Electronic health records (EHRs) were never designed to burden clinicians, but, over time, that’s exactly what happened. In the latest session of Dossier’s Nursing Informatics Webinar Series, EHR Optimization & Usability: A Nurse Leader’s Guide, speakers Nicole Duke, MSN, RN-BC and E’Jai Ellies, an implementation specialist for Dossier, unpacked why today’s EHR experience often feels disconnected from real clinical practice and how nurse leaders can reclaim the system so it truly supports patient care, workforce wellbeing, and operational excellence.
Why EHRs Don’t Fit the Way Nurses Work
In the webinar, Nicole pointed out EHRs weren’t originally designed around the clinical workflow. They were built to meet organizational, billing, and regulatory needs. Over time, this foundation created layers of documentation that often don’t match how nurses actually think, prioritize, or move through a shift.
E’Jai added that implementation teams historically made decisions without real frontline input. Workflows were mapped out in conference rooms, not in patient rooms or hallways. The result? Systems that function on paper but feel unintuitive in practice.
This disconnect explains why so many nurses still juggle unnecessary clicks, duplicate entry, and workarounds to get through their day.
Interoperability and Usability: Two Sides of the Same Problem
Nicole and E’Jai both emphasized that interoperability – getting systems to “speak the same language” – directly shapes the user experience. When information doesn’t move cleanly between tools or departments, nurses fill the gaps. They spend time hunting for data, repeating documentation, or correcting incomplete information.
That extra effort impacts more than efficiency. It influences patient safety, nurse wellbeing, and even the timeliness of care.
The Documentation Burden Is a Leadership Issue
Nicole highlighted how much of a nurse’s day is absorbed by documentation. The lived experience shared during the webinar was clear: the time spent in the EHR often eclipses time spent with patients.
This contributes to mental fatigue, missed educational moments, and a sense that the EHR owns the workflow instead of supporting it. For organizations, the ripple effects extend to communication breakdowns and errors that influence patient outcomes.
That’s why, as both speakers emphasized, EHR optimization can’t be treated as an IT initiative alone. It is a clinical, operational, and workforce priority.
Start Small—But Start with the Right People
Both Nicole and E’Jai stressed the importance of beginning with manageable improvements rather than trying to overhaul everything at once. Small, focused changes often unlock the biggest impact, especially when leaders identify high-friction areas like flow sheets or handoffs.
Optimizing an EHR can feel overwhelming. Nicole offered a clear roadmap:
1. Start Small
Choose a single, high-impact workflow, such as flow sheets, order sets, handoff tools. Avoid system-wide overhauls at first.
2. Bring the Right People to the Table Early
Include:
- Frontline nurses
- Informatics specialists
- Educators
- IT partners
Workflow redesign must start at the point of care, not in a conference room.
3. Observe the Current State
Sit with nurses. Watch how they navigate the chart. Look for:
- Redundant clicks
- Duplicate documentation
- Bottlenecks
- Areas where staff “work around” the system
These everyday inefficiencies add up to hours.
4. Use Built-In Analytics
Nicole shared an example from her informatics work, using the EHR’s native analytics to track:
- Where users spend the most time
- How many clicks tasks require
- Which departments struggle most
Identifying that nurses were duplicating entries across multiple flow sheets led to a focused sprint. After redesigning the flow sheet to match the natural clinical workflow, the results were measurable: hours of documentation time returned, improved usability, and increased confidence in navigation.
Sustaining Progress Through Structure and Competency
The webinar also underscored that optimization is not a one-time event. Nicole described how governance, through informatics committees and clinical leadership involvement, keeps EHR decisions aligned with organizational goals and regulatory requirements.
Competency plays an equally important role. Traditional two-hour EHR classes don’t truly prepare clinicians. Leaders need meaningful, ongoing competency strategies that reinforce workflow understanding, digital literacy, and safe documentation practices. This aligns with the type of structured support Dossier enables for health systems.
EHR Optimization as an Investment in People
The shared message from the webinar was simple: optimizing the EHR isn’t just about better screens or fewer clicks. It is about improving the daily experience of nurses and, in turn, improving care.
When nurse leaders champion usability, they reduce frustration, strengthen communication, and create more time for what matters most—patients.