It was about eight years ago when clinical and IT leaders at UCHealth in Aurora, Colorado first started their EHR (electronic health record) journey with a go-live at the health system’s academic hospital, the University of Colorado Hospital. And as the health system kept on growing and merging with other organizations, the EHR rollouts continued across the enterprise as well.
But while leaders at UCHealth were seeing great adoption of the technology, as well as great use of the EHR that was also driving value, the reality was that the health system needed to help its physicians become more efficient in their use of the systems. “It felt like we were working too hard for the EHR, rather than having the EHR work for us,” says Steve Hess, CIO at UCHealth.
Hess presented on his organization’s initiative, called “EHR 2.0 Sprint,” at the CHIME (College for Healthcare Information Management Executives) Fall 2017 CIO Forum on Nov. 1 in San Antonio, Texas, and also spoke with Healthcare Informatics separately about the core processes and strategies involved in the project. Having tried numerous methods to improve physician-EHR workflow, UCHealth now deploys the “EHR 2.0 Sprint,” which is a two-week intensive immersion in clinic with a small team.
The motivation behind this initiative, Hess says, was that while UCHealth was already doing a lot of things to improve its general use of its Epic EHR, it was noticing that the individual clinics and providers were still struggling. “There were doing documentation at home and finishing their notes well after patients already left, so we needed to think of a different way for doctors, nurses and schedulers to become more efficient,” Hess says. “So we redirected resources that were spent on global optimization efforts and had [those people] instead go into the clinics, shadow the doctors and nurses, and help them improve the way they were using the EHR.” While UCHealth had already trained many of these folks years ago, and three EHR versions ago, “they weren’t able to take advantage of the new functionality. So having us go into the clinics really helped them,” Hess says.
Indeed, while the organization’s original optimization efforts helped its physicians in some ways, the benefits were not very visible to them, says Hess, noting that doctors are mostly concerned about how IT can help get them through their days without major burden. “We [designated] two weeks where we had a team go in to spend time with them, and there’s really nothing like it. Physicians don’t have time to come in before clinic hours, during lunch or after clinic hours to come to our webinars for tips and tricks on how to [improve] their EHR use. So we invested the time to go into their practices, and show them the low-hanging fruit, and that was well received,” Hess says.
Importantly, the initiative involved no new resources or FTEs; Hess’ team took the existing resources that were devoted to other optimization efforts and redirected them to helping physicians at an individual level. “We had 11 people, but not FTEs, and they were led by a project coordinator who ran the show,” Hess says. “We wanted to use the agile methodology, with a physician informaticist, an individual who reports to our CMIO, [along with a few] Epic ambulatory analysts and some trainers. We looked at physicians’ templates and how they were doing things in the EHR, and we were able to show them some new ways they can be doing things and newer versions of the EHR that they never learned,” Hess says.
Leaders at UCHealth believe that there are two core pieces that are aligned with physician burnout. The first is the use of technology and tools, and the second is making sure that everyone in the organization is working at the top of their scope [of practice], Hess says. “Making sure everyone is working to the top of their authority and doing things that will set up the patient and the doctor for success, and also improving the use of tools, is a parallel path. And we’re doing both of these things,” he says.
UCHealth has about 540 clinics, so while Hess says he would love to have the resources to go into the clinics every week, that’s just not feasible. But, he notes, his team is working closely with operational and clinical leaders so that they can show the pre- and post-burnout scores, net promoter scores, and the improved use of the tools to show the value that has been gained.
What’s more, the feedback from the doctors has been terrific, Hess attests. “They love the individual attention and the fact that this is two weeks long.” However, he adds, the true test will be seeing if this initiative is sustainable and how many doctors and clinics the team can get to on an annual basis. “What will the scores look like a year from now? The reality is that the EHR is constantly evolving, so in a perfect world we are revisiting every clinic and doctor on a routine basis,” he says. “Also in a perfect world, you would make the EHRs as intuitive as Amazon and other best-in-class user interfaces. But there are obviously some limitations,” Hess admits.
He adds that the goal is not to tie this initiative to the increased number of patients a doctor is seeing per week, but rather only tie it to provider satisfaction and burnout. “Hopefully doctors can now go home and have a work/life balance that is different than before. It’s those little things, and maybe it’s more subjective than objective, but hopefully it goes back to why they became a doctor or a nurse in the first place,” Hess says.