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Tip Tuesday: Following the Guidance of Leonardo da Vinci

The quote “simplicity is the ultimate sophistication,” originally from Leonardo da Vinci and the headline of one of Apple’s first marketing brochures in 1977, underscores the design philosophy that led to much of Apple’s success. Unfortunately, modern electronic health record (EHR) documentation workflows are far from simple. Regulatory, legal, reporting, payor, and other documentation requirements have shifted the focus of clinical workflows from patient care to data entry. These requirements result in suboptimal Frankenstein-like EHRs and uncertainty about how to make things better.

To successfully transform the way that nurses and physicians use the EHR, organizations must create an optimization program that both continually implements new features and refines existing content to match requirements. Unlike with a house, initiating an EHR optimization program is not as simple as calling a contractor. A successful EHR optimization program engages operations, effectively communicates with all users, and includes leadership buy in. Optimization programs should also follow the guidance of Leonardo da Vinci and Apple: where possible, simplify.

Physician orders, notes and nursing flowsheets are common examples of EHR workflows that often are not simplified and optimized in an EHR. This happens because over time requests come in to add new prompts, but due to the complexity of healthcare documentation requirements, it’s uncommon to get a request to remove prompts. Taking a step back to look at each prompt’s purpose, if it is captured elsewhere, and how the information is being used will result in a surprising amount of ‘clicks’ that can be removed.

Typically, during the initial implementation of an EHR, a large focus is put on having the most up to date features and matching system configuration to end user workflows. Over time, despite regular upgrades and the best efforts of IT departments, these systems get out of date and contain redundant documentation, obsolete required ‘clicks’, and inefficient processes. This challenge is not that dissimilar from the upkeep associated with owning a house. When maintenance or upgrades are deferred year after year the house will require a lot of work or even ‘gut rehab’ to get it back to original condition. Bringing order to complexity takes a lot of hard work, but the power of simplicity can give physicians and other care givers just what they need in a digital world.

Does your EHR require a few upgrades or a ‘gut rehab’? Contact Avaap if you would like to initiate a program focused on optimizing your EHR or specific workflows.