- Introducing new technologies into physicians’ offices, emergency departments, and hospital rooms gives clinicians opportunities to optimize clinical efficiency, access accurate health data, and deliver high-quality patient care.
But these benefits usually aren’t realized until providers overcome the adjustment period that accompanies new changes to daily operations and clinical workflows.
Shortening this adjustment period was top-of-mind when executives of the IT team at Pennsylvania-based Uniontown Hospital began to strategize ways to further digitize hospital operations.
Health IT adoption at the hospital had been a gradual undertaking, Uniontown Health Information Management Director Karen Keniston told EHRIntelligence.com.
She and her colleagues — Uniontown Director of IT and Informatics Tracy Porterfield and Clinical Informatics Integration Analyst Jennifer Abraham — assisted clinicians with utilizing a Cerner EHR system that first went live at the hospital in 2002.
For years after the go-live, Uniontown staff members used a hybrid of electronic and paper form documentation.
“Lab and x-rays were electronic, for example,” said Keniston. “Then progress notes were in paper form.”
Over time, the hospital’s executive and IT teams worked toward completely digitizing clinical and administrative operations for a comprehensive electronic health record.
“What seemed to be the biggest missing piece was having the physicians progress notes integrated into an electronic form,” Keniston explained. “The documents had to be transcribed, so there was a delay in getting them into the EMR. Some method to get those immediately available for the physicians to review was a desirable outcome.”
To improve clinical efficiency and sidestep the need for transcription, Uniontown worked with Cerner to develop and implement a clinical documentation and note review solution. Cerner and the Uniontown IT team integrated the health IT solution, Dynamic Documentation, directly into the hospital’s EHR system.
Over the course of three months, physicians adopted the clinical documentation review solution along with a medical Dragon voice-recognition software to record physician notes.
“We did some configuration changes ahead of time,” noted Keniston. “We read every physician’s name into Dragon, so their names were already there and spelled correctly.”
But ensuring the EHR-integrated clinical documentation solution was primed for physician use was only half the battle.
The hospital’s health IT team also needed a several-pronged strategy to ensure a high level of consistent clinician engagement with the tool.
Promoting clinician engagement with new health IT tools
The Uniontown IT team knew there would be some hesitance among clinicians to incorporate the use of a new health IT tool into their everyday routines. The adjustment period that follows health IT adoption can negatively affect clinical productivity, slow clinical or administrative operations, and lead to physician dissatisfaction and frustration.
In efforts to minimize this adjustment period and help clinicians thoroughly understand how to use the new technology, Uniontown required that clinicians attend training sessions.
“This required attendance had a huge impact on the success and adoption of Dynamic Documentation,” said Abraham. “Also, during the training session we made sure every doctor got the same message. The expectations were common at each session.”
The IT team monitored these training sessions to gauge how well clinicians were taking to the tools.
“That was important for us,” Keniston emphasized. “There was someone from the team at all of the education sessions, so we could see who was getting it and who wasn’t, and identify anyone who may need extra help.”
Two Cerner representatives and several members of the IT project team attended each three-hour training session. The team conducted each training session according to a standardized script to ensure every physician received the same training.
“We had bullet points that we made sure to hit,” said Abrahams, “And between points we interjected. Every single training session included the same pieces of information about how to use Dragon and Dynamic Documentation.”
The team made sure to offer three sessions per day for two weeks to ensure physicians with different schedules could attend at least one session.
“There were evening sessions, early mornings, sessions in the middle of the day,” said Keniston.
In addition to offering plenty of sessions to fit any physician schedule, Uniontown also gave physicians the opportunity to gain hands-on experience with the new health IT tools.
“Each person had their own computer and their own dictation microphone,” said Keniston. “You need to actually do it to be able to learn it.”
The team kept class sizes under 15 physicians per session to ensure each physician could receive at-elbow support from Cerner executives and members of the Uniontown IT team if needed.
In the days prior to the health IT tool go-live, the team held a “favorites fair” — eight-hour sessions during which physicians were invited to head down to their medical staff lounges, meet with representatives of the health IT team, and create favorites lists. The IT team built these favorites lists into physician workflows on the day of the go-live to improve system usability.
“The day we went live, they already had their favorites built in,” said Abraham. “The favorites fair was packed most of the time. We really got a lot of participation for that. We helped them create their smart templates and specific workflows.”
The other prong of the implementation strategy involved Uniontown partnering with Cerner to launch a physician optimization project.
The physician optimization project centered on ensuring clinicians were confident using the technology, as well as helping other clinicians troubleshoot problems as they cropped up.
“We divided physicians into four specialty groups, and we brought in physician champions for each specialty,” said Abraham. “These physician champions were the drivers. They were the voice of that group of doctors. They gave us input and designed their own systems. We very much took the approach that this was their system, and we’re just helping them build it.”
Physician champions also helped their colleagues resolve issues with the new health IT tools.
“When other physicians ran up against a problem, we were able to refer them to their peer as opposed to IT,” added Abraham.
As part of the optimization project, the IT team also created four specialized clinical workflows.
“We had workflows for inpatient medicine, surgery, cardiology, and pediatrics,” explained Abraham. “We had physician champions from each of those areas help to build their workflows to that specialty.”
“Whenever the physician logged in — say the physician was a surgeon. They would have their specific labs,” she continued. “The workflow is specific to what each department needs.”
Specialized physician workflows are especially important for pediatricians.
“What pediatricians choose to view is very different for a child than it is for an adult,” maintained Keniston. “So there were specific labs, specific results, and specific testing that was more important for pediatricians than it would be for a general inpatient medicine physician.”
Specializing clinical workflows saves clinicians time by presenting them with the most relevant clinical information for their specialty, rather than requiring that clinicians dig through excessive amounts of data.
“It’s going to display the higher priority information,” said Abraham. “For cardiologists, they wanted all of the radiology testing for their patients to automatically pull into their notes.”
The team plans to expand on these efforts to customize physician workflows to specific specialties in the future.
“We have four specialties now, and our goal is to spread that out and have every physician specialty represented,” Abraham said.
The use of physician champions, comprehensive training sessions, and usability improvements significantly paid off for the hospital. Uniontown’s surgeon champion told the IT team the clinical documentation tool was the biggest improvement to clinical processes he had seen in the 30 years he had been at the hospital.
But Uniontown couldn’t have realized such significant improvements in clinical efficiency if it wasn’t for high levels of clinician buy-in.
“If you don’t give physicians something that’s going to make their life better, or add value, you won’t gain adoption,” said Porterfield. “Getting their buy-in and getting their feedback — that’s what makes the difference.”
The physician optimization project was an integral part of achieving high-levels of clinician engagement.
“Including the physician optimization was the right thing to do,” Porterfield said. “It would not have been as good of an experience if we just threw electronic documentation out there. IT is the entire workflow that gives providers a more efficient process.”
Ultimately, ensuring providers were able to contribute to workflow design and offer the IT feedback throughout the implementation and optimization phase was key to promoting widespread health IT adoption and use at Uniontown.
“Providers have to have a voice,” said Porterfield. “When you’re training them, you’re getting one-on-one feedback. You’re finding out what they like, what they don’t like. Listening and communicating with clinicians is key.”