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Un-complicating Healthcare IT

How to Use Lean IT Methods to Improve EHR Performance and Usability

Nov 17, 2016 12:00:00 PM Posted by Jim Green | Senior Healthcare IT Consultant

ICE Tech Progression InfographicSince the introduction of EHRs, many people who interact directly with the applications have had negative feelings. This is well documented. Technical innovations within healthcare organizations can come with frustrating moments of not knowing how to use the new application, the application not working the way it should or workflow problems occurring while using the systems. These frustrations not only affect the person who is using the application but they also affect the customer or patient who is on the other end.

According to a survey by PricewaterhouseCoopers, here are some technology development trends among CEOs within healthcare organizations today:

  • 89% of CEOs plan to improve their organization’s ability to innovate
  • 93% of CEOs plan to change their organization’s technology investments
  • 95% of CEOs are investing in new ways to use big data
  • 86-88% of CEOs believe technology will transform their business within the next five years

These statistics clue us in on what leaders in healthcare organizations believe about what the future of technology can be. However:

  • Only 25% of CEOs have implemented any innovation to change their IT
  • Only 33% of CEOs have altered their technology investments
  • Only 36% of CEOs confirmed making progress in dealing with big data

These statistics aren’t promising, causing many CEOs and other healthcare workers to feel nervous about the speed of technological change within the industry. In that same study, it states that 41% of CEOs now feel that their IT department is unprepared for the coming change.

One huge change that has already occurred is the introduction of EHRs, which resulted in turning away from the “paper method.” However, some organizations still do both, adding unnecessary, repetitive work and time to the day. This causes frustration, information being missed and providers and nurses being unhappy with their EHR. EHR usability is perceived to be an IT issue when often the problems lie in processes. This is where Lean methods can make a huge difference.

Is it really a software issue? No.

Due to improper EHR usability precious time throughout the day is lost. On average, physicians lose 78 minutes per day due to EHR-related time. Lean thinking can help get that time back.

Let’s look at an example. A CEO confronts a nurse because she is behind on her daily duties, like dispensing meds for patients. The nurse says it is due to it taking so long to do her charting through an EHR. What took her so long? From some observations taken at a community hosptial, nurses spend about 35% of their time documenting, 20% on direct patient care, and only 7% on assessment and surveillance. The nurses carry an average of 7-12 different devices, causing a 23% error rate when taking notes on paper before imputing the data into EHR.

Looking at this example through a Lean lens, there’s one thing that can be noticed, there are often no set standards for the documentation effort. By writing down notes on paper and then charting in “batch mode” into the EHR, the user adds time that is unneeded and can lead to mix ups if nurses forget which pocket their notes are in for a certain patient. Using Lean to come up with a set standard will inevitably reduce time and error. An even bigger benefit though is that Lean methods are designed to engage end users and increase standards adherence.

There is a way to make your EHR usage more effective

First, it’s time to come to the realization that you can’t buy new software to automatically achieve some new level of operational success. Buying and implementing software is only a small part of it. With Lean, it’s about “creativity over capital.” In other words, there’s a lot of low cost or no cost ways to streamline processes and we have found there is no situation that can’t be improved upon.


We create new value by reducing wasteful activities, and Lean thinking helps us to do so. In practicing Lean, we talk often about value added vs. non-value added activities. Using the A3 methodology, you will identify wastes which will identify root cause issues with EHR usage. There are some wastes you can realistically get rid of and some wastes that are just plain necessary for patient care. The Lean methods will help filter issues in a way that is meaningful to the patients and the staff.

The results of these efforts really speak for themselves. Let’s take a look at a healthcare organization ICE has worked with to put Lean initiatives to work. Before implementing Lean thinking, this healthcare organization had 47 identified wastes and 35 total process steps with their EHR documentation process. After implanting Lean thinking, there were only 15 wastes identified and they reduced their EHR documentation process to 26 total steps. These are both significant reductions, just by making simple Lean changes.

By making simple Lean changes, there was a huge impact all around the healthcare organization whether it was a savings of time or money. They were able to save 30 minutes per patient equaling a total savings of $270,000 per year. You, too, could save by implementing Lean into your organization.


What Lean Healthcare Really Is And How To Get Started In Your Hospital

Jim Green | Senior Healthcare IT Consultant

Jim has over 20 years of experience in developing, managing, and implementing IT projects and solutions in healthcare, publishing, and insurance industries. Jim is currently serving hospitals and clinics in a CIO role, specializing in EHR optimization, process improvement, IT planning, and leading IT teams.