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How to balance EHR productivity requirements with training

When I became a physician over 25 years ago, I learned to chart on paper. I scribbled down medications on prescription pads, never knowing whether they were filled. I made phone calls asking for charts to be faxed and jotted reminders on sticky notes for nurses to call patients back with their lab results.

Nurses had to try to understand my handwriting, which I have been assured by many—from my third grade teacher to my colleagues today—is the world’s worst. It definitely wasn't good for efficiency or ideal for patient safety.

Electronic health records have changed all of that. I know that the prescriptions I write match the medications given to patients by the pharmacy. I have instant access to patient records when I need them. Lab results are sent automatically to patients, and nurses can easily read what I write in my orders without a collaborative translation session.

Most importantly, the digitization of medicine has improved care and outcomes for patients. Doctors and patients are automatically reminded about preventive care and can act on reminders right away, so rates of vaccinations, mammograms and colonoscopies have all gone up.

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I’m regularly warned about drug-to-drug interactions, and I use that information to change what I prescribe and choose a better option for my patients. Some doctors say that they feel like they were better doctors when they documented on paper, but the data on preventive care and patient outcomes shows that this just isn’t true.

Even with all of the evidence that EHRs improve care, they’re often the scapegoat in conversations about physician burnout. It’s a tough time to be a physician; we’re challenged to keep up with rapid changes in technology and ever-changing government regulations. Quality, compliance and regulations can leave us feeling frustrated about our loss of autonomy and lack of control.

But at Novant Health, we feel that our Epic EHR is one of the many tools in our toolkit to improve the physician experience and enable us to refocus on patient care. We spend years in medical school mastering our craft; it follows that we should spend some time also learning to master our tools. To this end, we created a provider development and support team that combines data with at-the-elbow assistance to support our providers.

Epic’s provider efficiency reporting tool, called Signal, gives us a starting point. We use its time-in-system metrics and pair that data with quality metrics to measure how system use impacts patient outcomes. For example, we can see how long providers are spending in In Basket and the top types of messages received, as well as the amount of time providers are spending on notes each day and how much of that time is after clinic hours. We can drill down to specialties and individual providers, then compare our metrics with other organizations. These benchmarks help us identify providers who might need additional support.

Of course, the numbers only tell part of the story. In-person mentorship is critical for helping us understand the person behind the Signal data. By sitting down and having conversations with physicians, the provider development and support team can hear their questions directly and provide tailored suggestions to improve efficiency. They work with physicians to update their settings so the system works best for them. We’re deeply invested in supporting our providers and creating an environment of mentorship, support and encouragement.

It’s clear that our work is paying off. According to data from the Arch Collaborative study conducted by KLAS, our providers are in the 91st percentile, compared with other large organizations across the country when it comes to satisfaction with using the EHR.

We’re improving the physician experience while also providing high-quality care to patients; Novant Health is in the top decile for A1C control, colon cancer and cervical cancer screening, and in the 88th percentile for breast cancer screening, compared with other organizations using Epic.

We’re a small team, but we work closely with physicians, and are making big strides toward improving the physician experience. I truly feel that the better the physician’s experience, the better we care for our patients.

Editor's Note: A video interview with Dr. Griffin describing Novant Health's program can be found here.

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