A full spectrum of challenges awaits those who would like to try to optimize the EHR/EMR (electronic health record/electronic medical record) experience for physicians and other clinicians, a panel of healthcare IT leaders agreed on Friday, during the closing hour of the Northeast Healthcare Innovation Summit, sponsored by Healthcare Innovation, and held at the Revere Boston Common hotel in downtown Boston.
During a wide-ranging panel discussion entitled “Winning Strategies for Developing an Inclusive EMR Experience,” Mitchell Josephson, vice president of the ARCH Collaborative at the Orem, Utah-based KLAS Research, led a panel discussion following his presentation, entitled “Unleashing the Healthcare Revolution,” in which he detailed some of the recent research findings of the ARCH Collaborative, and spoke at length about what EHR/EMR usability is, and about some of the advances being made by the leaders of patient care organizations that have been pioneering EHR/EMR optimization in recent years.
Josephson led a distinguished panel of healthcare IT leaders, including Dhrumil Shah, M.C., CMIO at Compass Medical, a multispecialty medical group with six clinic locations in southeastern Massachusetts; Spencer Erman, M.D., vice president and CMIO at Hartford HealthCare, the seven-hospital integrated health system based in Hartford, Connecticut; and Christine VanZandbergen, M.P.H., M.S., associate vice president, IS applications, at the Philadelphia-based, six-hospital Penn Medicine integrated health system.
All members of the panel agreed that achieving true optimization of EHRs/EMRs involves an ongoing, continuous process, one that requires leadership, ingenuity, and persistence.
Among the issues the panel discussed at length was that of training. Penn Medicine’s VanZandbergen said that “We surveyed our providers about 18 months ago, and two areas we saw were around training and education, as well as trust and transparency issues. We decided to focus on training and education. We were a legacy customer, and what we had built 15 years ago, really was not optimized up to current functionality. We did two critical things,” she said. “One, we focused on individual sessions with clinicians who were struggling; secondly, we offered sessions to providers. We offered blocks, some early in the morning, some in the evening, some during the middle of the day—and in different locations. We did it twice, last year in the fall, and then again in the spring. We had 700 providers sign up and got really good feedback from them about it. You always get the most engaged folks.”
“If I know that you have training programs, that tells me nothing about the satisfaction or success your physicians are having with the EHR,” Josephson opined. “But if I can look at the way you’re engaging with your physicians, that means a lot. Be creative with your messaging—instead of just sending a message saying, ‘Come for training tonight,’ say something like, ‘Get the suck out of the EHR!’ That shows me you’re messaging differently and also creating more personalized training content.”
With regard to how leaders should frame all these issues, Hartford HealthCare’s Erman said, “I don’t like it when we just want to make providers ‘satisfied’; satisfaction is not our goal. We want to return to the joy of medicine, as Steven Strongwater said,” referring to the day’s keynote presentation by Strongwater, the president and CEO of the Boston-based Atrius Health, a 31-location multispecialty group/ambulatory care delivery organization, in which Strongwater talked about the need to bring joy back into care delivery, for physicians and other clinicians. “The other problematic term is ‘resilience’; we don’t want the providers to experience trauma in the first place. Steve talked about providers losing control and not being able to practice medicine in the way they want to. Designing a well-run training program will help. But we’ve also got to deal with the amount of time providers are spending on the EHR, two hours for every hour of time with the patient. But how long were physicians spending before, on paper? In many cases, they were spending similar amount of times with paper.”
VanZandbergen added that “Personalization is very important. Yes, Epic is very complex, very cluttered, with big screens. By spending the time and effort to make the EHR work for you, setting it up the way you want it, that makes a difference. We Spent a day or day and a half with every practice recently, working with nurses and PAs and then with the physicians themselves, and looked at where each physician could improve upon his experience.”
The reality, Compass Medical’s Shah said, is that “There’s too much to learn at the point of implementation, no one can learn it all then; you need to go back later and learn more.”
Erman noted that, in order to achieve success among physicians, “We also involved the squeaky wheels. We didn’t want to engage just the tech-heads; we wanted the ones who were complainers, to get engaged. We started a program last fall called ‘Nix to Clicks,’” he added. “People would send us messages asking why they had to spend so much effort clicking in certain areas. And we were able to fix almost 70 percent of issues they brought up, and reduced over 200,000 clicks in three months. You don’t want the geeks on your committee; you want the end-users who are suffering pain. And in the first month, we were able to return two minutes per patient to providers. That can save an hour a day in total, if you’re seeing 20 or 22 patients a day,” he noted.
Josephson said, “To that point about satisfaction, one point Mr. Strongwater talked about this morning was the perceived reduction in quality of care with EHR implementation. We’ve had over 100 patient care organizations re-measure quality of care and other elements. The quality of care measure is not improving. So that represents something like a 2.0 opportunity for research. So why do you think quality of care is not moving?”
“Trying to find information is like trying to search for a needle in a haystack,” VanZandbergen said. “The key is to make all the information in the system available to the end-users. As that problem starts to get soled me, because I t has to. Data is building up, noise is building. Over time, we’ll be able to address it.”
Erman, who practiced clinically for many years, noted that there was dissatisfaction in the paper-based world, too, that should be remembered. “I hated writing notes, on paper, hated dictation and transcription,” he said.
Shah brought up the question of connections between physician EHR satisfaction and high levels of achievement in terms of HEDIS scores, which measure outcomes quality and patient experience, among other elements. “Here’s an example,” he said. “Disney never talks about visitor satisfaction; they talk about the visitor experience. And are providers with high net satisfaction experience with EHRs also getting high scores on HEDIS data? We need to look at connections in the data.”
Josephson responded, “At KLAS, we talk about a healthcare revolution, we want to see a point where the caregiver feels that technology is essential to their practice. Relative to that, from your seat in your organization, when you look at the things that need to happen in the next five to ten years, what needs to happen with the EHR?”
“We need to get rid of everything unrelated to patient care, and the stuff that’s stupid and technically not necessary, from the EHR,” Erman replied immediately. Referencing the federal Centers for Medicare & Medicaid Services, he added that “CMS came out with a blue ribbon task force a few months ago on how to streamline the HER. The executive summary was 75 pages—that speaks volumes.”
“There are known variables, known unknown variables, and unknown unknown variables,” Shah said. “And for any technology to solve all those unknown unknown variables, is a huge task. But things have gotten tremendously better. And the EHR has gotten much better. And HC is a supply chain industry. At the end of the day, we’re selling provider-patient relationships. This is the only industry where we’ve taken front-line workers, the providers, and asked them to pay for the tools they’re using. Imagine auto workers having to pay for the tools they use to build cars. This is a relationship industry. At the end of the day, what will work is putting the patient and provider, two human beings, in front of each other. We need the tools; I’m not saying we should go back to the paper chart; we need the technology. Just don’t put anything between the human beings.”
“We’ve just got to refocus the conversation,” VanZandbergen added. “The conversation right now is about the technology, and not the patient-physician relationship. The tools have to get better. And it’s limiting to think that technology for patient care can’t focus the way technology focuses in other industries. I’m going to be optimistic. And we’ve got to get there.”
