Successfully implementing and using an EHR requires a significant amount of coordination with attention to components such as software optimization, templates, workflow analysis, and many more. One challenge that faces practices is the selection and integration of computers so that they become adjunctive to the patient encounter and do not become an obstacle to delivering care.
Some practitioners may use the implementation of an EHR as an opportunity to move to a different location and build/configure new clinic space so that it is designed specifically as a technology-based practice. This has advantages in that office equipment and furnishings can be specifically purchased or built to fit the exact needs of the physicians and practice staff. If a wired local network is installed in the new practice, network jacks can be placed exactly where required for the intended hardware. Ensuring there is adequate desktop and counter space in examination rooms to accommodate computers and printers is also simple to do when designing new layouts. It is likely that any physician intending to spend a significant amount of money beyond the costs of an EHR will seek professional help from an office designer with experience working in medical practices. Certain specialties may have specific needs that differ from those of a generalist, so be sure to carefully check the references of a designer who has been referred to you and, if possible, visit a couple of practices that your contractor of choice has designed. You can use the opportunity to find out how well the office was designed and ask what they would have done differently after some experience working in the practice.
The majority of physicians who implement an EHR will upgrade their existing paper-based practices to accommodate information technology and computers. Based upon office size and layout, this can be a significant challenge. Small examination rooms can be difficult to reconfigure without losing seating space for patients or critical counter space if the room is too small to accommodate a desk. So, what are your options when integrating computers into an existing medical office?
Each clinic may differ to a small degree and, rather than providing specific examples, here are some suggestions to consider:
- Do you need a local network to run your EHR? If you install an EHR system that has a server locally in your office, you may need to install a network to connect to workstations in the examination rooms, scanning areas, front office, hallways, etc. If your office is located in an old building, this may incur significant cost as it may not be simple to run the wires through the ceiling and walls. Check with your landlord and consider this when you are selecting your EHR and intended hardware.
- With the growing prevalence of high-speed wireless access points and networks, it may be much more cost effective to run a wireless network for your examination room computers. However, make sure that you choose the fastest wireless network router and that you have an office survey completed to check the wireless signal strength throughout critical care areas. There is nothing more frustrating than having a great EHR and computers that continuously drop the network signal necessitating restarting the router or the computer. Also make sure that your wireless security settings are correctly configured.
- Make sure not to place the computer between you and your patient. The computer can act as a barrier and it can be disconcerting for patients to be looking at the back of a computer monitor wondering what it is that you are writing.
- Consider an L-shaped desk configuration enabling your patient to view the screen during the encounter. It is much more effective as a mechanism to engage patients in their own care; plus they will often identify errors or outdated information during the encounter allowing you to make the necessary corrections immediately.
- One of the most logical form-factors for physicians is the tablet computer. Just like a paper chart, this device can be used to input data using a pen to select items from a checklist or to enter information using handwriting recognition. Particularly in examination rooms that lack space for a fixed computer station, tablets can be a godsend. However, make sure that you have somewhere to “dock” the tablet while examining your patient so that the tablet is not left lying on a countertop or at the foot of the bed. This will protect your investment with the added benefit of charging the device during the encounter so that your battery is able to last for a full clinic shift.
- Some clinicians may opt for a second monitor screen specifically for the patient to view during the encounter. This may be a reasonable option and can be wall mounted for patient convenience. This is a reasonable option if the layout of the examination room requires a contortionist to share the computer screen while documenting clinical notes.
The following examples are provided for reference purposes regarding computer layouts in the examination room.
Do you have any experiences to share? Is there a computer configuration that you believe is optimal or do you have lessons learned to help others avoid common problems. Click on the “Comments” link below to share your thoughts.