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EHR Support Team Pushes User Satisfaction to Cut Clinician Burnout

Rush University Medical Center faced a significant clinician burnout problem, but new health IT management found a way to enhance EHR usability and mitigate frustration.

Just six years ago, Rush University Medical Center clinicians experienced a significant lack of EHR support and training, which resulted in increased frustration and a crippling case of clinician burnout. 

“In the past, the clinician would either ask a colleague that had spent some dedicated time and was willing to help them personalize their experience, or they would try to work with an analyst or a health IT specialist to explain to them their specialty or their clinical background to see if they could help them,” Jordan Dale, MD, Rush’s acting CMIO, said in an interview with EHRIntelligence.

Sometimes that method was successful if there was a natural subject matter expert in that specialty, Dale explained. However, if there was a knowledge gap or if Rush did not have a health IT expert or a clinician with experience working beside the clinician, the clinician experienced frustration and burden.

But under new CMIO leadership, the organization sought out its end-users to identify the critical sources of health IT and EHR frustration. Rush conducted its first KLAS Arch Collaborative survey in 2017. This survey identified several critical EHR usability issues that Rush clinicians and end-users consistently encountered.

That survey showed that the root of EHR issues at Rush were not out of the ordinary than those in the general healthcare community. Most of the issues related to that lack of specialty health IT personalization Dale mentioned above.

“We were in the middle of the pack of that initial survey and it seemed like the healthcare organizations that were supporting their providers in unique ways were utilizing various models,” Dale said. “That's when we committed to having a dedicated team that was primarily focused on provider satisfaction and how it relates to our electronic health record.”

From there on, Rush’s team of associate CMIOs bought in to improve clinician satisfaction, enhance understanding of the Epic EHR system, and represent the clinical workflows in their respective specialty areas. 

Rush associate CMIOs not only attended departmental meetings, held educational sessions, and gathered a group of physicians and analysts to work more closely with frontline clinicians, but they also developed the Provider Optimization and Experience Team (POET).

POET includes seven total individuals who hold a clinical license to fully understand clinical language or have extensive experience or training at the clinical level, such as five to ten years of go-live and optimization support, Dale explained. POET members aim to go beyond initial training and focus more on optimization and support, he added.

“I have a medical degree and did my clinical rotations in the United States,” Wasim Attar, MD, Rush POET, said to EHRIntelligence. “IT is a hobby of mine, and then I had a background in clinical informatics. When I work with providers, I focus on finding solutions, discovering workarounds, and trying to avoid delaying the individual’s workflow or negatively affecting patient care.”

While Attar was doing his medical rotations and utilizing Epic EHR, his superiors asked him to be a super-user for an Epic go-live.

“That's when I became interested in helping providers, and I shifted to a provider liaison where I focused on provider burnout and improving EHR efficiency,” Attar continued. “I just wanted to improve provider EHR experience and anything health IT-related that they use on a daily basis.”

Although some might think POET is an “IT help desk,” the team prides itself on building a relationship with the clinician while also providing a helpful service.

“The providers know that they can call a dedicated line to reach us,” Attar described. “We also have an email address, but I do not think that’s enough.”

“We’ve developed a relationship with the providers, and we’ve proved to them that we can help, or at least alleviate some of the pain they're experiencing. We can be in the room to see patients with them or even sit and listen to their complaints and pass the complaint onto leadership. That creates a solid relationship with the providers.”

Each clinician has a POET member who the clinician can contact directly. Or, in Attar’s case, it’s more proactive as he constantly checks in with his clinicians.

“That's what makes a big difference,” Attar said. “We are out there for them. We’re not just sitting and waiting for them to call us.”

“We are always engaged with our providers, always visible, and always trying to attend their department meetings,” Attar added. “If there is a big workflow change, or if there's a go-live, we try to meet with them, show them what's going to change, and take their feedback. If we can identify some of the issues before we go-live, we would absolutely try to prevent that from happening.”

Each POET also leverages physician EHR efficiency data for between 100 and 200 clinicians to identify those in need if a particular clinician is hesitant to reach out.

“There are physicians who are suffering in silence that weren't going to reach out to us, but we can tell they're having dinner with their family at 7 p.m. to 8 p.m., and then they're going back in the EHR to finish three hours of documentation,” Dale explained. “We know if a POET team member got 30 minutes with them, we could stop that or significantly reduce it.”

After implementing POET in 2017, Rush deployed a second KLAS Arch Collaborative survey, and the hospital saw tremendous results.

Rush clinician EHR satisfaction scores significantly improved and compared to other complex academic health systems, Rush was positioned near the top.

Additionally, Dale noticed a resounding number of comments that applauded the group of POETs.

“A lot of the subjective comments specifically called out POETs in a positive way, either by name or the program as a whole,” Dale indicated.

“It showed the amount of impact that we could have in those two years between the two surveys. The relationship-building aspect was a goal, but I personally didn’t recognize the full impact of some of that.” Dale continued.

It is also common for frequent POET line users to give holiday gifts to POET members, the Rush hospitalist added.

“That was just a warming experience for the team to see that that relationship is having a significant impact,” Dale maintained. “That’s the reality that a relationship can be solely focused on provider experience and both sides know there’s no ulterior motive to that relationship. That’s the part that eases physician burden the most.”

With POET in full swing, Rush clinicians have reduced documentation time by 30 to 35 percent and Dale said clinicians have felt at ease knowing a health IT optimization wouldn’t negatively impact patient care and performance.

“I think it's critically important to focus on the post-initial training personalization and optimization phase,” Dale recommended. “If an individual only spends a short amount of added time to feel safe and acclimated to a new vehicle, then the person won’t be able to maximize performance or comfort until she spends increased dedicated time on optimization to feel comfortable about that workflow.”

“Even if a health system doesn’t have a dedicated team or a large enough team to do it for every end-user, if the biggest burden is identified then the health system can focus on carving out time and addressing the key issues as early as possible to maximize satisfaction.”

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