A topic at the forefront of many hospitals we work with is how to address the ever-growing problem of physician burnout. There are certainly many factors, however a primary one is the dissatisfaction with the electronic health record (EHR) and extra time spent outside of patient care completing documentation.
Now, I’m not a doctor, I don’t claim to be a doctor, and I have no intention of becoming a doctor. I do however spend much of my time working with doctors on how to make heads or tails of their EHRs and how to make it a tool that can work for them rather than the other way around. The solution often lies with simplifying the tools that already exist and personalized customization of the EHR.
I recently read The New Yorker article by Atul Gawande about “Why Doctors Hate Their Computers.” There was certainly a lot to unpack there, but the main message was how EHRs have drastically changed the day-to-day of doctors and other medical professionals, often to their detriment. One quote from the article stuck with me: “Many fear that the advance of technology will replace us all with robots. Yet in fields like healthcare, the more imminent prospect is that it will make us all behave like robots. And the people we serve need something more than either robots or robot-like people can provide. They need human enterprises that can adapt to change.” It puts back into perspective that EHRs are here to stay and that IT and clinicians need to work together to find solutions on how to best serve the primary benefactor of a well-oiled health IT machine– the patient. Improving the usability of the EHR is critical to helping physicians to maintain high-quality patient care.
I recently had the opportunity to lead a project at a hospital on the west coast to implement a physician personalization program that aimed to take EHR usability to the next level and flip the script on EHR-related causes of physician burnout and dissatisfaction – lack of proper training and ongoing communication, over-leveraged system analysts, poor documentation and workflow configuration, etc. These challenges are not unique to this hospital, but our goal was to develop a collaborative approach that would put physicians in the driver’s seat and enable sustainable EHR usability improvements to both provide better patient care and reduce clinician time spent in the EHR.
During a four-month period, we were able to individually meet with more than 100 physicians, meeting several of them multiple times, to personalize the EHR and make configuration enhancements to reduce clicks through new and existing functionality. The results? We saw a 22-minute decrease (25%) in average time spent documenting in the EHR for inpatient physicians, with twice as many respondents saying they considered themselves advanced users of the system compared to prior to the personalization program.
We also saw upwards of 1.5 hours in daily time savings for several ambulatory physicians, proving that targeted personalization and system optimization can really move the needle. On top of the great feedback we received, 100 percent of physicians reported that they would recommend this type of individualized personalization to their colleagues.
Based on the success we saw with this hospital, I wanted to share a few considerations for implementing a successful physician personalization program.
Be Flexible – This can only be successful with strong physician participation, so make sure to provide proper marketing for the program up front. It is also critical to have coordinated outreach and options for learning – scheduled one-on-one sessions, drop-in personalization labs, and focused small-group sessions all received a positive response.
Do Your Homework – Given the limited time you have with a physician, it is important to focus on the problem areas first for each individual physician. Not all types of physicians have the same challenges, and tools like Epic’s PEP report, other system generated reports, and pre-personalization surveys will generate the best results.
Peer-to-Peer Training – We found that physicians were most responsive when being shown personalization opportunities by physician informaticists. Physician informaticists can translate clinical needs and challenges to the EHR capabilities in a relatable way. Not to mention the MD credentials go a long way in breaking down the common physician/IT barrier that tends to exist.
Agile Implementation – If you put follow-ups and minor system configurations into the typical help-desk triage, you set yourself up for failure. A major dissatisfier is not ever seeing the follow-through from training or optimization requests. Having a dedicated analyst available to rapidly build, test, and implement changes will improve physician adoption.
Track Metrics – Not every physician is interested in doing more EHR training, either not seeing the value or thinking they’ve figured it all out. Set KPIs and track the outcomes of the personalization sessions to help prove ROI and show the value to those physicians who may have held out initially. We found that even the most proficient physicians learned a new time-saving shortcut in a one-on-one session.
Follow-Up – The most critical component to sustained success is repetition and closing the loop with physicians when new system configurations are in place. At the end of the day, the primary focus is patient care and as we all know, tips and tricks are often forgotten. It takes time to incorporate these changes into day-to-day practice, so follow-up is key!
The future of technology in medicine has many promising prospects for improving physician satisfaction and reducing the burden of EHR-related tasks, but the reality is that these innovations move slowly from both a development and implementation/adoption standpoint, especially in healthcare. So, take the time now to help physicians improve EHR usability with the tools they have.
Jason Anderson is the EHR Clinical Practice Director at Avaap. He works with doctors and healthcare leaders to implement or optimize their EHR for increased clinician satisfaction and to support the goal of safer, efficient patient care.