Clinicians are all too familiar with the daily frustrations of fragmented systems, multiple logins and passwords, and click-heavy workflows. As stress and burnout continue rising, especially in high-pressure environments like emergency medicine, the usability of Electronic Patient Records (EPRs) has never been more critical.
It is widely known that poorly designed systems not only hinder efficiency but also add to the strain on healthcare professionals and can ultimately compromise patient safety. Here, I explore how change management and strong usability of EPRs can reduce burden by becoming effective digital enablers.
Change management to ensure usability
For three years, I’ve been part of the Maidstone and Tunbridge Wells NHS Trust (MTW) digital programme, which includes our EPR, provided by Altera Digital Health. When I reflect on the start of that period, the team and I took some fundamental first steps to manage change to lay robust foundations for our successful digital journey. We still use these steps today, as part of our continuous improvement cycles.
The critical first step was listening to end users. That means physically getting out on the wards, shadowing and speaking to users in order to understand the workflows and challenges, listening to their feedback and experiences. In my opinion, it’s the best way to learn. I’m passionate about this because in my experience, nine times out of ten, our perceptions of the workflows rarely align with actual reality. For example, clinicians will use workarounds and a variety of ways to perform a certain workflow.
It is absolutely key when designing and configuring digital workflows, that these optimise the clinical process and do not introduce constraints that require the clinician to change the way they work in order to use the system.
To support teams, establishing a clinically led culture in which users can voice their feedback on usability easily, by creating working groups, specific email addresses, telephone hotlines, etc., is key. And secondly, embedding usability testing into your change-control process. One of the mechanisms we use is exemplar wards to pilot digital changes and further configure the design before rolling out wider across the trust.
Clinically led, digitally enabled design
To support usability, clinician-led EPR design needs to become the norm and not just the intent. Clinical involvement should be mandated to accomplish this, particularly in early decisions but also throughout the design process, to build that lived experience into its core. The shift to establishing clinical informaticians (CIO, CCIO, CXIO and CNIO) is great progress towards clinically led design, but more could be achieved by extending this further to represent all clinical roles.
Ensuring executive buy in is another key enabler. But it must be backed up with strong visibility, action, consistency and clear messaging to support a shared vision from the top down. Ultimately, these approaches will work together to establish a much-needed wider culture shift. The current perception that EPR implementation and optimisation is an ‘IT project’ is dated and we need to start thinking of them as initiatives owned by the whole trust.
Impactful usability changes at MTW
The flexibility of our EPR system has enabled us to develop a solution that our clinicians want to use, and that has reduced stress and improved care. The biggest enhancement has been implementing streamlined specialty-specific clinical documentation, which has been transformative to design the right document for the right users. Having a mixture of free-text boxes and form fields has helped to improve data collection and efficiency and reduce documentation fatigue.
We’ve made significant time savings across wards by introducing automated vital signs directly from the blood pressure device into our EPR. Users flagged issues with the previous process that was prone to delays, transcription errors and inefficiencies. Our new workflow is reducing transcription errors and saving 2.5 minutes per observation, equating to approximately a 50% time saving for clinicians to record observations, freeing up thousands of hours each year for direct patient care and ultimately improving the care experience.
Our EPR includes tab integration with patient-context launching for users to navigate to supporting systems such as PACs and our shared care record. The flexibility of our EPR to suit our clinicians has played a big part in improving usability and we’ve recently started pulling useful information into one clinical summary. It enables us to respond to patient safety incidents by adding and removing fields quickly and work is currently ongoing to adapt our VTE (venous thromboembolism) assessment to further optimise the process.
The critical link between solution design and safer patient care
Any discussions on usability and design should always include patient safety requirements. From my experience, I know that clunky interfaces, multiple logins, alert overload and poor visibility of key information increases cognitive burden and slows decisions. So, we design those risks out, consciously considering these points as part of the design process.
There is still a huge belief that clinicians should adapt rather than demand better designed digital systems, a view that should be challenged. We have proven that with the right tools and robust clinical engagement, the flexibility of our system enables us to work with our clinical groups to optimise the processes for the benefit of both the clinical users and the patients.
Across the NHS, we need to start raising awareness on the correlation between design and patient safety. This will come from developing a digital-first culture that starts by having digital and data workstreams embedded into every activity at a trust.
As trusts embark on their EPR journeys, the goal isn’t to simply go live—that’s just the start. Transformational EPRs need to begin with an extensive team of committed clinicians, digital leads and EPR partners. Add to that, the right platform that is flexible, configurable and enables optimisation and strong usability is within reach to make it a true enabler for more effective care. The real goal is designing an EPR that is clinically led and digitally enabled.
By Johanna Kelly, Chief Nursing Information Officer, Maidstone and Tunbridge Wells NHS Trust