Why you can’t ignore EHR workflow

Do you know your EHR’s workflow is a critical part of your EHR’s success? How can you make sure your EHR is working for you not against you?

Many EHR implementations have failed due to problematic EHR workflow.

Though EHRs with problematic workflow are common, this issue shouldn’t be trivialized as the problematic EHR can end up being worse for the medical practice than a paper-based system.

An EHR with well-designed workflow should integrate into a medical practice in the same way a competent clinic staff member fits seamlessly into the clinic team.

Workflow can be described as the assumptions that are made about the order and manner a medical facility accomplishes its tasks.

When an EHR is adaptable to its users’ needs as well as the specific workflows of the medical practice, it is considered intuitive and easy to use because its workflows accommodate different general and specialty physician needs and the types of care the clinic provides.

If certain tasks or steps of the EHR workflows are inaccurate, overlooked or misguided, users will find the system difficult to use and often end up resorting to workarounds. This leads to inefficiencies, increases the risk of errors and impacts productivity and patient outcomes in the medical practice.

Thus, an EHR with well-designed workflow positively impacts productivity and can help improve the efficiency and quality of care provided by the practice.

In contrast, an EHR with poorly designed workflow is counterproductive, a pain to use, negatively impacts productivity in the clinic practice, and can lead to poor patient outcomes.

Users may complain that “the EHR forces us to do unnecessary things”, “it takes too long to accomplish a task using the EHR”, “it slows us down”, “it does not match our specialty’s workflows”, it does not match our practice workflows” or “the workflows cannot be changed without involving a programmer”.

To implement an EHR that is aligned to support health professionals’ efforts to deliver quality patient care, medical practices need to consider that the healthcare industry has important differentiators:

• Healthcare is a complex industry with many moving parts, so some workflows are complex.

• Healthcare is risk-averse because minor errors can lead to catastrophic results.

• The healthcare delivery process will not always follow the expected or predicted path to completion.

• Interruptions and exceptions are common in the healthcare delivery process.

• Interruptions increase the risk of patient errors.

• Healthcare providers must be able to rapidly evolve and adapt to foreseeable and unforeseeable changes in their environment.

 So, an EHR with well-designed workflow needs to demonstrate it supports health professionals to efficiently navigate and manage these factors.

• Does the EHR give users greater visibility of all workflow tasks or steps?

• Does the EHR give end users control of the EHRs workflow behavior?

• Is the EHR’s workflow malleable? Can non-programmer users easily bend workflow to fit their evolving needs, contexts or circumstances without constant reprogramming?

• During a patient appointment, can health providers effortlessly gain real-time information on the status of all tasks related to a patient’s care?

• Can health professionals using the EHR track the points at which they were interrupted from their tasks?

 While many EHRs incorporate the ability to modify workflow behavior without additional coding changes, the contexts or circumstances needing modifications need to have been foreseen by the programmer or medical practitioners and incorporated in the EHR’s initial design phase. Thus, the EHR would still not be as flexible as desired because modifications remain limited to foreseeable circumstances.

The capability to mold an EHR to adapt to unforeseen circumstances, to evolving medical practice needs, or to improve a process from new insights is possible when an EHR is built on a foundation designed for adaptability.

This kind of foundation is well-suited for healthcare because adaptable systems excel where processes can be complex.

High-volume, single- and multiple-provider medical practices in African countries should consider adopting EHRs built on adaptable foundations because of their flexibility and ability to allow non-programmers to easily adjust the system to suit their current and evolving needs.

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