For 40 years, Burger King positioned itself as the fast-food chain committed to delivering customers a customized product. Unlike most one-size-fits-all fast-food restaurants, Burger King, with its “have it your way” slogan, stressed a dedication to preparing burgers that meet the exact specifications of each patron. They even claimed that “special orders don’t upset us.”
Wouldn’t it be great if there were more of a Burger King-like approach to designing electronic health records (EHRs) that work exactly the way doctors want them to—so that physicians wouldn’t have to settle for one-size-fits-all solutions?
Unfortunately, EHR vendors, as well as health system leaders, rarely seek direct input from physicians to understand what doctors want and need in their EHRs.
In fairness, EHRs were originally designed to make billing and reimbursement operations more efficient—and not to support clinical thought processes and physician workflows. As a result, these legacy systems often have cumbersome user interfaces that are inefficient for physician users.
(Medicomp Systems)
Over the last decade, we’ve seen some progress in EHR design as stakeholders seek to leverage systems to enhance patient care and safety. However, rank-and-file clinicians are rarely consulted when new EHRs are implemented, and their recommendations for improving the end-user experience carry little weight with developers.
Unlike Burger King, the EHR world is not quite as open to “special orders”—at least from physicians. Thus, is it any wonder that physicians continue to express frustration with their EHRs?
If physicians could place a special order with their EHR vendor, what would they ask for? As a physician myself, here are three items I believe most doctors would request to “have it their way”:
1. Flexibility in workflows
No two clinical encounters are the same, which is why physicians need flexibility in their workflows, as these can vary by specialty and by physician. Furthermore, because not every patient presents the same way, workflows can vary by individual encounter, creating the need to alter workflows on the fly.
For example, a physician might prefer to start the visit documentation with the patient’s chief complaint, followed by a review of symptoms. This workflow might work well for most of the doctor’s patients, but not for that one patient who immediately wants to share details about the recent loss of his wife to cancer. For that clinical encounter, the physician might prefer to alter the documentation workflow, first capturing details about the patient’s current social history and assessing his mental health status before noting the chief complaint. To quickly modify the way information is presented in the documentation workflow, a clinician needs a flexible system that supports on-demand changes.
2. Rapid completion of routine, repetitive tasks
A good portion of a physician’s day is spent handling routine, repetitive tasks, such as refilling prescriptions and reviewing clinical orders and results. According to a 2019 Medscape survey on physician burnout, 74% of doctors reported spending at least 10 hours a week on administrative tasks, which is time that clinicians could otherwise spend delivering direct patient care. The survey also noted that administrative tasks have become one of the leading causes of physician burnout, which can negatively impact the quality of care, clinician productivity and patient satisfaction.
Physicians want their EHRs to improve efficiencies and not increase the time required to complete routine tasks. If doctors could custom-order their ideal EHR, they’d request tools to automate some of the many redundant tasks they perform each day. While some activities can be delegated to other staff, certain clinical tasks can only be handled by a physician.
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Doctors want tools that help them complete all their tasks rapidly and effectively, with a minimal number of clicks and within clinical workflows. They don’t want to have to exit out of a chart note to enter a new prescription and then jump to another screen to order a lab test. Instead, physicians want systems that integrate all these routine tasks into a single workspace, allowing them to quickly and efficiently complete orders and documentation.
3. Quick access to relevant clinical details at the point of care
The digitization of records has created an overwhelming amount of clinical data. More data doesn’t necessarily improve patient care, however, unless physicians have ready access to contextually relevant and trusted medical information that offers insight into patients’ medical histories and current problems.
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Physicians have access to clinical data from a variety of sources, including other providers, patients, and payers. But data is just data unless it is logically compiled and transformed into information. Rather than searching through pages and pages of disorganized data, physicians want tools that intelligently filter data and transform it into actionable information that is readily available for clinical decision-making. In addition, they want this high-value information at the point of care within standard workflows.
The delivery of care is enhanced when data is appropriately filtered and doctors are only presented with data that is contextually relevant to the patient they are treating. Consider a clinician who evaluates a patient with a persistent cough and then prescribes a suitable therapy. The physician might recommend an alternate therapy, however, if he or she is automatically reminded during the documentation process that the patient has diabetes. With quick access to relevant data within the doctor’s workflow, physician productivity is preserved and clinical outcomes are potentially superior.
Doctors are EHRs’ end users, and vendors and health system leaders must give them a seat at the table when designing and implementing EHRs. By listening more to physicians’ needs and wants, perhaps doctors would be a little less frustrated with their systems.
Jay Anders, M.D., is chief medical officer of Medicomp Systems, which provides physician-driven, point-of-care solutions that fix EHRs.