In Texas, clinical and informatics leaders at CHRISTUS Health—an Irving-headquartered health system that encompasses more than 600 patient care facilities operating in six U.S. states and three foreign markets—have been working to reduce physician dissatisfaction caused by electronic health records (EHRs). One of the key people involved in this process has been George Gellert, M.D., the former regional and associate system chief medical information officer (CMIO) at the health system.
Dr. Gellert, who is now a health informatics and clinical performance improvement advisor based in San Antonio, led an initiative that involved the implementation of a computer workstation single sign-on (SSO) solution in 19 community hospitals. In SSO technology, manual keyboard login is replaced with an identification badge reader that clinicians swipe for expedited access to the EHR and clinical applications while roaming the hospital, health system officials noted. As such, a study was launched to assess the clinical workflow and financial value of SSO implementation in reducing clinician time logging in to the EHR and clinical applications.
Gellert, in a recent interview with Healthcare Innovation, admits that the impetus behind the project was not to achieve any significant financial savings for the organization, but rather to reduce clinician dissatisfaction. “We estimated that over 15,000 physicians and other clinical end users in the CHRISTUS Health system were required to recall anywhere from eight to 20 or more passwords, resulting in them spending valuable time entering multiple usernames and passwords, and resetting forgotten credentials, which diverts time and attention from their care of patients,” said Gellert in a recently released announcement that accompanied the study’s results.
But to the surprise of Gellert and others on his team, recording more than 186,000 logins across 19 facilities over two 7-day periods, the study found that CHRISTUS Health experienced a substantial clinical and financial return on its investment in OneSign, a product from the Lexington, Mass.–based healthcare IT solutions company Imprivata.
Across the enterprise, SSO delivered substantial time savings in the workflows of physicians, nurses, and ancillary clinicians, giving them back the equivalent of 78.6 12-hour shifts (or 943.4 hours) per week, which equates to $3.2 million per year in time savings when clinicians are liberated from the EHR keyboard to instead focus on the delivery of patient care, officials revealed.
Gellert further discusses the impact of the initiative and the broader issue of reducing physician burden, which he made a core priority during his tenure at CHRISTUS Health. Below are excerpts of that interview.
Can you discuss the impact of the study on both your health system as a whole, but also the individual physicians who it affected?
When we started this, we didn’t have many expectations for a specific financial ROI, but rather we were doing it as a clinician satisfier. We engaged our clinicians as true partners in the implementation. They were involved in the design of our CPOE order sets as well as our clinical electronic documentation templates. And we always have communicated in this culture of collaboration the fact that we really understand and fully appreciate the level of dissatisfaction with the current stage of EHR maturation. And it didn’t matter which product it was; we’ve had EHRs from the three major leaders. While some were better than others, EHRs have been a major physician dissatisfier over the years, and RAND’s surveys have [backed that up]. Our clinicians felt that they spend too much time on these [systems], that they aren’t intuitive, that the user interface is not easily navigable, and that it is disruptive to their cognitive and clinical workflows. These complaints were the primary basis and motivator for CHRISTUS Health in regard to examining and then selecting a single sign-on solution as an offering.
We had regular meetings with clinicians, by department/service line, and captured all their concerns and requests. We really did single sign-on as a way to “walk the talk,” get beyond rhetoric, and demonstrate to our physicians that when there’s a solution that can save them time and grief with the EHR, that CHRISTUS Health would be willing to make that investment. We anticipated that it would be a time saver, but we had no sense of the magnitude of it, [financially].
As a former CMIO, with expertise in practicing medicine as well as in healthcare tech, the physician burnout issue hits home, I’m sure. In what other ways did you work on this challenge while at CHRISTUS?
My high-level thoughts are that I happen to be an optimist in this regard. I am very aware of the limitations of our existing state of the EHRs, but I tend to stand back a little bit and regard it more broadly than many of my colleagues. They are very upset, understandably, with something that not only consumes some of their time, but also that’s disruptive to their workflows. So I grasp that fully; when I was leading the implementation in CHRISTUS’ biggest market in San Antonio , I was very candid with the clinicians there, and we are acutely aware that all our EHRs leave much to be desired from an end user’s perspective.
So what I tried to do with the physicians was help them stand a little bit further back and be more objective about what was happening. I would challenge them and ask them to name any technology that when it debuted in its early maturation phases, was fully satisfactory to its end users. That just isn’t the case. Looking at the first cell phones of the mid 1990s, you had a three-pound brick that cost $3,000 and it did one thing via telephone, and it barely did that with any real effectiveness. Then, in the 15 to 17 year period following that, not only have cell phones become unimaginably advanced compared to where they were 15 years ago, but they cost a fraction of the price.
I tried to convey that this is a normal technology evolution process. For better or worse, clinicians are the “Chuck Yeager generation” of EHRs. Just as you needed to test pilot flight Yeager in order to figure out if we could orbit the Earth or then go to the moon and beyond, we need to go through this era of clinicians using, and criticizing, the EHR in all its aspects, so that the industry can continue to evolve.
We need to remember where we are as a country in terms of our healthcare safety. In the last three years, medical error-related deaths have moved from the leading cause of U.S. death to third. Only cancer and heart disease as groups exceed it. So, naturally, physicians get a little on edge when they hear that, and without being offensive I point that out that while we have had evidence-based medicine since the 1980s, and it’s been evolving, our problem has been that we haven’t had a means—a delivery vehicle—for effectively delivering and ensuring the actual practice of evidence-based medicine. So I would tell the physicians, if you have another strategy for massively distributing and ensuring the practice of evidence-based medicine, please tell me so I can go to the CEO and advocate on behalf of that idea. The room would fall deadly silent—there was nothing more to say.
How do you see the future?
At CHRISTUS, we first created a culture of supporting clinicians that was very much viewed as customer service, as we were in the business of health informatics and IT delivering excellent customer service to our physicians. Then we created a number of vehicles for continual communications—meetings with clinicians, by specialty or service line, on a regular basis, to capture their issues and report our progress, including regular newsletters on what’s coming down the pike, where we are with different implementations, and tricks and tips to save them time.
We truly tried to immerse our clinicians in a highly supportive environment for their adoption, while minimizing avoidable pain and also recognizing that we don’t yet have the Star Trek EHR. But we are convinced we will get there since technology only advances; it doesn’t regress. We don’t expect that we will be having these conversations in 10 years, because with artificial intelligence and natural language processing, all of these things will advance dramatically.
In 12 years, we will look at today’s EHR the way we look at the 1995 cell phone today. I am absolutely convinced of that, and if you convince your clinicians of that while acknowledging their pain points, you can be [successful]. At [CHRISTUS], my region was the highest performing in the enterprise as far as [EHR] adoption levels and low levels of physician dissatisfaction. And it all really comes down to one statement: respecting the clinician as a full partner.
Dr. George Gellert can be reached at [email protected]