Talk to your clinical colleagues and you’ll quickly discover that healthcare is in a vice and the pressure is ratcheting up. The staffing shortages, a viral tsunami, and a shifting reimbursement landscape are making a challenging environment even more difficult. My emergency medicine peers describe departments completely full of admitted patients who are overflowing into hallway beds (known as “boarding”) while the waiting room backs up further and further. The problems across healthcare are extraordinarily complex and go well beyond a single person, facility, or region. There are so many things out of a health system’s control and there is no silver bullet.
Interaction with the electronic health record (EHR), however, accounts for a huge proportion of a clinician’s time with at least one study estimating 4.5 hours per day! Importantly, the path that a clinician navigates through the EHR is completely within the control of a health system. It is imperative that health systems address inefficiencies, malfunctions, annoyances, and just generally, “stupid stuff.” Implementing changes to fix the clinician experience in the EHR has real impacts on time savings when scaled across an entire system, but also enables powerful messaging to show staff that the health system is committed to continuously improving their day-to-day work experience.
The Team Behind the Team
Health systems employ large IT teams to implement and modify the EHR. In order to truly understand how changes should be made, health systems also employ clinical informatics teams. In essence, these are teams of clinicians that are well versed in technical tools like the EHR, but can also translate a clinician’s needs into a series of steps (also called a workflow) in the EHR. These teams can have a variety of reporting and governance structures, but they are universally dwarfed in comparison to the demands put on them.
The evolution of relatively small clinical informatics teams has a variety of explanations, but historically talking about financial ROI for informatics has been difficult. I once heard it described like an elevator in a skyscraper. Do you need it? No, but it sure makes working there a whole lot easier and more efficient. Taking the analogy to the next level, what is the right number of elevators? I’d argue that most health systems are getting by with a single elevator, which has led to lines out the door and around the block. As a result, many employees continue to use the stairs because waiting isn’t an option when you need to get work done.
Monitoring a Complex System
Data is now universally accepted as the key to understanding the scope of a problem. We’ve hopefully moved beyond assessments that sound like, “I feel like this order set is used by everyone in the department” and onto assessments that say “this is exactly how the order set is used in the department.” With the widespread implementation of EHRs, easily accessible data is no longer an issue. So, what’s the problem and why are informatics teams overwhelmed?
Our team at Phrase Health often explains this through a modified data to wisdom pyramid. On one end, enacting local change based on the translation of data is the ultimate goal. On the other end, data is now ubiquitous. Furthermore, healthcare has succeeded in making “information” readily accessible. This is often reflected in a dedication to spinning up business intelligence (BI) dashboards that show charts and graphs. The overflowing availability of dashboards and interactive data puts the onus on the user to uncover and contextualize a problem.
As a result, the most important piece to strive for is the delivery of actionable insights. At Phrase Health, we support health systems in this effort by constantly sifting through our partner’s data and abstracting it through the lens of validated research and curated metrics. Not only does this support informatics but it complements analytics teams that are stretched so thin that it can take months to turn around answers to simple questions. Example insights include alert burden, order set variation, outlier provider overrides, anomaly detection, and feedback analysis to name a few.
A recent straightforward example can be highlighted from a partner site. There are two fundamental ways to get feedback from a clinician about a workflow. You can ask them directly, but this can be extremely time consuming. The other approach is to interpret their feedback directly from the EHR system. This can also be very time consuming, but validated research provides a solution to automate the process and immediately pinpoint the opportunities. Our partner found that an interruptive alert advised an order. Yet many users were providing feedback that saw the alert even though they had already ordered it. It was an easy fix to exclude firing the alert when the order has already been placed! Are your health system employees screaming into the void with nobody on the other end?
Bringing It Together
The inability to control external factors can make leading an organization through the current challenges in healthcare all the more frustrating. However, while the systems are complex, the workflows within the EHR are completely modifiable and provide low hanging fruit that demonstrate a commitment to the workforce. Health systems can continue to allow clinicians to scale stairs in a skyscraper and scream into the void or they can support informatics in improving the overall clinical experience.
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