Four Pearls to Dramatically Boost Your Workflow Efficiency
EHR Workflow
During my preparation for the board exam in clinical informatics, I found it interesting to study workflow management. Different doctors have vastly different workflows. Some prefer to start with the labs and imaging studies, while others begin with scheduled appointments and documents. The default setting for your EHR may not match what you do with every patient. However, you can set it up once, and it will take care of 95% of it. Minor adjustments in the future may be necessary, but they are unlikely to be significant.
It is best to learn how to change the order and simulate what you’ll do from opening the chart until you finish your note and close it. Reorder the different workflow components to match them. For example, here is mine in the order I do it for the left-sided menu and middle (content) panes:
- Chief Complaint
- Care Recommendations (quality metrics)
- Visits List (prior and upcoming clinic visits)
- Problem List
- Documents
- Home Medications
- Opioid Review
- Allergies, Histories (for surgeries, past, family, and social histories)
- Vital Signs
- Labs
- Radiology
- Pathology
- Clinical Media (to insert pictures)
- Order Entry
- Order Profile (previously-ordered studies)
- Outstanding Orders (pending labs)
- Clinical Charge Entry
My order for the third pane (where I document the note):
- History of Present Illness
- Review of Systems
- Physical Exam
- Assessment and Plan
- Diagnostics
- Procedures
This is an example of a logical and reasonable workflow, at least for me. Please think about yours and dedicate the time upfront to get it settled. If you notice after a few days that some things need improvement and reassortment, that’s a healthy sign since it indicates that you’re more aware of your workflow. It’ll take a few minutes at the moment but can save you much more in the future.
Auto-Texts and Smart Phrases
It’s helpful that we tend to do the same things repeatedly. The more effective your routine is, the more efficient you will be. It is the same as teachers who usually say the same things. One significant difference distinguishing the skilled is how well they prepare their lesson. Similarly, how a clinician establishes their routine determines how efficient and effective they can be.
I often save two types of data for future use. The first is the things I often type, like history elements, physical exams, reviews of systems, plans, or patient instructions. The second is the lengthy instructions, even if infrequent, that may consume much time to retype. These are called auto-texts in Cerner and smart phrases in Epic, but I need clarification on other systems. For example, history for thyroid nodules, instructions on how to take levothyroxine, my template for continuous glucose monitor interpretation, and diabetes target instructions for patients are among the commonly used ones. As you’ll see later in the patient encounter chapter, I always have written instructions for my patients to decrease miscommunication and reliance on memory. I occasionally order 24-hour urine testing and have saved a paragraph for that. These templates make life a bit easier, and I continue to edit and improve them as needed.
It is not difficult to insert customizations in your pre-written templates. For example, in Cerner, you can place an underscore “_” where you want to edit the information in your auto-texts and toggle between them by “F3”. In Epic, you can put asterisks “***” in your smart phrases and use F2 to toggle between them. This makes filling in the customizable parts of your templates much easier. If you use the mouse every time you want to modify a part of a template, you’ll likely miss some, and it’ll take more time. Make sure to mark all the areas that need to be modified, especially those containing modifiable data like gender, pronouns, and the ones you need to update.
Preferred Orders
Following the same train of thought, we tend to order the same things all the time. If you’re searching every time for orders, this is a big waste of precious time. Learn how to create your favorite lists and do them well. You do them once, and it will help you tremendously. For example, in my endocrinology world, I have favorite folders for thyroid, diabetes, adrenal, pituitary, and bones, among several others. I go to each folder, and all the lab and special script orders are there.
Order Sets
Several diseases for each specialty have a preset of labs and imaging studies to be done routinely. For example, in MEN 1, I order 15-20 labs and imaging studies annually. It’s best for these types of orders to be compiled in an order set and all these orders to be pre-checked. It’ll take just a couple of clicks to place the orders rather than the mental and physical burden of sorting them together every time. This can save a significant amount of time. Your clinical informatics specialist or champion can help you build these care sets, which are definitely worth the time and effort.
If you want to learn more about improving your clinic’s efficiency and effectiveness, consider reading my book, No Work After Hours, and viewing prior blog posts.
