHR workflows of the physicians had been optimized? We believe they would.
Personalization tools fall into three major categories:
- Data input
- Patient data retrieval
- Workflow/navigation
Data input personalization tools that streamline physician notes and other documentation (e.g. HPI) can reduce the amount of effort required to capture patient data in the exam room. The use of macros, preference lists, order sets, and templates create efficiencies for documenting patient data.
Personalization tools used to retrieve patient data from the EHR are correlated with higher levels of physician satisfaction across all personalizations. Customized report views, sort orders, and filters provide efficient means for physicians to access pertinent patient information quickly. These tools are useful for physicians for review before patient appointments, as well as during the patient exams.
Workflow and navigation personalization tools enable the physicians to quickly access EHR functions that are used most often with minimum “clicks.” Layouts provide this capability via a dashboard like functionality. Speed buttons/shortcuts enable physicians to quickly get to functions they need from almost anywhere in the EHR. If appropriately implemented, the workflow/navigation personalization tools can provide significant improvements in physician efficiency in using the EHR.
All personalization tools need to be evaluated for their ability to improve the efficiency of the physician EHR workflow for care delivery. If well designed and implemented, these personalization tools should decrease the time physicians spend on EHR functions.
It would be interesting to have the cited study done again after an optimization of EHR personalization tools supporting the physician workflows to see the impact. We believe the reduction in physician time spent in the EMR would be significant.
As we’ve gotten deeper into the data set provided by the Arch Collaborative, we’ve found that there are many optimizations available to clinicians that simply aren’t utilized. Part of this stems from a lack of ongoing training on the EHR, as most clinicians surveyed report no ongoing training. KLAS has found that 3-6 hours of annual training in the EHR is positively correlated with NEES.
Before expending the considerable resource effort on time and motion studies to evaluate the impact of the EHR on physician time, it is highly recommended the EHR first be evaluated for workflow optimization of the physicians being studied.