Shawn Carlson, LPN, and Clinical Systems Analyst at Juno Health, recently sat down with the Juno Health blog editorial team to discuss the importance of having clinicians lead the design of clinical software such as EHRs.
In honor of Nurses Week 2024, she also highlights her own experiences as a clinician and LPN, and how she, along with Juno Health’s staff of clinicians, are working to make delivering care easier.
The following has been edited for length and clarity.
Q: How has your experience as a clinician shaped your approach to developing EHR solutions?
Carlson: I've been a nurse in healthcare for 32 years, and I have witnessed the transition from paper to electronic systems right from the start.
I think back to my first job after nursing school, when I worked in a medical intensive care unit. At that time, they were testing a bedside electronic charting system, and the trainer taught us a keyboard shortcut that allowed us to quickly pull in data from the previous nurse's entry.
Everyone in the unit thought this was fantastic – it was efficient and saved time. However, management had a different perspective. They saw identical charting across multiple shifts for the same patient, which raised concerns about the quality and accuracy of patient records.
I didn't realize it at the time, but my early experiences with an EHR taught me a valuable lesson for my current work in EHR design – we should never create simplicity that leads to complacency.
Instead, we must strive for simplicity that promotes accuracy. This is why copy and paste features should be avoided.
Throughout my career, I've worked in a variety of healthcare settings, including hospitals and doctors’ offices, primarily focusing on surgical care, post-operative, and pre-operative care. Over the years, I've faced the challenge of balancing the time spent on computers with the time needed for direct patient care.
I've observed newer nurses staying up to an hour and a half after their shifts ended to complete documentation. They struggled with time management, trying to fit charting into the limited five-minute increments between patient care tasks. My team and I have considered these challenges in our work, constantly striving to find better solutions.
Q: How does Juno Health prioritize empowering clinicians to lead development?
Carlson: My answer to this question really focuses on our holistic approach to the vision behind Juno Health. The vision for Juno Health has really materialized through the same emphasis on simplicity that I’ve mentioned. At Juno Health, clinical workflows begin and end with clinicians.
Although it may sound cliché, we’ve achieved this goal. From conception to completion, there is always clinical input throughout the process. We involve clinicians in every stage of design, development, and testing of our software.
We firmly believe that clinicians can positively affect EHR implementation, and that proper EHR implementation improves overall care coordination and patient care.
As such, we continually ask ourselves a key question: "How do we make this effortless for the clinician?" Achieving this goal isn't easy. We follow the Software Development Life Cycle (SDLC) and employ dedicated designers adhering to industry standards like Nielsen Norman certifications.
We conduct multiple peer reviews and involve healthcare professionals from various levels, from entry-level workers to physicians and organizational CEOs. Our large team evaluates designs at each step before moving to the next stage of the approval process. Our committed management team oversees and approves the design, always striving to make the EHR easier to use.
Q: How does clinician-led design benefit EHR usability, as well as reduce burnout and improve the delivery of care?
Carlson: I'll touch on each aspect of our design process and explain them in detail. During the design phase, we use progressive disclosure to minimize visual clutter and reduce distractions. If a user doesn't need certain information at a given moment, we hide it to keep their focus on what they need to answer. This helps minimize distractions both visually and cognitively.
We also create user personas to guide our design decisions. These personas represent different user groups and roles within our system. By understanding who will use our software and how they will interact with it, we can create relevant, real-world examples of workflows as we design.
We also engage in fun and unconventional exercises when evaluating our designs. We literally count clicks to see how many it takes to document various tasks. We also time how long it takes to chart or enter data. While it may seem trivial, every second matters when clinicians need to complete documentation efficiently.
We've put a lot of effort into our configuration areas to create flexibility. This allows organizations to control how much time clinicians spend on documentation through the way they structure data capture. We use shared components, as Ashley Lee mentioned in her “Three with a SME” interview, to optimize charting by pulling already entered data and promoting consistency. This helps avoid charting a data point in multiple ways and reduces duplicate entries, saving time.
By organizing related information into data objects, we increase the time clinicians can spend with patients instead of on the computer. Ultimately, our goal is to give organizations the freedom to set their own data capture goals and control the speed and time required. In turn, we get to witness their success.
Please contact us here to learn more about how Juno Health is dedicated to building smarter, more flexible digital healthcare solutions.
