Direct clinician support helps OrthoVirginia optimize EHR use

Provider Support Specialists offer at-the-elbow assistance and serve as liaisons between clinicians and IT to improve care team and patient experiences.


photo courtesy of OrthoVirginia

As OrthoVirginia grew through combining orthopedic practices across the state, it aimed to achieve harmony among its diverse musculoskeletal practices through its electronic health records system. It used a support approach that has improved clinician engagement with its systems and increased their acumen and comfort in using the technology.

It wasn’t an easy road to follow – its first benchmarking effort in 2017 as part of the Arch Collaborative of KLAS Research found that clinician satisfaction with its record system was in the bottom quartile of all respondents. But after implementing provider support specialist program, its clinicians’ ratings moved it into the top quartile of participants in the Arch Collaborative, which surveys clinicians who use technology and shares best practices to improve its use.

The important role provider support specialists played in OrthoVirginia’s path to gaining clinician support for EHR use, which was featured in a presentation of the HDM KLASroom, demonstrates how to successfully work with clinicians – even those who struggle with using technology as part of their daily practice, executives at OrthoVirginia say.


The EHR as a common bond - organizational 'neuro network'

“As we tried to come together and become one organization, the EHR was one commonality, one thing we all share,” says H.C. Eschenroeder, MD, OrthoVirginia’s CMIO. “But in our first measurement (of clinician satisfaction with the EHR), we weren’t very good. It was a gargantuan task to bring all these groups together. What was next for us was optimization – taking this new tool and really making it work.”

Typical training and cajoling don’t work with clinicians if their trust hasn’t been earned, Eschenroeder says. And it’s crucial to understand the mindset of a clinician, juxtaposed against what he terms the “business school” approach.

In medical school, clinicians are self-trained and independent, he says. “Then, in business school, they work on projects, it’s team-oriented and collaborative. When you mix the two, it doesn’t really work. With IT, it’s all about projects and submitting tickets for changes, and it doesn’t really fit in with the ways that providers are really thinking.”

As OrthoVirginia sought to optimize the use of its EHR system from Epic, executives realized that a specialized form of at-the-elbow support was key. “People trust people,” he says. “I don’t think (clinicians) ‘personify’ organizations – in terms of teaching and trust – that’s a person-to-person thing.”

The use of provider support specialists grew out of an understanding that clinicians needed more than scribes that complete records or other support – they needed insights on how to best use the EHR, says Katie Brown, provider support manager for OrthoVirginia. The specialists go to the organization’s nearly three dozen clinics throughout the state to gain an understanding of clinicians’ needs. “We understand provider workflow from the beginning, from going live with Epic,” she says. “We’re able to anticipate their questions and concerns.”

The connective synapse

The provider support specialist program evolved from a scribe program, which it still operates, Eschenroeder says. The support specialists have a complete understanding of how best to use the EHR system, plus, they develop a thorough understanding of clinicians’ needs, he says. The specialists serve as the equivalent of “synapses” between clinicians and the EHR tech team, he explains. Those specialists “have been in clinics – they’ve seen good days and bad days by clinicians. They’re pretty well-versed – they’re almost like a horse whisperer.”

A support specialist typically starts by observing a clinician’s use of the EHR system and then helps them when they encounter difficulties with the system. “They interact with the provider while the provider is working, bringing them value,” Eschenroeder says.

“Helping providers on the fly helps build that trust,” Brown adds. Interacting with clinicians also helps support specialists anticipate problems that other clinicians might experience.

“We round into all the clinics every day – we see each person in the clinics that day. We also have rounding themes – we help to teach them different tips and tricks. We also publish a newsletter from Dr. Eschenroeder to highlight some of the functionality that would benefit them,” Brown says.

OrthoVirgina now has about one support specialist for every 40 clinicians. In addition to providing coaching, these specialists are available to handle clinicians’ requests for system modifications. Some 70 percent of those requests are for relatively easy changes, such as customization or data presentation changes, which the specialists can manage for the clinicians, Eschenroeder says. But when clinicians suggest more substantive changes, such as organization-wide modification of the EHR, the support specialists serve as liaisons to the IT team and initiate discussion of the proposed change within the organization.


The clinicians’ tool

The organization works to get clinicians to accept responsibility for learning how to effectively use the EHR and then advance their knowledge of the system.

Clinicians are held to this level of responsibility in their practice of medicine, Eschenroeder says. “We aim to create a culture of agency and accountability – we go to the surgeons and say, ‘You’re good in the OR, and you know how to use your tools. You have to be equally good in the clinic and use those tools – you can’t say you’re not a master of the EMR.”

As CMIO, Eschenroeder has the respect of his peers because he has had to grow in his expertise of the records system – what he calls an example of “eating your own dog food.” The goal is to focus on improvement.

“There is always something you can show them that can make them more efficient,” he says. “Then you can go from implementation to optimization. You win their trust that way – our providers are grateful for the support of the PSS (provider support specialists).”

Aiming for optimization of EHR use gets the clinician closer to the kind of practice of medicine they want to achieve, Eschenroeder explains. “What clinicians really want is orientation to the EHR so they can spend most of their time thinking about the patient and having the EHR serve them. They need to be delighted with their tools and not feel that the EHR is a sea anchor that’s slowing them down. The way to get there is mastery, and we will support you like crazy.”


Watch the full 40-minute Session with Dr Eschenroeder, Katie Brown, and KLAS research's Jason Hess.

In this session learn what it takes to create support systems and trust between clinicians, the organization, and the technologies deployed to deliver better care in an ever-evolving healthcare and technology landscape. 

Participants will learn:  

  • What creates a dichotomy of experience between clinicians when it comes to utilizing, mastering, and optimizing technologies.
  • Principles to apply in their organization that will help them move from a bottom quartile relationship between clinicians and their digital care tools to a top quartile relationship. 
  • How to apply these principles in new and complex situations, as well as unique organizational structures. 


Read more about the HDMKLASroom - Improving the Clinician & Care Team Experience

The HDM KLASroom

The HDM KLASroom explores the people, process and technology strategies for improving clinician experiences including access to data ‘when I need it’ and how to fulfill the undelivered promises of enhanced clinical experiences through optimized digital health technologies.

Read more about these episodes and sessions:

Episode 1 - The asymmetries of the care team experience (5 half-hour on-demand sessions)

Episode 2 - Data: start with the end in mind – the clinician/patient relationship (4 half-hour on-demand sessions)

Episode 3 - Data where I need it, when I need it (5 half-hour on-demand sessions)

Episode 4 - Reimagining the Clinician Experience (4 half-hour on-demand sessions)

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