A common EHR complaint from physicians is the added administrative burden that comes from documentation and EHR workflow, as well as the lessened time they have to spend with patients because of the increased administrative tasks. Physicians often report having to take their work home with them and finish documenting in the EHR at home. Atlanta-based Emory Healthcare calls this "Pajama Time," when physicians are in the EHR system from 6 p.m. to 6 a.m. and on weekends.
The health system piloted a program to reduce Pajama Time and the number of clicks required in its ambulatory workflow.
The project started during Emory's preparation for the ICD-10 transition, though Julie Hollberg, MD, CMIO of Emory Healthcare, says it is something the health system has been thinking about for a long time.
"With the rapid pace of regulatory demand of multiple things like meaningful use and pay-for-performance, there was a sense we were just adding and adding and adding to the burden on providers," Dr. Hollberg says. "What we wanted to try to do was give them back some time by making it more efficient to use the tools."
Emory, in collaboration with its EHR vendor Cerner, video recorded physicians who self-identified as "EHR-proficient" and counted the number of mouse clicks in their workflows. They then developed workflows within the EHR they thought would be more efficient for the providers.
Emory focused on four functions clinicians in every specialty use: chart review, documentation, diagnoses and medical reconciliation, and orders and billing. The system developed tools within these workflows and allowed participating physicians to pick and choose which of these tools they thought would best support them.
Included in the new tools Emory developed are some of Cerner's tools, such as Dynamic Documentation, a documentation tool, and Dragon voice recognition software.
Providing each physician an option of tools to integrate into their workflow was key, as it allowed physicians to customize their workflows in ways that made the most sense to them, Dr. Hollberg says.
Once the newly individualized workflows went live, physicians worked with coaches contracted from Cerner to further subspecialize the workflow and get more comfortable with the new tools. "That's an iterative process," she says. "It's not as if on day one you're going to know the most efficient way for [the workflow] to be set up. By having coaches there for four weeks, it enabled physicians to further customize and get maximum efficiency out of the tools."
Eight weeks after the new workflow go-lives, physicians' Pajama Time dropped 36 percent, and one-third of clicks were eliminated from their workflow. In total, 37 departments, 1,650 providers and five hospitals have participated in this program over the past seven months.
The saved time and clicks allow physicians to spend more time on patient care, which Dr. Hollberg says was a driver for the project.
"Our overall goal with this project was to leverage healthcare to make it easier to take care of the patient," she says.
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