EHR Customization

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During the whirl-wind of an implementation there are so many issues that need to be addressed that customization at the Enterprise and/or Organizational level seems to take a back seat. Many organizations make the mistake of implementing all of the pre-delivered notes, views and security classification groups without ever looking back to see if they have utility to the organization. Only after a multitude of complaints about the application from disgruntled providers do questions arise as to how the EHR can be improved for the benefit of its users.

This article is dedicated to covering some of the many changes that can be made to the EHR which will eliminate clicks and increase efficiency for all users.

Note Authoring Workspace (NAW)

When thinking of ways to improve the NAW consider the end users current workflows during a patient visit. Are they constantly navigating out of the note to work on things or see things that they could have handled from within the NAW? If the answer to this question is "Yes", then end users are wasting valuable time attempting to navigate the system instead of spending it on patient care. To avoid this, consider making the following changes:

  • Add additional tabs so that the end user has less clicks to get to flowsheets. This is done in TWAdmin, under WorkdefAdmin>Add/Edit Note View>Note.
  • Define Buttons to match the workflows that are used. The end user should not have to search for buttons that they use with every patient. Add buttons that add value to the workflows and remove those that won't. This is done by clicking "define buttons" > Commands, then drag and drop the button to the toolbar. This is done on a per tab basis where this functionality is available.

Clinical Desktop Views

The way a clinical desktop view is organized can either hinder or help end users in performing their job. Here are some suggestions which will help make these views more user friendly.

  • Create views that are role specific (e.g. Provider View, Clinical Staff View, Billing View etc...). This will ensure that the views match the common workflows for that role and these views can be standardized across the organization.
  • Remove any buttons from the view that are not being used or should not be used. Doing this will ensure that the user has an uncluttered, uncomplicated workspace.
  • Add buttons that will be useful to the user. For example, Providers verify results all the time. The associated buttons should be in plain sight within the appropriate clinical desktop view as defined buttons under the Patient Worklist Tab and/or any other tab where a user would need to verify results. This will save the user a number of clicks on a per patient basis if they are accustomed to using the right click menu items.
  • Don't give the users any more clinical desktop views than needed to do their job. Having numerous views can be confusing and over-whelming, so avoid this whenever possible.
  • Organize the viewing panes in a way that best supports the data that will be viewed within that pane. For example, it may be better to have flowsheets and chart viewer in a pane that takes up 1/2 of the total window. This will allow the users to see more information as it relates to reading notes and trending data over time.
  • Make sure that the first tab in every pane is the one that users need to see most often. Also consider the tabs in relation to each other. For example, most providers tend to look at Problems, Meds/Orders and the Chart Viewer at the same time. Ensure that when they are working in the clinical desktop that these tabs are viewable at the same time by placing them in separate viewing panes as the first tab in each.
  • Follow the 80/20 Rule and default items within each tab where ever applicable. For example, if users use a Health Maintenance flowsheet 80% of the time, this should be the first flowsheet in the list. An "*" can be added in front of the flowsheet name to move it to the top of the list.
  • Remember to default each user's primary clinical desktop view to avoid confusion. This can be done using SSMT.
  • DO NOT allow users to customize their own clinical desktop views. (Remove the "clinical desktop view-edit" security code from all applicable security classification groups.) This is a maintenance nightmare and is nearly impossible to support.

Security Classification Groups

Set these up by role. Remember that it is typically better to assign a group to a user than to add specific security codes on a per user basis. Only give enough security so that the members of the group can do their job.


These should be role specific. Ensure that defaults are set so that when a user clicks on a VTB item, the desired HTB document will open automatically. Remove any documents from the HTB that are not being used.