Issue link: https://beckershealthcare.uberflip.com/i/1439541
37 CIO / HEALTH IT have an optimization team composed of work- flow specialists, trainers, clinical personnel and a few EHR build folks. is team can work direct- ly with providers, watch how they practice, and then help streamline and automate key areas of physicians' overall workflow. It might be that EHR modifications are necessary, but it might also be a quick conversation with coding or compliance about a specific rule or reg- ulation and how it is being interpreted, maybe a change to the "click count" on a screen to explore ways to automate and reduce the effort — there are numerous ways that an optimization team could help deliver some solid improvements for the physician work day and directly help with physician burnout in the process. Jim Feen. Senior Vice President and CIO at Southcoast Health System (New Bedford, Mass.): ere is no singular approach to this critical problem. Clinician burnout now tran- scends the EHR as we (hopefully) move past the pandemic, but the EHR will continue to be the harbinger of pain and inefficiency in baselining how well an organization coordinates care and designs work effort among staff. How easy is it for patients to navigate your system and receive access to information or access to care? Have we refined advanced pro- vider-to-provider telehealth workflows that can accelerate care plan decisions and follow-ups, reducing burden for providers and staff? e questions are numerous, and all have an impact on stress and burden of work. As for what can be done: Focus on incorporat- ing the voice of the provider and clinician must be a continuous improvement effort with estab- lished support mechanisms/resources for your clinicians. is is the path to meaningful change. Coming out of the pandemic, this is where we must refocus our time, energy and resources. Our clinicians need us more than ever. Will Weider. Senior Vice President and CIO at PeaceHealth (Vancouver, Wash.): e combi- nation of regulatory, quality and organizational data collection requirements that get added into the EHR are primary contributors to burnout. Organizations must be vigilant regarding what caregivers are required to collect and document. Adding any new EHR documentation require- ments should require approval by a governance committee staffed with people that highly value caregiver time. Organizations also need ongoing efforts to streamline EHR design. EHR changes should be bundled into periodic releases to re- duce change fatigue. Ray Gensinger, MD. CIO at Hospital Sisters Health System (Springfield, Ill.): EHR burnout is a well-researched and scientifically document- ed phenomena that certainly needs addressing. Short of burning the EHRs to the ground and starting over while at the same time removing all of the documentation accessories (elements needed to respond to every CMS, Joint Commis- sion, registry and compliance reporting require- ment) we have to optimize, optimize, optimize! Optimization is a very tight and closed loop part- nership that includes the vendor, an organization's informatics and EHR staff and appropriate sub- segments of clinical partners. Many of us built ge- neric tools and workflows out of an abundance of speed and budgetary constraints and thus made everyone's job harder. While "standardization" has its upsides from a support perspective, it also came with a downside of care provider inefficien- cies that have been feeding the departure of our nurses, doctors and other clinicians. Taking a measured approach to the EHR features is essential. We have been assessing usefulness and effectiveness through face-to-face assess- ments, vendor reporting tools and standardized surveys and benchmarking. We are assessing all provider groups, not just our physicians. e results of those assessments allow us to: segment our users into clinically relevant and like user groups; refine "smart" tools that more smartly represent specialized user groups; elim- inate or push to the background those clinical decision support functions that are ignored con- sistently; produce focused education, in mul- tiple formats, that address optimized skills and workflows; and provide ongoing "at-the-elbow" personalization. To battle burnout, optimization needs to be the logical and well-funded phase following imple- mentation. e term of the optimization phase should be in perpetuity. Joel Klein, MD. Senior Vice President and CIO of University of Maryland Medical System (Baltimore): ere's lots of things that healthcare organizations can do around EHR burnout: implement better, more user-friendly systems; enable personalization; make dictation easy; offload tasks like answering messages into office pools; turn on mobile platforms; empower clinicians visibly in decision-making and gov- ernance; get rid of clutter; pay formal attention to usability; profile users and offer help to those who are struggling; improve training; aggres- sively eliminate unnecessary alerts; have avail- able enough working hardware like desktops; and communicate changes rather than have them just appear. In our organization, we have done a lot of work in all these areas. But there's even more that the industry and its regulation can do, like reduc- ing redundant or unnecessary documentation requirements, moving away from documenta- tion-driven billing and reimbursement, making ambient documentation better and more af- fordable, and taking a harder look at workforce needs, compensation and training. In the end, EHR burnout may be a symptom of larger dis- affection with the hard work of caring for our patients, and to make it better will mean doing many things from many directions — not any one single thing. Ash Goel, MD. Senior Vice President and CIO at Bronson Healthcare (Kalamazoo, Mich.): Clinicians have been at the forefront of manag- ing incredible demands on their time while deal- ing with the increasing cognitive burden and complexity of care that has been making this a near impossible task. ere are several aspects of the clinician burnout that are contributed to by the technology that is used in delivering clinical care — including the EHRs. ere are many actions that are being taken that need to continue and others that need to develop and be put in place as soon as possible, especially given the current and future resource shortages. Starting with a continued focus in the regulatory space to reduce documentation burden and to a shi in processes that enable team-based care documentation, we have had some success in the amount of time clinicians spend in the EHR on a daily basis. Programs designed to remove unnecessary clicks, redundant data and views to reduce clutter — as well as continuous loop process improvements by working with the clinicians — have been instrumental. Integrating natu- ral language processing technology to provide contextual interaction tools (to search for data, to input data and capture peripheral device in- formation), mobile device integration, medical (including nonradiological) imaging integration and use of artificial intelligence and machine learning to anticipate and present relevant data to clinicians are areas to continue to explore. In the end, we have to design processes and systems that enhance, enable and speed up work — not stop, hinder and slow it down. Rick Keller. Senior Vice President and CIO of Ardent Health Services (Nashville, Tenn.): To address, and hopefully prevent, clinicians EHR burnout within our organization, we provide support to clinicians from our clinical and phy- sician informatics support teams. e support is a hybrid approach where informatics staff work "at the elbow" as well as "at the ear" virtually. We recently finished our last 10 hospital Epic imple- mentations, so now our entire enterprise is using the platform. Part of our process is to provide personalization and training for clinicians to use the platform for smart text and phrases and streamlined or- der sets that minimize clicks for the users. We provide access to information from the system that measures "note bloat" so clinicians can learn to document more efficiently. We also have deployed a voice recognition solution for docu- menting within the chart. n