Building tools for your frontline physicians is just one piece of optimizing the EHR. Once tools are built, you want to ensure that they are actually used. I believe strong documentation of these tools as well as creatively considering ease of access can help to ensure their use.
Documenting Narrowly, Disclosing Progressively
To begin, there should be a central spot for a physician to go in order to reference what EHR tools are available to them. This needs to be different from simply linking to the documentation provided by the EHR company. This is something put together by your health system regarding the tools and processes it has built and is iterating on. Design here is important. Sending your physicians to a document or page that simply lists every tool available, with no regard to the breadth of the utility of those tools, will be nearly as unhelpful as no list at all. If a physician actively working on a shift opens a list of 3,000 tools, they will immediately close it and move on, using whatever (likely suboptimal) process they know.
If it is unhelpful to have a single list of tools, the next consideration is how the documentation of these tools should be organized. Headings and categories will be suboptimal. There is too much variance from person to person regarding how they would organize in this way, which means variance in how your physicians will search for things. Instead, I believe coming back to the consideration of the breadth of each tool is the correct answer. This will be easier to come to a consensus on. The key here is that you want your physician to immediately begin at a list of the tools built and designed specifically for that physician’s team, which is all they will need the vast majority of the time. From there, you can consider what gradations of breadth are useful for your health system (ex. hospital --> service line --> geographic area), linking from the initial document or page to increasing areas of breadth, progressively disclosing to the physician different levels as desired, lightly guiding them up the ladder while continuing to only show the minimum number of tools at a time.
How do you design the initial list of tools for a specific team? Where do you house it? You don’t need to decide. Give this to your EHR champions to determine what is best for their teams. You can provide the link to the documentation of the next step up in breadth. Consideration of how to handle the documentation of each step up is likely to depend on what gradations of breadth you feel are useful. This will determine who you tap in order to help decide on and design each piece.
This format of documenting and organizing will also be helpful for onboarding new physicians or locums coverage. The same goes for the constant churn of residents and medical students coming through your academic centers. This keeps the ever-ongoing rotation of new people from leading to constant paper cuts of incorrect documentation, billing preference lists not showing up, increased billing queries, incorrect procedure documentation… the list goes on.
Having a well-organized, progressively disclosed system for the tools available to your physicians can pay dividends going forward. As AI tools become increasingly available, you can harness this organized structure to provide proper context to the AI to assist in searching and providing information. As things are iterated on and new tools are built, this system will allow you to slot that information in seamlessly, updating the context.
Ease of Access
While documentation of your tools will go a long way to ensure use, there is another piece that can help here as well: creatively considering ease of access. While you have created good documentation, you want the need for it to be minimal. Instead, you want your physicians to be accessing your tools easily, at the point of work, needing to put little thought into it. This will vary depending on the tool. As examples, accessing commonly used note templates (H and P, progress note, discharge summary) should be as easy as pressing a button within the EHR that launches that note type and template. Perhaps you have less-used note templates, procedure notes and the like, where a constantly available button is overkill. Instead, perhaps you have a text expansion phrase that allows the physician to call up a list to choose one of the procedure notes to ensure proper documentation and billing. As another example, perhaps you have meetings with your physicians about billing; you now understand some of the pain points and confusions; this is passed to the EHR champion who can design and build a preference list that has the correct and well-described buttons for proper billing for their team.
Ease of access requires a very good understanding of how each team works, how they flow through the chart, what they look at, what the pain points are, and what is most useful for them and their patient population. This is difficult to solve from the outside, and again, an identified, team-specific EHR champion will work wonders here.
All of this– building the pieces, documenting what is available, making access obvious and easy– when built thoughtfully and creatively, creates an experience that finally builds the EHR into a useful and pleasant-to-use tool for your physicians, not something they feel they are fighting against in their day-to-day work.
These are my ideas based on working on the frontlines, not from leadership expertise in these areas. I am slow testing them out. What am I missing? What will not work or needs updating based on your experience?