Every healthcare organization has someone who knows the EHR better than anyone else. They know the templates, the reports, the workarounds, and how to fix the problem nobody else understands. These people are valuable, and mature organizations should have them.
But there is a difference between having a super user and depending on one, and when critical knowledge lives in a single person, the organization has built a single point of operational failure.
Ninety days after go-live, the support queue is the most honest record your agency keeps. Workarounds and training gaps and failing interfaces all end up there as tickets. Most teams read the queue one case at a time, close what they can, and move on. Almost nobody adds it up.
A Pareto chart is how you add it up. Sort your issue categories from most frequent to least, run a cumulative percentage line across the top, and mark where the line crosses 80%. The categories left of that mark are where your attention belongs, and it is usually a shorter list than people expect. Everything to the right is real. It is just not where the leverage is.
Most practices blame their EHR the moment productivity starts slipping. But after reviewing dozens of eClinicalWorks environments, I’ve noticed something that rarely gets the attention it deserves: the biggest productivity killers usually aren’t the software. They’re the workarounds that were created years ago, quietly became “how we do things here,” and never got revisited.
Those workarounds are signals. They point to a gap between how eClinicalWorks was configured, how staff was trained, and how the practice actually operates today. That gap is where eClinicalWorks workflow optimization should begin.
The best EHR implementation I ever saw was not run by IT.
Working on the vendor side, I delivered the same software to organizations that got very different results from it. The product was not the variable. The consequences were.
In most implementations I delivered, the project lived inside IT. The business case justified the purchase, then went into a drawer. Department leaders showed up for demos, signed off on timelines, and reappeared at go-live to ask why things looked different.
The project team carried the weight, and when adoption lagged, it was treated as a training problem. The executives who approved the spend were rarely the ones accountable for the return. The most commonly blamed party was the vendor. Their poor implementation was why adoption struggled. It was not the whole story.
A few years ago, I worked with a large multispecialty medical group that believed they had a referral problem.
Their leadership team kept asking the same question: “Why are so many patients never making it to the specialist?”
At first glance, the numbers were alarming. Thousands of referrals were being generated, yet only a fraction ever resulted in completed specialty appointments.
The instinct was to launch a referral management program immediately.
Instead, I recommended something different: don’t build a solution until you’ve audited the process.
That recommendation changed everything.
We’re excited to introduce Nicole Guevara, MD, MSHI, FAMIA, CPHIMS, ACHIP, as one of HealthTECH Resources’ partner consultants specializing in ambulatory EHR optimization and clinical operations advisory.