EHR Customization: Balancing Clinical and Business Needs

By October 22, 2019Healthcare IT

Finding the Sweet Spot of EHR Customization

To ensure they deliver the best-informed, most timely care possible, today’s healthcare providers (HCP) must gather ample data about patients’ health profiles from the moment they check in to the moment they check out. HCPs’ ability to assemble increasingly comprehensive patient profiles has been facilitated by the proliferation of Electronic Health Records (EHR). By marrying technology and process in a way that streamlines the recording, storage, and transmission of healthcare data, EHRs can help HCPs and patients alike improve both clinical and business outcomes. To manifest these improvements, health systems must be deliberate about how they design and optimize their EHRs. A design or optimization decision that produces a solution for one end user may produce a problem for another end user, which is why health systems should always be strategic about their introduction of new EHR functionalities. In cases in which an EHR customization initiative is deemed necessary, it is important to erect “guardrails” to prevent inefficient workflows, training challenges stemming from over-customization, and ineffective change management processes. These protections are key to ensuring EHR customization translates into real business value and improved HCP and patient outcomes.

The Benefits of EHR Customization

EHR systems typically come out of the box with a base set of functions, but HCPs’ workflows rarely fit into this default functionality. Fortunately, even minimal adjustments to an EHR system’s default functionality can maximize the system’s impact by improving its usability and minimizing resistance to its adoption. For example, a customization that creates more opportunities to capture discrete data will lead to more accurate reporting and more effective clinical decision-making. Similarly, customized reporting can fine-tune an HCP’s ability to track their EHR usage against standards like the federal government’s meaningful use criteria, which define the extent to which HCPs are required to use and exchange patient data via certified EHRs.

In short, over the last several years, a clear industry consensus has developed around the idea that relatively straightforward EHR customizations improve HCP satisfaction, regulatory compliance monitoring, and patient safety. However, these clear benefits notwithstanding, it can be difficult to execute EHR customization at scale, and poorly designed or implemented EHR workflows can lead to serious patient safety issues and upticks in HCP dissatisfaction in several ways.

1. Poorly Designed EHR Workflows Impede HCPs’ Diligence

When an HCP is unable to complete a workflow with ease, they often resort to shortcuts and improper documentation. Such ad hoc workarounds can cause a number of problems. For instance, if a workflow through which an HCP is supposed to populate patient-facing materials with content is unintuitive or impractical, the materials may end up being difficult to understand, compromising the quality or effectiveness of the post-visit care patients receive.

In most cases, EHR workflow failures are the result of unnecessary complexity and/or insufficient data access. When it comes to supporting HCPs’ processes, less tends to be more, as a workflow with too many screens or too many clicks often produces nothing but frustration. If an HCP must navigate between multiple views to access the patient data they need to complete a particular workflow, the risk of inaccurate data capture skyrockets — and, in turn, the utility of their EHR system plummets.

2. EHR Over-Customization Creates Training Challenges

Training healthcare professionals to use an EHR system’s default functionality can take hours of valuable time. And, more often than not, different stakeholders will need to use different EHR features from the get-go, creating the need for even more training hours dedicated to differentiated instruction.

When EHR customization initiatives are undertaken too zealously, the time required to adequately train each end user climbs even higher. Unfortunately, many health systems provide only general workflow training and static supplements like tip sheets and e-learning materials. These supplements are seldom enough to prepare healthcare professionals to use highly customized EHRs, and often lead to less-than-ideal user experiences. Without a comprehensive understanding of how customized EHR workflows should be used, HCPs risk forming bad habits and spreading (or believing) misinformation.

3. Ongoing EHR Support and Maintenance Require Mature Change Management

Since many EHR systems are managed by multiple teams, ongoing system support and maintenance can be a headache. As such, health systems need a well-conceived change management system to keep everyone informed at all times. Crafting such a system involves conducting a holistic impact analysis to prevent unintended negative effects and leveraging a governance model to confirm that the change at hand is driven by a clear business need, not simply a stakeholder wishlist.

Within most EHR support structures, there is quite a bit of overlap between the build being used by various support teams. That said, as the complexity of an EHR system grows, its end users’ ability to resolve problems quickly typically diminishes. For example, a build that is created by one team for a specific purpose may very well end up being reused by other teams down the line. If, in the future, changes to this build need to be made, all rework will have to be approved by multiple user bases, extending the time it takes to move the changes into a production state.

Customized EHR builds also introduce added complexity into future software upgrades. Most EHR vendors provide extensive release notes describing new system features (and specifying the affected builds), but it remains health systems’ responsibility to identify areas of risk within their own customizations.

Striking the Right Balance

There is no question that a reasonable amount of customization will greatly enhance any EHR system. However, determining what “reasonable” looks like in a given healthcare context can be a significant ask unto itself. Inefficient workflows, training challenges, and support and maintenance concerns are but a few of the potential issues a health system may encounter when customizing their EHRs. As a result, many health systems opt to work with a partner like SEI that can help them navigate the challenges of effective EHR implementation, customization, and maintenance. Ultimately, by striking the right balance between strategic customization and systemic complexity, health systems can leverage EHRs to improve key metrics pertaining to patient safety, HCP satisfaction, and regulatory compliance.

Rich Peace

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