Clinician Engagement, Tailored Training Key for EHR Implementations

Proactive leadership

The study authors emphasized that organizational leaders must create a governance structure that includes experts with operational and technical expertise to oversee the EHR transition and intervene as issues arise.

Organizational leaders should also ensure that clinicians are engaged in implementation planning and EHR configuration, they said.

“Clinicians are used to their daily workflows based on specific screens and content within the user interface of their existing EHR, but many of these workflow processes will be disrupted by the new EHR user interface displays, content, and navigation pathways as well as variations in adoption rates for these new workflows by the larger care team,” the authors explained.

Governance structures that ensure clinician engagement in the EHR implementation planning process could help optimize the EHR to meet user needs, the authors said.

Proactive risk assessment

The study authors noted that EHR implementations often result in workarounds that bypass safety procedures. For instance, an organization may need to modify existing clinical decision support mechanisms for a new EHR implementation.

“Proactive risk assessment, or the identification of potential risks before they occur with a goal of either mitigating their impact or preventing them from occurring, is thus essential,” the authors said.

The authors emphasized that the best strategy for proactive risk assessment is to useONC’s SAFER (Safety Assurance Factors for EHR Resilience) Guides, a suite of checklists that identify safety concerns related to EHR technology and clinical processes. 

Reduce unwarranted variation

Next, the study authors said that healthcare organizations should standardize certain EHR features, functions, and workflows to reduce unwarranted variation within the system.

For example, some healthcare organizations allow clinicians to create personalized order sets. However, this introduces significant practice variation and introduces long-term maintenance issues, the writers pointed out.

“Organizations should anticipate similar unwarranted variations related to EHR design, development, configuration, and use,” they wrote. “These variations worsen quality and increase cost.”

Additionally, reducing unwarranted variation in how clinical data is defined, coded, and stored can help increase interoperability with EHRs from other healthcare organizations, they explained.

Foresee information access problems

Ensuring providers maintain access to complete patient health data is essential to providing uninterrupted care during EHR implementations.

The study authors said that healthcare organizations should import as much valid coded data and free text data from their old EHR as possible in anticipation of information access problems.

“It may not be possible to automate all data migration tasks, therefore, healthcare organizations should invest in resources to manually migrate or ‘curate and prep’ each patient’s chart to reduce the cognitive burden associated with data reconciliation for each patient’s first visit with the new EHR,” they wrote.

Healthcare organizations should also review and test their data migrations to ensure they are complete, correct, and commensurate with newly collected data. If all necessary data cannot be migrated to the new system, read-only access to the old EHR needs to be maintained.

Support end-users

In preparation of go-live, healthcare organizations should provide end-users with “protected time” away from clinical duties to attend workflow specific training, the study authors noted.

Healthcare organizations should also provide additional one-on-one support to clinicians who continue to struggle with the system, they suggested.

In addition, healthcare organizations leadership should reduce the number of patients seen in clinics or treated in the hospital for the first few weeks following go-live while the system’s inevitable “kinks” are worked out, the authors wrote.