Case Studies / Optimization
23% reduction in documentation time. 18% improvement in physician satisfaction.
A 650-bed academic medical center had been on Cerner Millennium for seven years. Physician satisfaction with the EHR had declined to 62%. Documentation time had increased as workarounds accumulated. The organization needed optimization without disrupting ongoing clinical operations or research activities.
The medical center's Cerner implementation had succeeded technically but degraded operationally over time. New requirements were addressed through workarounds rather than system redesign. Documentation burden had increased incrementally until physicians spent 2+ hours per day on EHR tasks beyond direct patient care.
Previous optimization attempts had focused on training. Physicians were told to use the system more efficiently. This approach failed because the underlying workflows were the problem, not user behavior. The organization needed systematic workflow analysis and rebuild.
Complicating factors included active research protocols requiring specific documentation, teaching hospital workflows that differed from community settings, and a physician population with varying EHR proficiency levels.
TNG deployed a team of six consultants specializing in Cerner optimization. The engagement began with workflow observation—consultants shadowed physicians across eight departments to document actual EHR usage patterns versus intended workflows.
Each change was tested with physician champions before broad deployment. Modifications that increased documentation time, even slightly, were rejected or redesigned. The standard was measurable time savings—not feature addition.
Documentation time decreased by an average of 28 minutes per physician per day. Across 400+ physicians, this represented significant recovered clinical capacity. Physician satisfaction with the EHR increased from 62% to 80% in post-project surveys.
Alert override rates dropped below 40% for remaining alerts—indicating clinically meaningful decision support rather than background noise. Order entry time decreased as physicians navigated fewer, more relevant order sets.
TNG established a governance structure for ongoing optimization. A physician informatics committee now reviews proposed system changes. New order sets require clinical justification and consolidation review. Alert additions require evidence of clinical impact.
The medical center conducts quarterly workflow assessments in high-volume areas. Optimization is now continuous rather than periodic.
"We had tried to fix our EHR problems by training physicians to work around them. TNG showed us the system was the problem, not our users. The workflow analysis alone justified the engagement."
Academic Medical Center
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