Improving the EMR for a Better Provider Experience

UH Clinical Update - May 2017

By Cliff Megerian, MD, FACS, President, University Hospitals Physician Services

It has become abundantly clear that physician and provider burnout is a front-and-center issue. National survey data shows that 45 to 55 percent of all providers are affected. When physicians at health care institutions are asked about drivers of burnout, they often cite administrative burdens on physicians due to new laws and regulations.

Yet the leading cause of stress for the physicians surveyed nationally is electronic medical record (EMR) systems. All types of EMRs, from many vendors, are considered difficult and frustrating to use.

So at UH we are hardly alone in this reality. And while technical glitches will inevitably occur in EMRs and any complex systems, we can certainly minimize the issues and improve functionality – and we are.

Here are some of the significant enhancements we have made, and continue to make.

Under the direction of UH CEO Tom Zenty and Joy Grosser, who became UH Chief Information Officer in September, we held operational meetings with the leadership team at Allscripts, our EMR vendor, to document our provider experience and speed solutions.

A key challenge has been system stability – our UHCare Ambulatory EMR system has been down far too frequently.

Another issue has been multiple patient records. As Joy explains, “You put in an EMR so doctors can see a patient’s whole story in one place. Before, there were separate records for inpatient, outpatient and ED visits. Today, a bridge between systems provides a more unified view and better access to clinical information across the UH system.”

To connect our inpatient and outpatient care environments, we installed a program called EHR Agent. It displays as a pop-up window in the EMR and is the fastest way for doctors to view notes and lab results from more than 40 sources across UH and affiliated providers. Now inpatient doctors can view notes from the ambulatory record, and ambulatory doctors can view notes from the inpatient record. Learn more about EHR Agent.

UH leaders are committed to Allscripts, a system in which we had made an enormous investment. At least one member of the Allscripts leadership team is now dedicated exclusively to UH. Allscripts has a daily presence on our campus to address any issues that arise.

Next, as Joy says, “We peeled back the onion all the way, to find out what providers’ expectations were – very specifically. For example, ‘How long should a screen flip take?’“

Our UH Family Practice in Sharon Township became the initial pilot for technical and software issues that had to be addressed throughout the system. We have about 165 locations in our system, including physician practices and hospitals, and all will benefit from the progress we are making with Allscripts and our IT department.

Perhaps the most important action we’ve taken is to create a Physician Services & IT panel comprised by physicians and physician leaders. This put in place a communications pipeline that would keep IT clearly informed about specific physician issues with the EMR. Physicians who join me on this panel include Drs. Jeffrey Peters, Cindy Zelis, George Topalsky, Brad Hillard, Jeff Sunshine, Drew Hertz and Marie Kuchynski.

Other areas of improvement include a reduction in the time it takes to log in and to turn pages; we’ve added memory and an upgrade that allows physicians to get to notes in the EMR much more quickly. We’ve increased ways to streamline workflow, such as CareGuides, which are a more efficient way for doctors to place orders for a patient based on a specific diagnosis. Ambulatory doctors used CareGuides to create effective patient care plans more than 220,000 times in 2016.

An April upgrade also fixed several priority issues:

• Clinical Contention window no longer displays behind the main system window, alleviating an impression that the EMR had stopped responding 
• Duplicate Rx options restored for controlled substances 
• Authorization error for medication renewals fixed, permitting clinical staff to process renewals 
• Vital signs screen more conducive to provider workflow
• Surescripts medications display as authorized, easing reconciliations

Metrics culled from our IT data show progress:

• Application response time increased 30 percent from March 2015 to January 2017. 
• Citrix login times improved 36 percent.
• UHCare Ambulatory login times improved 49 percent.
• There has been a 75 percent reduction in Dragon dictation software issues. 
• UHCare Ambulatory web server now has redundant capacity.
• UH systems performance exceeded Allscripts documented performance standards.
• Screen-flip time from 2015 to 2017 has improved from 1.47 seconds to 1.09 seconds (on average).

In 2016, doctors using UHCare Ambulatory processed 32.5 million orders, documented 2.1 million notes and submitted 2.9 million prescriptions.

Improvements are occurring with the guidance of your physician colleagues, and with support from system leaders and IT leadership. Teams from Allscripts are meeting with our physicians: meetings have been held with acute care physicians and primary care physicians. Meetings with other physician groups are continuing.

We have an opportunity to make changes and enhancements to a system that most impacts the provider experience. And we want to make sure that UH providers are the owners of this process – and that it works for you.

We want you to help us shape it.