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Six EHR Optimization Tactics to Streamline Clinical Workflows
With EHR adoption across almost all US hospitals, the digital health transformation has moved towards EHR optimization to improve clinical workflows.
Across the industry, healthcare organizations are tapping EHR optimization tools to streamline clinical workflows in an effort to combat a crippling clinician burnout problem.
The HITECH Act of 2009 successfully promoted EHR adoption nationwide, but the sudden proliferation of EHRs has increased clinician burnout. In a 2018 poll, 71 percent of physicians nationwide agreed that EHRs contribute significantly to burnout, and 59 percent said that EHRs need a complete overhaul.
What's more, clinicians who are very dissatisfied with the EHR are almost three times as likely to report that they are likely to leave their organization compared to clinicians who are very satisfied with the EHR. With a national shortage of 124,000 physicians expected by 2034, physician retention will be more critical than ever in the coming years.
While EHR optimization is individual to each healthcare organization based on its needs, the following strategies—a list that is not exhaustive—are some of the most common ways practices are looking to improve workflows and provider satisfaction.
Clinical Documentation Automation
Physicians spend 34 to 55 percent of their workday creating notes and reviewing records in the EHR, according to a 2018 study published in Mayo Clinic Proceedings.
While some of the time spent on EHR documentation creates ongoing patient health histories, much of it functions as billing and regulatory compliance documents, expounding the association between EHR use and burnout.
For example, among primary care residents and teaching physicians that reported burnout in a 2017 study, 75 percent attributed "some or a lot" of their burnout to EHR use.
Provider frustration with EHR documentation has paved the way for the medical scribing industry. Medical scribes listen to patient-provider encounters virtually or in person and complete EHR notes for clinicians.
However, recent advancements in artificial intelligence (AI) have brought to market automated EHR documentation solutions that can assemble clinical information from multiple sources faster than humans. The tools, often called "digital scribes," use speech recognition and natural language processing (NLP) to create EHR notes in real time by listening to patient-provider encounters.
Moreover, AI-enhanced clinical decision support software can analyze a note's content and provide evidence-based recommendations in real time during the note-creation process.
While digital scribe technology is on the market, it has only emerged in recent years. However, a 2023 KLAS report revealed high satisfaction rates among early adopters, with customers noting the system's ability to alleviate clinician burnout.
While digital scribes show promise, interviewed organizations also pointed out challenges with the technology, including high expenses and the need for enhanced EHR integration and quicker note return time.
Telehealth EHR Integrations
Popularized by the COVID-19 pandemic, telehealth tools allow providers to see patients remotely through video or audio-based visits. While some telehealth tools are stand-alone platforms, most telehealth providers now design solutions that integrate into many EHR systems, enhancing interoperability and improving the clinician experience.
According to a study published in The Annals of Internal Medicine, providers spend over 16 minutes using the EHR per patient encounter. Making telehealth visits easily accessible within the EHR can help give providers back more time for patient-centered care.
When telehealth systems are integrated into the EHR, providers can access their virtual appointments seamlessly. On the other hand, stand-alone telehealth platforms require multiple clicks to bounce between documentation and video screens, adding to clinician burden.
EHR integration also automates data entry and eliminates the need to enter the same patient information multiple times. After the telehealth visit, the clinician creates a summary of the visit, which uploads to the EHR. Without integration, the clinician must enter the same information into the EHR and telehealth platform separately.
Further, providers have reported that access to the EHR during a telehealth visit facilitates better care and rapport with the patient, according to the Michigan Medical Society. Additionally, clinicians can easily create visit summaries and transmit them to patients with orders for diagnostic tests or referrals.
In a 2022 KLAS report, customers ranked EHR vendor Epic’s virtual care integration the highest overall ratings due to the platform’s ability to support a strong patient experience. Multiple customers also pointed to the “deep integration” benefits of the Epic platform.
Respondents said having a unified system that allows patients to schedule appointments, access records, and see their doctor virtually gives patients more power and confidence in the health IT.
HIE Search Engines
Connecting to a health information exchange (HIE) helps healthcare providers access patient data for care coordination. However, meaningfully using that information for clinical decision support is not always easy due to a lack of data aggregation. HIEs often run into the same problem as stand-alone telehealth platforms; providers must often leave their native EHR workflows to log on to HIE portals and search for patient information.
However, in recent years, EHR vendors have developed HIE search engines to streamline patient data exchange. Take the PRISMA tool from EHR vendor eClinicalWorks for example.
The EHR-based platform connects to two national interoperability networks: Carequality and CommonWell Health Alliance. The Carequality interoperability framework connects over 600,000 providers across the country, and CommonWell's network currently has over 26,000 provider sites and more than 144 million enrolled individuals.
Using PRISMA, providers can generate automated searches that return patient health records in seconds. Physicians then have access to a searchable timeline view of each patient's health history, including lab reports and imaging results. The HIE search engine also aggregates patient data from insurance payers and patients' wearable devices to promote enhanced interoperability.
ePrescribing Tools
ePrescribing has taken the healthcare industry by storm in the past two decades, offering a more efficient prescribing option.
Providers have traditionally conducted data exchanges related to prescriptions via fax and phone. However, these manual communication methods can contribute to administrative burden. ePrescribing tools allow providers to enter prescription information into the EHR and securely transmit the prescription to pharmacies electronically.
While research has found that ePrescribing takes providers about 20 seconds longer per patient, time savings in the overall prescribing process compared to handwriting prescriptions offset this added time.
For instance, ePrescribing tools allow prescribers to streamline prior authorization, a utilization management strategy that payers use to ensure patients access the most cost-effective medication available for their clinical needs.
When a drug has prior authorization requirements, providers must submit certain documents to the payer for permission to prescribe the drug. However, the traditional prior authorization process via fax can lead to delays in patient care.
According to a 2019 AMA survey, 64 percent of providers must wait a full business day to receive prior authorization feedback from payers; 29 percent reported waiting at least three business days.
Electronic prior authorization (ePA) aims to speed up the process by sending prior authorization documents digitally instead of via phone or fax. ePA can be integrated directly within EHR workflows to allow providers to easily.
A 2021 AHIP study found that providers who used ePA for most of their patients reported less administrative work related to prior authorizations; 54 percent had fewer prior authorization-related phone calls, and 58 percent had fewer faxes related to prior authorization.
EHR Templates
Structured EHR templates are notes created in advance for common cases seen by a clinic, according to the California Health Care Foundation (CHCF). Structured templates aim to support uniform data capture, reduce documentation time, and provide clinical decision support.
Templates work well for scenarios with an isolated problem with a limited number of predictable variations, according to CHCF. For example, a template for a patient with a complaint of headache can provide clinicians with a set of signs and symptoms to check.
Similarly, structured templates work well for specialty care settings with a limited range of diagnoses and conditions and well-care checkups that follow a routine schedule. However, CHCF noted that templates are not optimal for all clinical scenarios, including caring for patients with multiple chronic conditions.
While some studies have found that EHR templates improve note quality, other research has suggested that the individualized nature of EHR templates can present challenges.
A 2021 study found that clinicians at an academic medical center used 100,000 unique EHR templates over two years, and 83 percent of templates were only used by one clinician. While templates can mitigate clinician burden in the short term, such a large volume of individualized templates could lead clinicians to leverage outdated clinical guidance.
The study authors suggested reframing template use as a form of computer programming to maintain the benefits of personalization while still supporting standardized documentation to improve clinician burden.
"Version control systems—which let individual developers' fork' and edit documents while preserving a link to the original so changes can be propagated to their copy without overwriting their edits—might let individual clinicians tailor default templates to their unique workflows while still making it possible to quickly propagate changes across an organization when policies change," they explained.
As the digital health transformation progresses, ensuring that health IT systems reflect clinical workflows will be critical for technology to help, not hinder, high-quality care delivery.