Clinical Workflow Optimization Key for EHR Usability, Satisfaction 

On a research mission observing numerous orthopedists years ago, Paul Brient, athenahealth’s chief product officer, said it was almost as if the doctors were doing different things altogether, despite their shared specialty. These stark differences, observed even across the same type of medicine, give prudence to the argument for stronger EHR optimization to streamline workflows.

“The biggest pain point that doctors have about EHR is that it gets in the way of patient care and doesn't provide net benefits,” Brient said in an interview with EHRIntelligence. “Many physicians are still in the belief, perhaps correctly so, that the EHR is not helping them in terms of patient care.”

Longer clinical notes, greater EHR inbox volumes, and an overall increase in the EHR workload in recent years have mounted clinician burden concerns.

Brient said that EHR vendors must create health IT that supports individual provider needs so instead of getting in the way of patient care, EHR systems can help providers improve care quality. 

“The goal, like any workflow tool, is to make it so that the EHR workflow in the computer is the same workflow that the physician is following,” Brient said. 

Since clinicians from different areas of medicine have vastly different daily tasks and procedures, they require specialized workflows, he explained. 

“If you're a primary care physician and you're doing an annual well visit, you have a bunch of preventative care things you want to focus on, which is a very different situation than if you're a surgeon taking care of someone post-op or preparing someone for a surgery,” Brient pointed out.

To support differences in provider workflows, physicians can tailor their workflow through the EHR in terms of what information is presented on the screen, he said.

For example, easy access to x-rays, CT scans, and MRIs is important for orthopedic specialists, but not as important for primary care physicians, Brient noted. 

“The way we tailor the presentation to be responsive to the type of physician and the type of encounter is a real key to making the EHR much more intuitive and much more usable,” he said. 

Brient noted that provider workflows can vary greatly even within a particular discipline. For instance, he recalled visits to several specialist orthopedists to observe their workflows and it was almost as if they were doing different tasks altogether. 

“It's important for us as vendors to understand those differences, embrace those differences, and support them,” he said. “You have to make the system incredibly flexible and configurable so that it can work the way the physician thinks.”

Brient noted that while surveys can be helpful in determining how to improve EHR usability at a particular institution, the best way to understand what physicians need in their health IT is through in-person observation.  

“The key is to develop deep, experiential understanding of what's happening in the physician office,” he said. “For the most part, we're not clinicians at athenahealth. We're software folks. It's really important for us to be out with physicians who are caring for patients day in, day out, and understand the workflows and the diversity of the work.”

Physicially being in the physician’s office allows EHR vendors to come up with more breakthrough solutions to EHR usability problems, Brient said.

“If you go there and you experience what physicians are doing, your creative juices can flow and you can think about the problem at a more mental level,” he said. 

Brient explained that observations in physicians’ offices have led athenahealth to make improvements to patient check-in processes, for example.

Often, the front desk staff at a physician’s office is in charge of inputting patient health insurance information into the EHR. If the information is entered incorrectly, which happens sometimes due to human error, everything else downstream falls apart in terms of reimbursement and patient payment.

Brient said that rather than trying to make that process better, the EHR vendor got rid of it all together. athenahealth developers created an artificial intelligence (AI) tool that can read patient’s insurance cards and match the patient up to the correct insurance package. 

“That's probably not an idea that we would get from our customers necessarily, we might but it's unlikely,” he explained. “But if you stand there and watch knowing that in the back end, some of the insurance information is inaccurate, you kind of go, ‘Wait a minute, let's get back to the peripherals here and solve this problem differently.’”

Brient said that athenahealth is working on infusing AI into other areas of the EHR to improve the clinician experience. Currently, the vendor is focusing on leveraging AI for discharge workflows. 

He noted that patient discharge processes within the EHR often lead to end-user frustration. 

“One of the things that drives doctors crazy is they will put all their orders in the EHR at discharge time, and then they go to discharge this patient and up comes a bunch of questions on the screen,” he explained.

Often, these questions can be answered by items the provider already had entered into the system which rightfully leads to frustration, Brient noted.

“EHRs are relatively dumb,” he said. “We're doing a ton of work around making sure that the EHR understands the patient, the clinician, and the context of the encounter so that we can thoughtfully serve up information.”

“We can, frankly, put lower in the hierarchy information that's not relevant to that situation and avoid asking the dumb questions,” he said. “We work really hard to beat those out of our system.”