Most large healthcare provider organizations have teams working to optimize their electronic health record use, but Allina Health in Minnesota is particularly aggressive in its efforts to help clinicians get the most out of the EHR. “We have a philosophy of keeping things simple and keeping the computer out of the way of that provider/patient interaction,” says David Ingham, M.D., medical director of ambulatory services. Since early 2018, Allina informaticists have been creating dashboards that take provider efficiency profile (PEP) data from Epic and present it in a much more usable format.
Ingham uses a metaphor of a coach helping a golfer improve his or her swing to describe what his team is doing. “We really do use it in a coaching fashion, at least as a jumping-off point,” he says. Allina’s performance support trainers are the front line for ongoing training. It used to be if they have 10 minutes with a provider, they might spend eight of the 10 minutes figuring out what they needed help with. “But if they have data on provider tendencies,” he explained, “it allows them to focus on trouble spots and not on the things they are already good at.”
Allina’s Clinic Provider Efficiency Dashboard (CPED) report includes 15 key indicators such as total EMR time per patient and usage of specific macros called SmartTools. By deploying interventions, measuring impact, and then adjusting or expanding the intervention accordingly, Allina has seen improved provider engagement, higher utilization of important SmartTools, and less time spent in the EHR. “By helping them build SmartTools that work for them, you can save them a little time every day,” Ingham says.
Providers can look at their own CPED performance compared to the average of their peers. For some of the physicians, it is eye-opening to find they are spending 15 minutes per patient writing notes and their peers are averaging only 11. But Ingham stresses that it is important that this effort is not viewed as “Big Brother” watching every click. “If you don’t do this right, providers might see it as just another thng they are getting graded on. We worked hard to be transparent and make clear our only goal is to help doctors get home on time and spend more time with their family and focus on patient care instead of spending time on the computer. Everything is to identify areas of opportunity to help them be more efficient.”
Allina has found that primary-care physicians are spending 30 seconds less per patient after hours writing notes, and at least part of that improvement is attributable to CPED, Ingham says. That may not sound like much of a change, but it means that if a busy physician sees 20 patients per day, she now has 10 additional minutes of time each evening that previously was spent in the EHR.
Of course, EHR optimization work is never really done. Most CPED work has been primary care-focused so far, but in 2019 Allina is moving to specialty practices. “We are very serious about using data as a feedback loop to understand how we are doing,” Ingham says.
