Balancing Workflow Customization with an EHR

I’m a HUGE proponent of mapping your current workflows and evaluating how that applies to your EMR implementation. It’s absolutely essential to be able to do it right. It’s not an easy or necessarily fun task, but it pays big dividends when you go live with an EMR.

However, far too many people get caught up with “my workflows” versus the “EMR workflows.” Some people like to argue that an EMR vendor should be able to customize their software to be able to support my current paper work flows. Other people argue that you should toss aside your current workflows and adopt the “best practices” standards of your EMR vendor.

Of course, the real answer is as it should be: somewhere in the middle. The EMR should be built so that you can customize many of the features to match the way you see patients and the way you practice medicine. In fact, this should be part of the evaluation process when selecting an EMR vendor. However, let’s not also be naive enough to think that some things in the electronic world won’t be easier to do than they would have been in the paper world.

You better hope that your EMR implementation does change some of your current processes for the better. That’s part of the reason why your implementing an EMR. You want to improve something about your clinic. If nothing changed, then where would the improvement come from?

Like everything in life, workflow customization just requires balancing your current workflow with the EMR vendor’s suggested workflow and the features of the software.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

12 Comments

  • I agree. In software engineering, assuming you know what is best for the client leads to failure. You can make the same statement about the workflow of an office. Just because the same process has been in the works for years doesn’t mean it is optimal.

    My client called me not two days ago expressing this exact sentiment. He wanted me to make ‘conversation pieces’; mock-ups of parts of the application that would drastically change the flow of the office. These probably won’t be implemented seriously, but fresh eyes, either on code or an office system, can be productive.

  • Keep in mind that it’s not just about the initial workflow of “patient comes in, gets treated, billed, out the door”, it’s also the long term benefit of having all that electronic data available later for reports, patient management, and other tasks you couldn’t do easily without an EMR.

    But yes, you have valid points, just wanted to through that out there.

  • Medisoft,

    I am just curious, do you capture metadata on the how users interact with your application? The office manager and scheduler in our office expressed a desire to be able to track not only things like lab values and treatment durations, but also things like average waiting times or lab tech efficiency.

    I realize this gets into the nitty-gritty of a particular office, I was just wondering if you had any insight on that type of reporting.

    -Nick

  • Nick,
    Our EMR has wait times built into the application. Basically each patient has a number of statuses. Those statuses are changed as they move through the process (check in, nurse intake, etc). Those statuses work as a “queue” or “notification” so we know where the patients are at in the process. It also provides some really interesting reports such as: Patient arrival times, patient wait time for a nurse, patient wait time for a provider, total visit time, etc.

    Some of this is also automated since all of our patients check in at a kiosk for their appointment where they fill out paperwork (including signing things electronically). Other status changes are done by the nurses or providers as they finish with a patient.

  • John,

    I like the status ideas. We are incorporating locations as well as statuses. Maybe those will prove extraneous.

    I’m guessing that different statuses could be factored out for each office implementation, but are most offices’ work-flows alike enough that a lot of customization is not needed?

    Nick

  • We’d love to be able to customize the statuses we use. In fact, we’ve requested more status to be able to do more granular reporting and also to show where a patient’s at in the process better. Plus, we modify the status based on if they are there for only a nurse visit (ie. immunization) or a regular visit. The same is true for other clinics that use the same EMR as we do. They might treat “statuses” very differently than we do since there workflow might be different. For example, we have multiple floors and so the status helps us communicate where a patient is and when they might make it to the next floor.

  • We have wait-time reports as well, but I was more referring to reports that are much easier for the physician to run such as “list all patients with this diagnosis, or list all patients on this Rx”, etc.

    Maybe “drug x” has new side effects discovered, a Dr could run a simple report show shows all his patients on that drug and he could check their status.

  • Medisoft,
    Those reports are really easy and standard in every EMR I’ve seen. Another one we use is immunizations given. We also expect that a report by lot number is going to be useful one day when there’s a recall. Something that would have been impossible before EMR (without manually checking every chart or something).

    We’ve also done reports out of our EMR to do studies on obesity and how our clinicians were addressing patients whose BMI were over a certain level and whether obesity was diagnosed along with their presenting concern.

    I could list a lot more. With my EMR we have a zillion built in reports, but we also have crystal reports connected to the database where we can create custom reports.

  • Data like obesity is interesting in regard to the post here and one I made today at my site. back to speaking about workflows, there may be some attributes of a patient that require different flows. For example, if a patient was obese and required a certain bed, or was an inmate under supervision, the workflows could potentially be much different.

    I know that my client has a designated treatment area for inmate chemotherapy treatment, for instance.

  • I have worked with many practices over the years to implement EHR. The first part of my implementations was to document workflows. Very often, I found that the way things were being done was not the best way. I am sure many practices see this also. I would use a combination of best practices and what the practice was doing to make the providers as efficient as possible. After getting used to using an EMR, most providers are interested in expolring what they can do next and improve workflows. It is a constantly evolving job.

  • Michael,
    I agree. You never really stop evaluating workflows. This is even more true as an EMR vendor releases new features that might affect the workflow.

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