Close Print View Issue

How Many Clicks Does It Take?

GettyImages-565975329.jpgDocumentation burden remains an ongoing challenge in our fast-moving digital medical age. When using an electronic medical record (EMR), there is a tremendous amount of information to read, filter, react to, and file all the while placing emphasis on the sick patient in front of you. Digital tools like Cerner help us analyze data, track, trend, and guide the care we provide our patients. At Northern Light Health, our clinical informatics and information systems leaders and staff are constantly looking for ways to make this burden more manageable.

Adoption mastery sessions, developed and taught by Northern Light Health EMR experts, instruct clinical staff to enhance their understanding of Cerner workflows, and reduce inefficiencies. This translates to less scrolling, fewer clicks, and more necessary information “face-up” instead of several clicks/screens away. 

Mastery sessions are workflow-focused and based on real clinical scenarios. Before each session, a survey is distributed to clinical staff to target areas requiring focused education. Every session is accompanied by a detailed handout, usable for offline review and reference. Our “behind the scenes” view of Cerner helps us to understand where providers and nurses spend the most time in the EHR, and our teaching takes this into account to decrease the amount of time our providers spend in the EHR. Every member organization has a regionally implemented adoption plan, implemented by their medical informatics officers, regional nursing informatics officers, and supported by Clinical Informatics (CI) staff. 

At Northern Light Eastern Maine Medical Center, family practice providers who attended all trainings shaved 60 seconds off their time in Cerner per patient and decreased their documentation time by 25 seconds per patient. When navigating through the EMR, miscellaneous time per patient was reduced by 96 seconds/patient. These time savings translated into more visits being made available, as family practitioner providers were able to see more patients following adoption mastery trainings.

“I knew that many of the things I did in my day to day work flow were clunky, likely as a result of work-arounds I had incorporated over the years. I was very interested to see what features Cerner had to make the work more efficient,” says Sarah Crane, DO, of Northern Light Primary Care Hampden. “Taking a few months to get familiar with the system followed by a “master class” was an effective way to learn these efficiency tricks, as learning all of this at the beginning would have likely been fairly overwhelming and difficult to retain. I’m very glad I went to these sessions.”

Other work to decrease documentation burden has focused on removing unnecessary documentation and streamlining the documentation in the workflow. At Northern Light Health, across the system, nursing documentation for the adult medical-surgical patient has made major improvement. Each element of documentation was reviewed for appropriateness using evidence-based practice and practice-based evidence. Thus far, NLH has implemented changes to the admission and physical assessment workflows. By creating views in the EHR that bring the most relevant information to the top, NLH nurses have decreased the number of clicks by 8.8 million annually and decreased the amount of time required to document by more than 3,500 hours per year. These changes have done more than decrease the documentation burden, it also supports the critical thinking process. Following the implementation of the physical assessment changes, multiple novice nurses expressed the sentiment that the documentation format helps them understand what should be assessed and documented. 

We still have a lot of work to do to reduce and refine the burden of documentation on our nurses and providers, but with the right leadership, structure, and support in place, we’re off to a great start!