- Physicians are highly-trained individuals who require the right kind of support when implementing new activities or technologies as part of their clinical workflows.
This is especially true relative to the physician EHR experience, says Emory Healthcare CMIO Julie Hollberg, MD. "I have been the CMIO for four years and the physician champion when we went live with CPOE in the inpatient setting. When we went live, we had bodies everywhere. I jokingly say physicians want help in the exact moment when they want it, not ten minutes before or after," she tells EHRIntelligence.com.
Emory Healthcare has embarked on a serious health IT undertaking with its recent provider EHR optimization project which aims to bring 32 different specialty-focused views of the electronic chart to its 1,650 physicians across 5 acute care hospitals and more than 90 ambulatory sites. The subject was also part of a talk Hollberg gave at Cerner’s Ambulatory Summit last month.
Critical to the project's success is supporting physician EHR users the right way at the right time.
"My telepathic ability to predict those needs for 1650 physicians is bad," says Hollberg. "The way you compensate for that is that you put bodies there to help in the exact moment when they need it. That is expensive, but it is one of the only ways that you can get the greatest adoption of the technology."
As the Emory Healthcare CMIO notes, an important distinction exists between EHR technology as is and how it is best used to support the provider experience.
"The technology like many things does amazing things, but it’s just a tool. You have to learn how to use it just like everything else. We have coupled this with required training so that people have a skeleton from which to hang new knowledge from the coaches when they are in clinic," adds Hollberg.
The provider EHR optimization project kicked off in March with planning and entered its first pilot in June with the cardiology department. It is slated to roll out to the entire health system by the middle of September.
Justifying the high cost
Not only expansive, the project is also expensive, but worth the cost to Hollberg because of how at-the-elbow support drives EHR adoption.
"There is very high touch related to this project," she reveals. "It is difficult to build credibility and trust with the physicians that the EHR is going to make their lives better. So one of the ways we have been able to build that trust is by partnering with Cerner and quickly responding to their issues."
The provider EHR optimization project represents an important milestone for the Cerner shop, whose EHR and health IT use spans more than two decades. Its impetus is to eliminate clinical inefficiencies caused by having to reproduce the same information in a multitude of places.
"Previously, we would document the diagnosis of a paper encounter form; they would write the diagnosis on radiology; they would write the diagnosis or history on a referral," Hollberg explains "Now with moving toward better utilization of the problem list and the electronic charge capture, they can associate those diagnoses with each individual order or bill very quickly."
To develop each specialty-specific view of the EHR, Hollberg et al. met with leaders from each department to gather details about what their physicians need and want to see in the electronic record.
"The advantages of that is that each division or department is able to customize what data they want face-up to increase the efficiency in terms of the amount of time it takes to navigate the chart," she maintains. "We’re also dovetailing this with our ICD-10 rollout and moving from paper to CPOE in the ambulatory setting and showing them how they can leverage the EHR to document once and carry that data throughout the patient visit."
Providing providers with support
More crucial to the success of the provider EHR optimization project than physician engagement is physician support in the form of at-the-elbow support as each department goes live.
"We’re investing very, very heavily in the trainers," says Hollberg. "We’re spending millions of dollars to give providers one-on-one Cerner coaches at the elbow for two weeks solid in clinic and then tapering down after that with a plan for 30-, 60-, and 90-day touches and follow-up."
Mirroring this kind of support is high touch between Hollberg's team and physician leaders from various department as the latter enter production mode.
"During the week of go-live we have twice a day conference calls with the physician lead, clinical operations and administrative practice leads to go over the ongoing list of what the issues are and be able to react to those real time," she notes. "The week after go-live, we move from move from twice a day conference calls to three times a week. However, the coaches are there on an ongoing basis and have a daily meeting or debrief and issues that are a problem are escalated to us."
What works for patient care likely extend to physicians incorporating new technology into their clinical practice — a hands-on approach leads to a more positive (and likely more successful) outcome.