Mutiny on the Horizon for EHRs? Probably Not-But Here are Steps to Ease Clinician Frustration

A recent op-ed in TheNew York Times urged doctors and nurses to unite in their demands for less time yoked to the EHR, which the authors noted now accounts for a full 50% of the workday.

This is a concerning statistic for health plan executives-who require much of the documentation that consumes clinicians’ workdays. It’s especially important to payers that are evolving their business model by acquiring provider organizations. While there may be limits to what these entities can do to change documentation requirements, the entire healthcare industry can work together to help clinicians get more value from EHRs while spending less time on them.

Make care coordination a practice-wide capability

Clinicians will depend on EHRs for the foreseeable future, but they need not stay tethered to them, experts say. Many health plans are now equipping medical and behavioral healthcare practices in their networks with shared platforms for care coordination, including for complex populations.

“An unintended consequence of the industry’s shift to implement EHR systems is that the physician has, in many ways, become the bottleneck,” says Doug Duskin, president of HealthBI, the technology division of integrated delivery system Equality Health. “Time that would otherwise be spent with their patients is now spent on managing clinical documentation. This is where care coordination platforms play a critical role, by sharing actionable information across the practice-including identified preventive gaps, chronic conditions, and recommended next steps in care.”

Unlike EHRs, at least as they were originally designed and deployed, these platforms can be used by practice staff as a daily tool for value-based or preventive care coordination, Duskin says. This takes a tremendous burden off physicians, even while giving a new ability to take on more risk-and to move the needle on persistently poor health.

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Duskin notes the underlying benefit of technology that enables practice staff to consume and act on information from the care coordination platform. “It’s empowering those who support the physician to share in managing the practice’s day-to-day workflow. In turn, that allows physicians to shift their focus back, once again, to the patient,” he explains.

More data consumption, less data entry

As a nurse with years of experience in the profession in hospitals and in the Army, Dana Bensinger has strong opinions about how clinicians should be spending their time. And it’s not in front of the screen for the better part of a day.

“Shortcomings in interoperability, combined with the increased documentation requirements for payment, has turned nurses and doctors into data entry people. In reality, they are supposed to be data consumers,” notes Bensinger, who today leads EHR implementation and optimization projects at IT solutions consultancy CTG.

A primary care doctor should not have to enter the date of a diabetic patient’s last eye exam, Bensinger adds. Likewise a nurse should not be manually entering vital signs. “That data should be automatically pulled into the EHR from a source system and eliminate the need to document it,” says Bensinger.

To reduce documentation burnout, Bensinger says to: “Take stock of who is collecting what data. Then determine if they should even be collecting certain data rather than acquiring it from other sources. When CIOs or CMIOs are asked to add data elements to the EHR, they should first  ask ‘where can we get this data?’-not ‘who is going to collect it,’” Bensinger advises.

Bensinger also recommends making it easier for patients to share their data via the patient portal. In just one example, patients on pain medication can answer simple graphic pain scales sent from the portal. Bensinger notes this eliminates the need for nurses to document the pain medication’s effectiveness, while engaging and empowering the patient in the care plan. It also allows the doctor to see if the care plan is working.

He also recommends setting up clinical dashboards that summarize and present meaningful data at a glance. “Clinicians should never have to hunt for data,” Bensinger says.

Tedium out, good data in

EHRs have the potential to facilitate an intuitive flow of information, but too often require prolonged clicking and scrolling instead.

Doug Cusick, CEO at TransformativeMed, believes physicians are spending half their time on EHRs because workflows in the system aren’t configured to how the physician really works. That can be changed, he says, through applications embedded in--or interoperable with--the EHR.

Some specific examples of how these apps are helping include eliminating or auto-completing mundane steps that have been filled elsewhere, or applying algorithms to prompt next steps,” Cusick says. “In another time-saver, providers can dictate an update to a patient’s to-do list and have it automatically write to the EHR.”

Cusick adds: “Ultimately, these apps present information in the EHR in a clinician-intuitive way, specific to the user’s primary interests and presented in their preferred, personalized layout.”

Of course, sometimes no matter how a system is configured, the needed information isn’t there. Julie Mann, chief commercial officer at Holon Solutions, has a recommendation here for healthcare technology leaders.

“Health plans, providers and technology vendors should take a look at ‘data surfacing,’ a technology advance that injects intelligent data into the clinical workflow at the right time,” Mann says. “This is typically at the point of care with the EHR. Data surfacing is one of the single most important steps to take to reduce the amount of time and clicks it takes to find critical patient data in the EHR.”

As for what kinds of data, the technique itself is data-agnostic. But as providers increasingly take on risk, a fuller picture of patient care within a system they already use can considerably improve their opinion of the EHR.

“Many providers now operate within a complex healthcare landscape that straddles both traditional fee-for-service and innovative value-based payment models,” says Heather Trafton, chief operating officer at Arcadia who is also a physician assistant. “As they take on responsibility for the financial care of their patients-in addition to the clinical--they need a comprehensive view of patient care across the care continuum. They also need critical information to be synthesized at the point of care.”

Trafton adds: “EHRs can be supplemented with time-sensitive and meaningful clinical data that eases the burden of providing more coordinated care, reduces duplication of care and improves patient outcomes. Moreover, this information can be presented to providers within their existing clinical workflows. This increases their ability to offer better preventative care and improve chronic disease management, while substantially reducing administrative burden.”

Put your EHR to the test

One more crucial piece of advice for improving satisfaction with an existing EHR comes from Tanya Johnson, global solution director at CTG.  

“Increase regular system testing, especially to be sure that new upgrades haven’t negatively impacted what are often customized workflows within the EHR. This catches errors early before they become a source of frustration--or worse,” Johnson says.

She notes despite the increased risk of medical errors and clinician burnout, regular testing rates are typically low in healthcare organizations.

“This isn’t a real surprise,” Johnson says. “Testing requires the right people using the right tools. Here automated testing solutions can significantly increase testing coverage and accuracy, while ultimately make the EHR easier to use and less prone to errors.”

She adds that once automated, healthcare organizations can leverage AI for exploratory testing to identify ways to make workflows more efficient--giving time back to providers.

“This will build critical trust in the system,” Johnson says.

Rebuilding trust in EHRs may be a daunting proposition. But it’s an imperative for technology that, despite the calls for organized revolt, have become permanently and deeply embedded in the nation’s healthcare.