Tips to Help Your EHR Blend into Your Practice Design

Dan Hamilton, chief operating officer of Nor-Lea Hospital District in Lovington, N.M., had two primary goals when redesigning the district's rapidly expanding outpatient clinic: reduce patient wait times and improve staff efficiency. A combination of smart technology and design solved both issues.

Hamilton and his colleagues centered the new design around "self-rooming" using a patient flow system developed by Traverse City, Mich.-based Versus Technology. Instead of waiting for a nurse to retrieve them from the waiting area, patients are assigned a room at registration and given a color-coded badge that electronically tracks their location and allows staff to monitor which rooms are in use.

As the system is fine tuned, Hamilton expects to eliminate the lobby/waiting area altogether.

"We designed our clinic around the medical home concept and self-rooming with no waiting rooms, which has given us some options," he says. "The existing waiting room is equipped with electrical cabling, plumbing, Wi-Fi data, and phone lines in the floors, so that in the future we can use that space to add more providers."

Nor-Lea incorporated other smart design elements, such as color-coded hallways and centralized staff work areas, aimed at improving the patient experience and facilitating teamwork.

Read on for advice from experts on how to use layout and design elements to make your practice more efficient and patient-focused.

MASTER THE FIRST IMPRESSION

One of the first design elements to consider is what patients see when they walk through the front door. Are they greeted by a friendly receptionist in an open, light-filled space or forced to tap on a glass partition to get a staff member's attention?

"Often, that staff member finishes whatever they're doing before opening the glass," says Patrick Fugeman, vice president for design and construction at Christiana Care Health System in Wilmington, Del. "The design trend we're seeing is to keep the backup functions out of the greeting area in order to present a much calmer arrival for patients."

Historically, many medical offices were set up as a series of closed spaces partly out of concern for confidentiality, says Elizabeth Woodcock, an Atlanta-based medical practice consultant and author of the book "Mastering Patient Flow." However, privacy measures taken too far make waiting rooms seem like holding tanks with barriers to keep patients at bay.

"We've realized that we don't need to do business that way anymore," she says. "The trend is to keep the front office open with some team members always up front and a partition to cover administrative areas."

Woodcock suggests thinking of the waiting area as a "living room." It should convey professionalism and efficiency while offering added features to ease patients' waits, such as computer workstations, play areas for children, and access to coffee and water.

When deciding how to set up the waiting area, it's useful to look at the space from the patient's perspective, says Rosalyn Cama, a New Haven, Conn.-based interior designer and author of "Evidence-based Healthcare Design." For example, make sure patients can see the receptionist from the waiting area so they can make eye contact if necessary, and include a table and chairs for filling out forms instead of forcing patients to balance clipboards on their laps.

In orthopedic practices, build in extra space to store walkers, crutches, and wheelchairs. Also consider mobility issues and choose floor surfaces that are smooth enough to accommodate walkers and wheelchairs while being free of potential tripping hazards.

"Accommodate people with respect and comfort," says Fugeman. "Seating should be comfortable and right-sized, from small waiting chairs and tables for children to bariatric chairs for larger patients."

Remember that first impressions often determine how patients rate the practice online and respond to satisfaction surveys, says Cama.

"People have expectations of what's going to happen at their visit and within that first 6 feet, their perceptions either support it, are somewhat disappointed, or are totally blown away," she says. "We talk to our clients about how to create that better response."

CONSIDER PATIENT FLOW

The potential advantages of using self-rooming technology were getting lost in Nor-Lea's old clinic because patients often couldn't find their assigned rooms, says Hamilton. The new clinic's design addresses that issue by arranging exam rooms in a square around a centralized staff work area and numbering rooms in a logical sequence.

After patients receive their electronic badges at registration, they proceed to corresponding color-coded hallways or suites, where exam rooms are numbered sequentially in the 100s, 200s, 300s, or 400s. The design allows patients get to their exam rooms more quickly, he says.

"In the new clinic, by the time patients are checked in and sent upstairs, the nurses are ready to meet them," says Hamilton. "Meanwhile, the reception staff can see when rooms are occupied and know where to send the next patient."

Exam rooms should be set up for comfort and efficiency, says Fugeman. Every room should have a private area for undressing, a sink, and essential supplies. Besides the exam table, provide a chair and possibly a small table for patient-physician discussion after the physical exam.

"Think of the exam room as a visit room," says Woodcock. Always provide a place for patients to sit as opposed to having them perch on the exam table while talking with the physician. Similarly, provide chairs in "sub-waiting" areas outside exam rooms so patients don't have to sit on the exam table until the physician arrives.

"The times in between are what the patient often remembers," says Cama. "What are they doing in the time between the greeting and admission, the admission and the exam, the exam and the consultation?" she says. "Consider what that experience is like and whether the built environment lets them be in control of that time."

FACILIATE TEAMWORK

Newer designs tend to de-emphasize private offices and focus on team areas that encourage collaboration, says Woodcock. Private physician offices should be placed outside of the patient care area, while a shared work area should be located centrally where clinicians can access it easily in between seeing patients.

Centralized workstations boost efficiency, she adds. They allow physicians to take care of routine tasks, such as returning calls or looking at test results that can pile up if left until the physicians returns to his office.

When remodeling an existing office, think about converting space once used for paper files into a central workstation, says Woodcock. Many offices have switched to electronic medical records and now have a large central area that can be used in other ways.

When designing the workstations, make sure staff members have easy access to necessary equipment, such as fax and credit card machines, and printers, she says.

"When people have to walk around the office to do everything it affects productivity, but we promote that by not having efficient workstations.  Look at the cabinetry and organization around the employee, and whether it forces the employee to get up often in order to get their job done."

Janet Colwell is a Brooklyn, N.Y.-based freelance writer specializing in healthcare. With more than 20 years experience as a journalist, she writes frequently about clinical and practice management issues for several national health industry publications. She can be reached at editor@physicianspractice.com.

This article originally appeared in the April 2015 issue of Physicians Practice.