Physicians at Honolulu-based Hawaii Pacific Health were optimistic that they could eliminate at least some of the documentation tasks they performed when using their EHR, which had been in place for more than 10 years,
To identify the changes that needed to be made, Hawaii Pacific launched a program dubbed “Getting Rid of Stupid Stuff” focused on getting rid of anything in EHR which didn’t work. Leaders asked employees to “look at their daily documentation experience and nominate anything in the EHR that they thought was poorly designed, unnecessary, or just plain stupid,” wrote Melinda Ashton, M.D. in a recent letter to the New England Journal of Medicine.
Starting in October 2017, employees began identifying problems with the EHR documentation workflow. These included documentation that was never meant to happen and would be easy to eliminate or fix; documentation that was needed but could be done more efficiently or effectively; and documentation that was needed for which clinicians didn’t understand the need or know about all of the tools available to complete it.
Some of the fixes employees recommended were more-or-less no-brainers, such as removing a requirement that nurses working with adolescent patients assess the cord, a feature which should only have applied to newborn babies.
In another case, the emergency medicine department was able to remove the requirement that clinicians print an after-visit summary, obtain the signature and scan it back in the system after learning that the step wasn’t necessary. The organization also reduced the frequency of required nursing assessments and documentation by nurses, from as many as several times in a 12-hour shift to solely when they assumed care of a patient.
In addition, they learned that Hawaii Pacific needed to do a better job of educating staff about the documentation tools that were available. This need was underscored by the fact that several requests came in from physicians asking for sorting and filtering capabilities to the EHR already possessed. The organization did have a physician-documentation optimization team in place already to help clinicians use the EHR efficiently, but most physicians had said that they didn’t have time to meet with the team.
Along the way, the team decided to remove 10 of the 12 most frequent alerts for physicians because they were being ignored, in addition to reviewing order sets by removing the ones that hadn’t been used recently.
In addition to getting a lot of useful feedback on improving physician workflow in the EHR, the Stupid Stuff program has put a process in place for continuing to improve EHR performance. Over time, it’s been embraced warmly by employees, Ashton reports.
“When the campaign was unveiled, it was largely met with surprise and sheepish laughter, then applause,” Ashton writes. “We seem to have struck a nerve. It appears that there is stupid stuff all around us.”