EPIC OPTIMIZATION
By Susan North
It seems like the application will never be ready for deployment. But at long last, that
day does come. One by one, the applications and sites are rolled out. Success! But…the work
is far from over. To ensure that the system is clinically sound, the workflows are efficient,
the users are proficient, and the organizational objectives are achieved, optimization must
occur.
Optimization is an important aspect of any Epic implementation. Due to the staffing
constraints of most IT shops, often the same team is building, implementing, resolving
issues and maybe even training. This does not give much opportunity to fix workflow issues.
Periodic reassessment of build and workflow is a must.
A good optimization plan focuses on the application, workflows, end user skill
development and the role of the clinicians. It addresses the expectations of the users and
the required skills necessary to most effectively use the system. It promotes an emphasis on
workflows and seeks quality improvement.
Start the optimization process using pre-assessment tools. Combine the practice of direct
observation with user surveys or site evaluations. Observe the use of documentation tools,
inbasket messaging, keyboard and mouse skills.
- Are users utilizing smart tools?
- How many encounters are completed during exams or between patients?
- Are users working inbasket messages throughout the day as time permits, or waiting until the end of the day to catch up?
- Are preference lists being used? Are they adequately built?
- Do providers have problems finding procedures or diagnoses when ordering?
- What is the ratio of talking to typing? Is there good interaction with the patient?
- Are the right people doing the right job?
- Identify problematic or inefficient workflows. Look for areas to improve patient safety and financial position, and reduce redundancies and variations in workflow. Standardize whenever possible.
- Survey the end users to identify their areas of concern.
- Would more training be beneficial?
- Is help needed building charting tools?
- Do users know how/where to report issues?
- What are their biggest issues affecting efficiency?
- What would users change about the system if given the opportunity?
- Survey the helpdesk to identify the ten most frequently reported issues
Create a summary from the direct observation and surveys, and begin your optimization
plan. Not all changes need to be big ones. Sometimes only small changes are needed. Be sure
to use a change management strategy. Try to avoid throwing too many changes at the staff.
After all, they are still adjusting to this new experience. Control the timing of upgrades
as much as possible. Perhaps limit upgrades to once a year.
Focus on smart set development. Sometimes there is a need for more general smart sets for
routine exams. Provide an opportunity for the providers to add documentation easily for
those “oh, by the way” problems that patients inevitably bring up during the course of an
office visit. Increase the use of smart phrases and encourage providers to share their smart
phrases with one another. Utilize defaults for orders and referrals whenever possible. Add
synonyms to make ordering procedures easier. These are relatively simple solutions that can
enhance efficiency without drastically changing workflow. Look for new functionality that
can be added to enhance the system’s capabilities. Suggest that staff work in basket
messages between each visit rather than waiting for the end of the day. Create new pools
that will complement workflow. Strive to provide a non-threatening approach to assisting the
users. Develop refresher courses and upgrade training materials. These can be on-line,
self-paced tutorials.
To address the initial question, “Are we done yet?”, the answer is no. Most likely, the
answer will always be no. Optimization requires a periodic reassessment of build and
workflows, and the need for additional education. The only way to assure the most efficient
use of the system and increase end user proficiency and satisfaction is to continuously
observe and identify opportunities for improvement. If you should have any questions, please
contact us!