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EHR Quality Improvement: 3 Ideas for Eliminating Waste

Author: Michelle Scott, MSM, BSN, RN-BC

HealthIT.gov lists continued quality improvement as the last step in implementing or upgrading a hospital EHR system. But quality improvement doesn’t wait until go-live of the EHR. It begins during planning and also applies to implementation methodology.

At CereCore, we apply Lean Six Sigma principles to improve each phase of our implementation methodology (Planning, Build, Testing, Go-Live). Here, I’ll discuss three areas where this approach resulted in better time and resource utilization for the MEDITECH projects our team has delivered across the nation.

Well, that was a waste.

Lean Six Sigma defines waste as any activity that consumes resources and creates no value for the customer. During an EHR implementation or optimization project, waste can be the under-utilization of resources. At a hospital, waste is time and effort spent on tasks such as double data entry or unnecessary steps when one could be caring for patients.

The following are areas where we eliminated waste during EHR implementations and potential untapped opportunities for your next EHR project:

  • Utilize multi-module expertise.

While it can be easy to overlook expertise on your consulting bench because the individual is typically focused on one area, it is here we find opportunities for utilizing our resources efficiently and reduce costs for clients. All of our team members have a strong knowledge of MEDITECH, many with expertise in multiple modules as well as direct clinical care. For example, Tina Joyce is knowledgeable in both the pharmacy and advanced clinical modules for MEDITECH. For one of our clients, we tasked Tina with building order sets for both non-medication and medication components. Because one person managed the entire order set, it eliminated the need to add another resource to the project at more cost to the client. Additionally, this allowed us to assign our pharmacy resources on other client projects.

  • Automate testing.

Part of any EHR implementation is testing the financial build.  There are several steps to this process, and the first step is validating the correct charges are attached. This is often a manual process that takes many hours to validate. We developed an automated orderable charge testing tool that saves our clients an average of $18k per project. We are currently piloting new automation for integrated testing, a manual process that requires multiple resources to enter items repetitively and can take weeks to complete. Automating manual processes such as these not only reduce labor hours and cost but also reduce the potential for human error, which is another form of waste in Lean Six Sigma.

  • Update toolkits and workflow documentation.

Our team found additional opportunities to streamline MEDITECH projects by reviewing and updating project toolkits and documentation. Our documentation is focused on eliminating unnecessary workflow steps during the planning phase to build a more efficient EHR for end-users. We started with a review of workflow documentation from our clinical subject matter experts to determine if planning sessions included a comprehensive and up to date list of client questions. We also updated our go-live readiness template after finding some duplicate content that required editing for both clients and consulting during the final review. Again, a form of waste that is easy to address with upfront effort.

Whether during project kickoff meetings or projects involving multiple teams, setting up a culture of trust is essential for process improvement. The client and implementation team both must be able to freely share their thoughts and ideas on what is working and what is not before, during, and after the project is completed.

The old saying “if it ain’t broke don’t fix it” may hold in some cases, a focus on continuous improvement asks the questions: Is what you are doing still working as well as it could? Are we focusing on the right information? Are we using the right technology? There was a time when our team used a basic spreadsheet and a PowerPoint to discuss project status and resource utilization. We now utilize a Microsoft PowerBI dashboard in our monthly calls. Technology and healthcare are in a constant state of advancement. As a result, our hospital clients, and the patients they serve, deserve our dedication to continuously evaluating our processes to be more efficient, accurate, and cost-effective.

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