In a recent post, Dr. Edmond Billings discusses the inevitable decline of EMR vendors who ‘teach to the test’ of Meaningful Use at the expense of good software design. Citing the results of multiple physician surveys, he concludes:
Clearly, the usability of EHRs has gotten worse with the implementation of Meaningful Use. Many have been coded to certification requirements, not designed to make achieving Meaningful Use a byproduct of improved workflow automation. Where basic EHR usage is not already established, bolted on functionality forces clinicians to take additional steps that further disrupt workflow.
Achieving the part where Meaningful Use is a “byproduct of improved workflow automation” requires the first step of actually improving the office workflow. Before we do that, we need to think hard about what the office workflow is.
1. What work is being done?
2. What is required to get work done?
Orders require lab results, notes and other clinical information.
Pre-certification requires orders and insurance information.
Treatment requires lab results and dosing information.
So… How can we get more work done more quickly?
It seems like we need to increase the flow of information.
Moving from paper charts is a no-brainer in this regard. Suddenly everyone can access the same information without fighting over a paper chart, but as Dr. Billings and the studies he sites suggest, using an EMR system is not always sufficient to increase information throughput. If the software is poorly designed, or information is not easily accessible, it might just be faster to find the paper chart.
So, how do we increase information flow?
The Big Board:
The concept is not novel, but it is very powerful is done correctly. In Ankhos we have developed a feature where system-wide tasks are posted and filterable by department (Scheduling, Insurance, Physician, etc.)
Insurance – “John Doe needs chemo pre-cert”
Scheduling – “Call Jane Doe for a reschedule”
Scheduling – “The CT scan for Jim Beam is in, please schedule follow-up”
Physician – “Check lab results for Phyllis Doe”
Nurses – “Review treatment for Bill Smith”
Each one of these tasks links directly to the chart, with lab results, scans, past treatments all in one place. Anyone can add a comment to any task and anyone can claim a task to work on.
So how does this increase productivity? Amortization and parallel processing.
Amortization: For one person, the big board is daunting, but with an entire office working on little bits of a task at a time, the work becomes much more manageable. Moments that might be idle can be spent chipping away at these tasks, decreasing the overall office-time spent working. All first hand accounts from our users have proven this out so far.
Parallel Processing: The office receives nearly 300 lab results, radiology reports and referrals per day. Each must be reviewed and any acute issues must be dealt with immediately. This is clearly too much for one person to complete and get home in time for dinner (and only certain employees are qualified to act on certain tasks). By showing these tasks on the ‘Big Board’, practicioners can spend spare cycles reviewing these labs and by the end of the day, the big board is blank.
The Big Board has worked far beyond my expectations. I have had users reach out to me to say how much easier and faster it is to get their work done. No more sticky notes. No separate todo-lists for each employee. Everyone chips in and they all go home earlier.
Before we went paperless, physicians would be sitting with a stack of charts at the end of the day, staying until 7:00 sometimes looking at lab results.
With the Big Board, everyone is home in time for dinner.
Now that we have achieved meaningful use in with Ankhos, we can begin achieving Meaningful Use.