The Lean Electronic Health Record : A Journey toward Optimized Care book cover
1st Edition

The Lean Electronic Health Record
A Journey toward Optimized Care

ISBN 9781138626584
Published January 11, 2018 by Productivity Press
276 Pages 48 B/W Illustrations

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Book Description

The Electronic Health Record (EHR) is a reflection of the way your organization conducts business. If you’re looking to make lasting improvements in the delivery of care, you must start with looking at the system from your patient’s perspective to understand what is of value and what is simply waste. When you begin seeing in this way, you’ll begin building in this way. When you begin building in this way, you’ll begin driving improvements in your care delivery. Only then will your EHR be able to support lasting improvements, driving better patient care and outcomes at lower costs. 

Healthcare organizations are under increasing pressure to improve on all fronts. This can be achieved, but only by changing the very way we look at care. No longer can we look at care just from the organization or provider’s perspective; we must start with the end in mind – the patient. Compelling case studies, discussed throughout this book, demonstrate that modifying processes and workflows using Lean methodologies lead to substantial improvements. These changes must be undertaken in a clear, consistent, and methodical manner. When implementing an EHR based on existing workflows and sometimes antiquated processes, organizations struggle to sustain improvements.

Many organizations have deployed an EHR and now face optimization challenges, including the decision to move to a new EHR vendor. The financial implications of upgrading, optimizing or replacing an EHR system are significant and laden with risk. Choose the wrong vendor, the wrong system, or the wrong approach and you may struggle under the weight of that decision for decades.  Organizations that successfully leverage the convergence of needs – patients demanding better care, providers needing more efficient workflows and organizations desiring better financials – will survive and thrive.

This book ties together current healthcare challenges with proven Lean methodologies to provide a clear, concise roadmap to help organizations drive real improvements in the selection, implementation, and on-going management of their EHR systems. Improving patient care, improving the provider experience and reducing organizational costs are the next frontier in the use of EHRs and this book provides a roadmap to that desired future state.

Table of Contents

Part 1: The reason for action – why should we change?

Chapter 1: Always start with the patient

  • A more seamless experience
  • A safer experience
  • Self-service options
  • Easy access to medical records

Chapter 2: Take care of ourselves before we take care of others

  • Provider burnout is exasperated by today’s EHRs
  • The promise of a simplified user experience has not materialized
  • Getting a day’s work done in a day

Chapter 3: Dollars and cents

  • Can an EHR have a return on investment?
  • Keep it simple. Avoid the bells and whistles
  • "Out of the box" work flows reduce install hassles (and cost)

Part 2: The blank slate – Installing a brand new EHR system

Chapter 4: Requirements Gathering

  • Hardware considerations
  • Infrastructure
  • Software considerations
  • Analytics and measurement needs

Chapter 5: Design Phase

  • Lean workflows
  • Gap analysis
  • Engaging the end users
  • Lean project management

Chapter 6: Testing Phase and User Acceptance

  • Super users
  • The lean approach to product and process testing

Chapter 7: Go-Live

  • Planning the go-live
  • Support "at the elbow" for the providers

Chapter 8: Optimization

  • Standards and Evidence-based practice maintenance
  • Managing for daily improvement (MDI)
  • Continuous improvement

Part 3: Houston, we have a problem – what to do with an existing EHR system

Chapter 9: Standardize by specialty

Chapter 10: The model line

Chapter 11: Spread the model

Part 4: Lessons Learned … and learned again

Chapter 12: Do not replicate a broken current state into a new EHR

Chapter 13: Standardization is not optional

Chapter 14: Engage users and patients early and often

Appendix: Tools and Templates for use in lean EHR implementation

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Ronald Bercawis the president of Breakthrough Horizons, LTD, a management consulting company specializing in world-class improvement through the application of the Toyota Production System, more commonly known as "Lean." With over twenty years of experience in operations, his Lean management experience was gained through multiple enterprise transformations in different industries including custom packaging, power reliability electronic assembly, and test and measurement products.

Educated at Purdue University, Bercaw learned the details and disciplined applications of Lean principles, habits, and tools from both the Shingijutsu Sensei and their first generation disciples. Working in both shop floor and above-the-shop-floor areas, He has vigorously strived to remove waste from businesses through the involvement and ideas of the people doing the work.

Bercaw has consulting experience in the healthcare sector (U.S. and Canadian health systems including primary care, acute care, and community applications of both clinical and back shop improvement), the commercial sector (administrations, manufacturing, distribution, supply chain, and engineering), and the public sector (U.S. Army, U.S. Navy, U.S. Air Force including Maintenance, Repair, and Overhaul (MRO) assignments, Pentagon, and Surgeon General Assignments). He is also the author of Taking Improvement from the Assembly Line to Healthcare: The Application of Lean within the Healthcare Industry, published by CRC Press (2012), and Lean Leadership for Healthcare: Approaches to Lean Transformation (2013) both recipients of the Shingo Research & Professional Publication Award.


Kurt A. Knoth is Vice President, Performance Improvement and Patient Experience at Spectrum Health where he is responsible for all aspects of Process Improvement, Patient Experience, Patient Family Advisory Councils (PFACS) and Sustainability for Spectrum Health’s 12 Hospitals, 1,400 provider Medical Group and our health plan, Priority Health. Kurt functions as a part of the Spectrum Health executive leadership team to shape and reinforce the culture of improvement, vision, prioritize goals/objectives, and establishes the direction of process improvement system-wide to ensure the highest standards are met through the eyes of our patients and members. He is also responsible for building alignment between all organizations on the prioritization of projects which strengthen and transform our model of care.

Spectrum’s vision is to be the Leader in Health by 2020. By applying the principals of the Toyota Production System to our clinical and administrative processes, we our driving world class improvement in safety, quality, cost and access. By including our customers (patients and families) in our improvement work, we are also driving world class improvements in our Patient Experience.


Susan Snedaker is an experienced IT professional specializing in infrastructure strategy and infrastructure services. As Director of IT Infrastructure & Operations at Tucson Medical Center, a HIMSS Stage 7 Certified and Most Wired Hospital, her team delivers high availability infrastructure technology and solutions for a complex and integrated hospital environment.

Ms. Snedaker is the author of six technical books on Windows Server technologies and IT project management and business continuity/disaster recovery. Second Edition of Business Continuity and Disaster Recovery for IT Professionals (Elsevier, October 2013) with Chris Rima provides an updated roadmap for creating BC & DR plans for organizations of all sizes. She is also the author of the forthcoming book, Leading Healthcare IT: Managing to Succeed (CRC Press, 2016).

Her areas of expertise include: IT infrastructure services, technology and operations; venture capital, investor, start up due diligence; strategic business planning; disaster recovery planning, business continuity strategies; enterprise architecture and strategic technical planning; healthcare IT including medical equipment management, systems integration, business case development/ROI, project management, technology implementation, leadership and change management.



"For some reason we thought the Electronic Medical Records would solve all of our healthcare problems. So we misapplied computer solutions to solve problems of bad processes and rigid cultures. Lean management can help by engaging people in improving processes, identifying their real information needs, and making EMR truly value added."

-Jeffrey K. Liker, PHD Author, The Toyota Way

"Organizations that do not consider the workflows and processes for their EHR will never optimize or achieve highly reliable outcomes. HRO organizations align and invest in their informatics and Lean teams. These teams collaborate together can achieve the triple aim and effective use of the EHR, and happiness of users and patients alike. This book is an important demonstration of these methodologies."

-Michael J. Kramer, M.D. – SVP and Chief Quality Officer

"Kurt, Ron and Susan have a message: the Electronic Health Record (EHR) can help or hinder the healthcare delivery system. By following the proven methodology detailed within The Lean Electronic Health Record the EHR can be the enabler of better and coordinated care. A must read for doctors and administrators truly interested in putting the patient in the heart of healthcare."

- Helen Zak

"The Lean EHR is a clear, concise description of the use of Lean principles in a real-world setting. Written in a relaxed, personalized writing style, the authors successfully guide the reader through a detailed Lean process for a very complex project. It is an excellent resource for those teaching Lean principles in academia, as well as healthcare teams planning to implement a new EHR."

-Gail Bullard, DHEd, MSHA, RN, LBBH, Lean Healthcare Program Coordinator, Ferris State University