My new favorite quote came from a recent customer meeting last week and went something like this: 

“I feel like we’ve bought a Ferrari and we’re driving it around town, but we’ve never taken it over 35 miles per hour.” 

To stretch the analogy further, most people would agree that it wouldn’t make sense to assume the lack of speed is a mechanical issue, one worthy of a team of highly-trained mechanics checking every component of the engine, transmission and suspension to diagnose the problem. A better approach would be to start by ensuring the driver is prepared for high-speed maneuvering, then review that the infrastructure and route can support the speeds planned and, finally, confirm that the car is up to the task. 

In other words, it all comes down to people, processes and systems. These are the exact same areas of focus for any successful, holistic optimization project.


The goal of any implementation is to deliver a system that supports the needs of the users. This includes the front-line clinicians’ delivery care, support staff tasked with ensuring efficient use of clinical time and the finance teams charged with capturing the revenue necessary to support continued operation. Significant resources are focused on ensuring that the training prior to go-live provides a thorough, efficient process for learning the new workflows and system functionality needed to support all impacted areas. 

Fast forward one year (or three, five or even 10 years after go-live), and there have been multiple upgrades with new functionality. Content has evolved, new specialties have been added and employees have come and gone. Has your training evolved along with your system? Do you have processes in place to leverage the experience and efficiency of your power users to assist new and struggling users? Do you even know which users are your power users and which are struggling? How do you support personalization of the system to meet the needs of individual users?

These are all questions to answer before lifting the hood of your EHR and checking for issues.


Similar to training and user efficiency, workflows and processes evolve over time as new regulations, organizational initiatives and ancillary systems are added. Ensure documented workflows match the real world activities and responsibilities of your users. Focus not only on the workflows within your IT systems, but also on the dependant processes happening throughout your organization. For example, administering a medication involves not only order entry, pharmacy dispensing and documenting on the MAR, but also materials management, medical device management, interdisciplinary communication, clinical documentation, nursing task management and a host of other dependent tasks.

As Peter Drucker once said, “If you can’t measure it, you can’t improve it.” Thankfully, Epic provides extensive data on system usage and process efficiency through their analytics tools. These tools can be utilized to populate reports and dashboards that provide deep insight into the effectiveness and efficiency of current workflows and processes. Provider efficiency reports, Radar, Signal data and SlicerDicer can be leveraged to provide even more information. Use these resources to develop a targeted list of processes, locations and workflows needing additional investigation before developing your list of potential optimization initiatives.


Counter-intuitively, I recommend evaluating your system for potential optimizations only after gaining a firm understanding of your user base and the effectiveness of current workflows. Often times, these steps will determine the need for orderset consolidation, billing workqueue redesign, charge router rule edits, specialty-specific documentation tools and other system-based optimization projects. 

One major caveat would be the need to closely evaluate the frequency and quality of your previous upgrades. Were all Nova notes reviewed and implemented as appropriate or just the required ones? Are you participating in Epic’s Honor Roll and Gold Stars programs? What cool new functionality, like Storyboard, has your organization missed?

A holistic approach to system optimization focusing not just on system improvements, but also on preparing your users and designing efficient workflows is crucial to maximizing the impact on your organization and return on your IT investment. As Sammy Hagar once said, “I can’t get my car out of second gear, what used to take two hours now takes all day.” Split your focus between people, processes and systems, and your Ferrari will be setting track records in no time!

Need help planning and executing your optimization project? Medix Technology experts are ready to help. Connect with our team today to learn more!

About the Author:
Jason Kulaga Medix Technology Author PhotoJason Kulaga, Practice Director – Healthcare Solutions, joined Medix Technology to focus on leading and growing the consulting and advisory services practice. Jason is a PMP certified registered nurse with 25 years of experience in healthcare, including 4 years working at Epic in clinical implementation and 15 years overall experience in EHR implementation, project management, delivery oversight and consulting leadership. Jason is primarily focused on mentoring and advising internal consultants and Medix Technology clients on topics including implementation planning, project management, community connect, interoperability, workflow and system optimization, change management, project governance and physician adoption.