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​Instituting a computerized physician order entry (CPOE) at La Rabida Children's Hospital was anything but glitch-free, said Rishi Agrawal, MD, attending physician at the small children's specialty hospital.

Users complained that they had to click numerous times just to order a simple item; the system would crash without explanation; and it wasn't possible to e-prescribe within the new software network.

Agrawal and his group were able to customize their electronic health records (EHR), building templates specifically for his practice group, but found that there were times that pre-specified content would be have been easier and faster to implement.

He and the other clinicians liked being able to see summary views of health issues, medications, problems and allergies, but were frustrated that certain parts of a patient's chart were too hardcoded. In the end, though, Agrawal says he learned many important lessons to share with other practices.

"Engaging both clinical and non-clinical staff to map out current workflows is an essential first step to determining which processes need to be optimized," says Agrawal, who mapped out workflows using Microsoft Visio.

Once workflows are mapped out, comparing current workflows with anticipated workflows under the new EHR is a crucial step, says Agrawal. Instead of just replicating paper workflow electronically, create new workflows that take advantage of the EHR's capabilities

Feedback from users is also critical to having a top-performing EHR, according to Agrawal. "Make sure to have a process in place for end-users to suggest tweaks to the EHR build and for these requests to be reviewed and implemented," says Agrawal, adding practices will typically find that end-users will provide a wealth of feedback, but such feedback needs to be incorporated in a systematic way.

Specifically, look for processes that end-users are working around, as these may need extra attention to fix. And all staff should be engaged, not just physicians.

The EHR became easier and faster as time went on, but the process still took longer than anticipated, Agrawal says. Still, managing information for his challenging patient group ultimately will provide more effective care coordination and sustainable healthcare. And in the end, all without those multiple clicking sessions.

Implementation Tips:

  • ​Try one-on-one training sessions instead of large group lectures.
  • Use desktops with wide screens, which helps with multitasking and flipping between programs.
  • Remember that electronic records are still geared toward acute episodic care but fall short for managing chronic illness and complex care planning.
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