Section 6.3 Optimize
Optimization Strategies for Point of Care
Charting
Use this tool to help electronic health record (EHR) and health information exchange (HIE) users
make the cultural shift to using the system at the point of care (POC). These users are therapists or
other professionals who interview clients and conduct interventions. EHR users also may include any
staff members who are required to use the system while they are working with clients, such as client
registration personnel and others.
Time needed: 16 – 20 hours
Suggested other tools: NA
How to Use
1. If you have not done so already, engage all who will be users of the EHR and HIE in the
process of system selection and implementation—especially surrounding requirements
specifications, workflow and process analysis and redesign, configuration of data entry
templates, clinical decision support, and how the system will be rolled out. Staff will be
trained on how to use the system, but optimizing use of the EHR and HIE at the POC starts
long before training and continues after training and go-live.
2. Determine the need for optimization strategies through these various stages. Specifically:
 Recognize that complaints are often a sign that new approaches may be necessary to
help users overcome concerns.
 Walkthroughs for casual observation may be undertaken. Look to see if workarounds
are being used, or whether the system is not used at all. It is more difficult to do this
in the behavioral health environment than in a medical environment, but group
therapy sessions and certain other situations may be amenable to this type of help.
 Track and review simple health information technology (HIT) adoption statistics,
such as: user logins (every intended user should be logging in); volume of dictation
(expected to decrease); printer usage (may go up if someone doesn’t want to use the
computer); scanning handwritten forms (should decrease); overtime (should decrease
after initial learning curve is mastered). If users continue to type data entries rather
than using templated fields, this may signal lack of trust in the system and problems
for clinical decision support, data reporting, and quality activities.
 Lack of quality improvement goal achievement often points to underlying EHR
utilization issues. For example, if your planned interventions guided by decision
support in the EHR do not result in fewer suicide attempts among clients, the EHR
may not be being used properly. Another example: If your community is engaged in
an accountable care organization, adopting a patient-centered medical home, or other
health reform initiative and the number of hospital readmissions with evidence of
depression are not decreasing, the community may not be making appropriate
referrals to your facility or you may not be using HIE or be engaged in an HIE
organization (HIO).
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3. Once the need for an optimization strategy is identified, consider the best way to gain optimal
use of the EHR.
Following are some suggested strategies. You can develop others, as appropriate. The key is to spot
the need for an optimization strategy early and not hesitate to apply the strategy. The problem you
have encountered will most likely worsen if action is not taken.
Strategies
Consider the following strategies when seeking to optimize use of EHR and HIE at the POC.
 Map the workflow and processes as they are performed today. Compare this with the
“improved with EHR” workflow and process map that you wish to implement. Discuss with
the affected individuals what the issues are, and have them identify ways to adopt your
suggested improved workflow and process or revise it.
 Directly observe how an individual is using the EHR. Any number of factors can cause
issues, and often problems can be easily corrected with additional training or some slight
modification, such as reinforced training on the application, improvement in general
computer skills, template redesign, data capture aids (i.e., copy and paste, favorites lists,
larger font size), adjusting the sensitivity of clinical decision support (having only
“important” alerts fire so they are not ignored).
 Consider the physical environment. One complaint that sometimes arises when implementing
EHRs is that therapists still may need to wait for information. If a receptionist or health
information management professional obtains needed information or scans documents into
the system, the therapist will not have access to that data at POC and may need to interrupt
the interview or drop a line in inquiry, to be completed at a later time. Reviewing the physical
layout of interview rooms, therapy rooms, and potentially even the entire facility may reveal
the need for changes. Consider additional workstations, portable devices, and strategies
described below for using the computer with clients (see Section 2.13 Space Planning).
 Role play to help new users feel comfortable with changes in how work is performed using a
computer while with a client. Using your test environment, play the role of various kinds of
clients, including those who may be fearful of the computer and those who simply don’t care
whether you are using a computer. Discuss and agree how best to handle each type of client.
 Script how to introduce the EHR to clients and even acknowledge that you are new to the
EHR and may need to take a bit more time or focus a bit more closely on the documentation.
Most clients won’t mind if you explain this to them; some may even offer to help.
 Adopt the role-playing strategy used during new user training as “client training” for those
who are most fearful of EHR. Instead of just jumping into using the EHR at the POC with
these clients or using a script approach to introducing the computer, tell the clients you have
a new system that entails using the computer. Ask the client’s permission to “show them how
the computer works to help them overcome their issues” (substitute language that applies to
each client).
 Evaluate data requirements. Many clinicians complain that they are expected to collect and
record much more data in the EHR than when they were using paper. In some cases, the lack
of data collection in the past has caused problems; more complete documentation in the EHR
is generally considered a benefit. More complete documentation takes more time and may not
always be necessary. Be aware that the system may ask for some data that are rarely needed;
changing these from required to optional may be in order. If the need for an evaluation of
data requirements arises, evaluate all uses of the data (i.e., data element impacts the
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performance of a clinical decision support rule or is required for claims processing). A team
of clinicians should conduct the review and make decisions about changes.
 Evaluate whether you have alternative sources for data that would reduce the data entry
burden. At a minimum, the client’s gender, birth date, and other demographic data should
flow from a registration system or form that is filled out by the client before the visit or in the
waiting room. Ideally, these forms should be automated so the client can enter them directly
into your system. Utilities are also available that lead the patient through a series of contextsensitive, clinically-oriented questions, as well (i.e., specific to reason for visit, etc.).The data
can then flow to your EHR where the user only has to verify data about which the user has a
question. Some of these utilities provide data capture for a patient to use from home through
a secure Web portal, or via a kiosk in the examining room. Some of this data may also be
able to be derived from your HIO, if client has provided consent.
 Explain the value of the data. Data collection can appear meaningless if users don’t
understand the purpose. At a minimum, users should be involved in deciding what data to
collect and should be provided aggregate results of quality measures (e.g., benchmarks,
baseline, and improvements).
 Re-evaluate. Continue to work on any issues identified, and continue to identifying new
issues. Even when all appears to be working well, new issues may arise or old ones may
resurface. If issues are permanently resolved, take time to celebrate. Celebrating success,
acknowledging that an issue has been overcome, and inquiring about whether things are
going more smoothly is all critical to success.
Copyright © 2014 Stratis Health.
Section 6 Optimize—Optimization Strategies for Point of Care Charting - 3
Updated 01-01-14