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How an AI Assistant is Advancing EHR Documentation, Decreasing Burden

Providence is implementing an artificial intelligence EHR documentation solution to mitigate clinician burden and enhance EHR documentation.

Clinicians at Providence, one of the country’s most extensive health systems, are feeling the clinical impact of COVID-19 and clinician burnout is becoming widespread across its 51 hospitals and 1,085 physician clinics.

Once COVID-19 hit, more and more patients were coming to the system’s clinics and hospitals, forcing clinicians to spend more time in front of the EHR.

EHR documentation, when clinicians record clinical information as provider notes in real-time during an encounter, help providers share patient information among health providers. However, the practice has its drawbacks.

“EHR documentation is probably the single greatest burnout issue for our clinicians,” BJ Moore, CIO and executive vice president of Providence, said in an interview with EHRIntelligence. “We've done everything, including hire scribes to help with that process. It's something doctors just worked through and that, unfortunately, adds to their burnout.”

According to the American Medical Association, the clinician burnout rate is roughly 44 percent, which is much higher than burnout rates in other professions. That burnout is closely linked with EHR use and demanding reporting burden.

“It is probably the single biggest complaint,” Moore said. “Not only does it burn out our clinicians, but it also impacts the quality of patient interaction. Instead of having face-to-face interaction with the patient, a lot of times the caregiver is on a keyboard looking over their shoulder as they enter this information in the medical record.”

Moore and his team contacted its long-term partner, Nuance Communications, to expand its current speech to text solution to boost patient and caregiver experience. While the health system already has a documentation solution in place, this is an isolated device rather than an optimization on that product.

“It's not just an upgrade on our current solution,” Moore explained. “It's a separate device that sits in the clinical environment, listens for the conversation, and then sends the conversation to the cloud to conduct the artificial intelligence component.”

While EHR adoption has its benefits, Moore said it can negatively impact the clinician to patient encounter and it ultimately adds more time to the clinician workday. This solution aims to enable clinicians to focus on the patient and spend less time on administrative tasks that contribute to frustration and clinician burnout.

The technology is effective because it can parse through clinical and non-clinical patient-provider conversations, Moore said.

Once the conversation switches from casual to medical, then the tool starts to record. It identifies the doctor and the patient, then it takes the important information and integrates that information into the patient’s health record without the clinician needing to hold down a button to record. It allows for a more natural conversation, Moore explained.

While Moore is excited about the new technology, he cautioned the potentially steep learning curve for its users and explained it’s not a “just plug and play" integration.

“We're excited to change the way we deal with burnout, especially during COVID, which is a real issue,” Moore continued. “Whatever we can do to directly address burnout, it is the right thing to do.”

The solution is currently in the pilot phase, so although there’s been positive feedback from its users, there is limited feedback from a high number of Providence clinicians. However, the health system and the two developers are working together to further optimize the product before deploying it across the entire health system.

Providence is continuing to make strides to fight clinician burden and ease EHR usability by adopting Epic Systems EHR across its 51-hospital, seven-state system. As of now, the health system utilizes Epic, Allscripts, and MEDITECH. However, starting in December 2020 through 2022, the entire health system will be on one streamlined platform to boost interoperability.

“We're moving all of our clinical environments, both ambulatory as well as our ministries and hospitals to Epic,” Moore said. “Having all of our caregivers and our patients on a single electronic health record will allow for a more seamless patient-caregiver experience. Then we can optimize a single workflow, a single system, a single process to make it more effective.”

Because of COVID-19, Moore said the majority of the staff is training remotely on the EHR system.

“Whereas today, if we make a tweak or an optimization, we have to make it across multiple systems and multiple products. It hurts our ability to create that seamless experience,” concluded Moore.

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