EMR design should include workflow analysis, always be evolving
ORLANDO—A scalable, evolving approach of using EMRs has been implemented at Massachusetts General Hospital (MGH) in Boston, which could serve as a model of adoption in other medical facilities, according to a presentation at the 2008 HIMSS conference.

Sanjay Chaudhary, MBBS, MHA, and Omar Santiago, MSc, MBA, of MGH, explained that their learning objectives are to review how usability analysis can improve EMR workflows; to demonstrate how workflow analysis can improve usage of EMRs; and to open a dialogue towards discovering new ways to increase usage and enhance the usability of EMRs.

Mass General uses in-house, web-based EMR that was developed in 2002. There are more than 100 practices using the EMR.

The benefits of using an EMR are the ability to share clinical data; flexible data entry that allows dictation and templates; efficient medication management; and efficient laboratory management.

Despite the benefits, Chaudhary acknowledged that certain challenges exist, such as disruptive transformation of existing workflows, different groups of users with different needs (clinicians vs. healthcare policy people) and the continuously evolving functionality. As a result, Chaudhary stressed that workflow analysis needs to be conducted to assess the needs of the facility.

Santiago and Chaudhary worked with a focus group, and allowed the MGH group to observe how the various groups work through the EMR process, and evaluated the current workflow. Based on their observations, they proposed a new workflow.

The MGH EMR Pilot Project, called LMR, was an eight-week intensive project where analysts collaborated with clinicians to evaluate and improve current documentation workflows. “Through observations and feedback we learned that there is not enough time for clinicians to document,” according to Santiago and Chaudhary. “We just observed; we didn’t interfere. We want to see how they use the EMR,” Santiago said.

For example, through the observation and data (workflow) analysis, they observed that documentation processing time could be reduced by increasing the use of the EMR during the encounter and through the usage of other documentation technologies, such as voice recognition or form-based encounter notes.

The goal of the LMR project was to improve practice efficiency by better utilizing the EMR. “We were able to work with the physician to create a new template,” Santiago said.

Based on the data gained through the pilot project, Santiago and Chaudhary collaborated with GE Healthcare to implement some of the changes.

In their research, Chaudhary and Santiago found that:
  • EMRs represent a major transformation of the work environment;
  • Many challenges exist not only in EMR design, but also in EMR training and implementation;
  • Continuously measuring EMR usability and identifying usability design enhancements can enhance EMR usability;
  • Workflow analysis can improve EMR usage by enabling smoother flow;
  • EMR and IT tools can be leveraged to facilitate workflow;
  • Change management is essential.
However, Santiago concluded that “you want to see a movement toward progression, and there’s always room for improvement. We are continuously looking for better methods, especially gathering better quantitative tools. And, we hope to develop best practices that can be used elsewhere and not just internally.”