Becker's Hospital Review

23 Executive Briefing The Chicago-based company is consistently expanding its offerings through its longstanding relationship with a major multinational technology company to complement its software products and operating systems. That company is Microsoft. Allscripts made its community care EHR platform available through the cloud via Microsoft Azure. This single-platform solution is an end-to-end offering with clinical, financial and ambulatory content to reinforce organizations' operational and financial health. The cloud solution offers the same capabilities as the on-premise version of the EHR, but the subscription model enables faster implementation and includes upgrades. Sunrise™ Community Care is hosted on Microsoft Azure's secure cloud, with annual upgrades, disaster recovery and high availability for planned and predictable maintenance during non-peak times, making it a more secure shield against the cyberthreats targeting community hospitals that Mr. Black discussed. Allscripts and Microsoft are established partners that consistently seek new ways to strengthen their collaboration. In fact, Allscripts is Microsoft's 2019 U.S health partner of the year. In January 2019, Microsoft and Allscripts subsidiary Veradigm inked a memorandum of understanding to develop a product to help researchers conduct clinical studies through the Allscripts cloud-based EHR. The collaboration will first focus on extending Allscripts cloud-based EHR platforms with innovative technologies that enable integrative research, such as automated match- making to pair patients and providers with the right study protocols. Casey McGee, vice president of partner development for Microsoft US, said the relationship with Allscripts is symbolic of Microsoft's philosophy for innovation. Since it was founded in 1975, Microsoft has viewed itself as a company built upon partnerships and relationships within the ecosystem. This outlook is principal to Microsoft Co- Founder Bill Gate's philanthropic efforts with the Bill and Melinda Gates Foundation, which through its Global Health Division, aims to reduce health inequities and eradicate disease. "The work we do with Allscripts is built on trust. We need partners like Allscripts to come to us with innovation," said Mr. McGee. "What we create comes alive when our partners come to us with new ideas and projects. The only way that Bill and Melinda Gates solve diseases or improve care is through partnerships." A system approach to address clinician burden in community hospitals, one interaction at a time One difficulty Allscripts aims to alleviate through innovation is clinician burnout, a pernicious problem affecting hospitals of all sizes in all locations. No one organization has cracked the code on how best to counter it. "Leaders are spending a significant amount of money on burnout; it's an ongoing problem that isn't going away," said Ross Teague, PhD, director of user experience for Allscripts. But Dr. Teague also pointed out that burnout is not necessarily a new problem. The uncomfortable reality is that healthcare has burned out clinicians for a long time, but patient outcomes have remained steady since clinicians are quite proficient in adapting to their environment. This reality doesn't mean clinician fatigue is something hospitals can afford to ignore — for a host of reasons. There are varying degrees of burnout, but even the most moderate are detrimental to organizations. On a daily basis, burned out clinicians are less likely to mentor peers or participate in initiatives, such as task forces and governance groups. Patients are also less engaged when members of their care team are not engaged. Allscripts believes burden is a system problem. There are many causes, but not one is singularly responsible. "You can't view it as, 'If we didn't have as many regulatory problems, burnout would go away.' Some health IT vendors also say they are the secondary problem, thinking it's other things that cause burnout," said Dr. Teague. It's critical to consider all of burnout's contributing factors when designing solutions to conquer this longstanding, growing problem. If burnout is viewed in a single modality, any attempted solutions will only exacerbate other demands on clinicians' time and energy. How is Allscripts addressing clinician burnout? The company begins by targeting one the biggest culprits: cognitive fatigue. Cognitive fatigue can be defined as a subjective lack of mental energy that interferes with our activities. Experts say it most commonly results from the accumulation of excess: too many decisions, too many interruptions, too much work in too little time, and too many demands or shifts in attention without proper time to pause and restore cognitive reserves. The thing about cognitive fatigue is that it's often experienced in the background compared to the primary pain points clinicians encounter in the foreground of their daily EHR use. Take clicks, for example. If asked whether Allscripts should create an EHR that required substantially fewer clicks, most clinicians would cheer in agreement. But if an EHR contained all of the same data fields for patient demographics, progress notes, vital signs, medical histories, diagnoses, medications and immunization dates in a single frame — yes, clicks would be eliminated. But the cognitive effort required to navigate such a dense interface would undoubtedly result in fatigue and in little time. "It would be an unusable EHR. It doesn't matter if you get rid of clicks or scrolling if it can't be used," said Dr. Teague. Instead, Allscripts is focusing on incremental but meaningful adaptations within its EHRs, including Sunrise Community Care, to cumulatively reduce clinicians' cognitive exertion when using the EHR and related software. When IT interfaces put clinicians' cognitive resources in competition, straightforward work takes more effort than it otherwise could. Dr. Teague compares it to a jog around a park, but while wearing 45-pound firefighter gear — for no reason. Consider the presentation of dates. It is much easier to

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