Where We've Been Where We're Going

My full remarks from the recent UH State of the System meeting

UH Clinical Update - June 2018

By Cliff Megerian, MD, FACS, President, UH Physician Network & System Institutes

As always, I first want to say again, thank you for all you do here. It is you, our physicians at University Hospitals, who are the reason for our success as a system. In four years we have grown from having 1,300 to 2,200 employed physicians – and that is exactly why our hospital system thrives. You are an enormous part of the reason it has grown to 18 hospitals, 50-plus medical office buildings and 210 sites.

Looking at it from another perspective: we have grown our share of the market in the region from 20 percent to 33 percent, and that is because of the trust that people have in our physicians and in the level of care that we at UH provide.

As a result, we now have the responsibility of managing the day-to-day health of 1.3 million patients this year. That’s an incredible number of people – about the size of the city of Dallas.

We could never accomplish this without you, our greatest asset. That is why I consider 2018 to be the year of the physician – the time when we do everything we can to improve the satisfaction and work environment for all of you and your provider colleagues.

However, like most health care organizations, we have realized that right at the time when we need our physicians most, is also the time when physicians throughout this country and here at UH are suffering from what many call burnout - which is often due largely to frustration and stress from everyday work-related activities.

Heading the list of burdens, to no one’s surprise, is the electronic medical records system. Between 55 and 70 percent of doctors in all health care organizations suffer from burnout and the majority cite the EMR as the reason behind it. And it does not matter which EMR system is used.

Last year, thanks to the survey of our physicians, we knew that there were a number of major areas we wanted to address to ease the burdens on you.

The first thing we did to help us get started was to hold a Physician Engagement Retreat – because we wanted to brainstorm, and to hear more. More than 100 people attended, including a core of 85 faculty and community physicians. The output from that meeting, and that group, guided our changes.

First in the all-important area of the EMR and IT:

• We restored UpToDate. All providers now have access to this clinical support resource directly through the UHCare Ambulatory EMR. 
• We stabilized our EMR system by dramatically reducing incidents of downtime.
• We improved access by significantly shortening log-in times.
• We enabled a unified view of patient information across our EMR system: now more than 93 percent of providers can directly view the variety of disparate EMR records with “EHR Agent,” and all providers can see displayed data from other EMRs in our Community Record.

Our current initiatives in IT and EMR include:

• Adding integrated clinical calculators in UHCare Ambulatory that can pull relevant data from a patient’s chart
• Connecting to the state OARRS system in UHCare Ambulatory to monitor a patient’s past or current prescription activity; UHCare Acute is already connected to OARRS.
• Enabling the use of electronic prescriptions for controlled substances
• Integrating surgery and anesthesia into UHCare Acute

We aren’t stopping there. Our future plans in IT include:

• Piloting remote scribes with virtual computer assistance, using voice-capture technology, similar to an Alexa device, and machine-learning to assist documentation
• Addressing population health with technology to notify providers – before a patient’s appointment – of screenings or other tests the patients are due for, such as a colonoscopy, immunizations, blood pressure check, glucose or A1C measurements
• Promoting clinical predictive analytics to providers, beginning with sepsis; by using patient records assimilated into vast arrays of data, risk projections will flow into the EMR to indicate which patients are at higher risk, why, and what preventive measures should be emphasized for that individual.

But the survey results were not only about EMR. The second significant area noted concerned facilities and staff. You told us you wanted improvements in those areas. So, to facilitate these activities:

• UHMG was awarded $2.3 million for equipment needs in 2018.
• UHMP was awarded $3 million for acquisitions in 2018.
• Each and every hospital is spending millions in improvements.
• And at UH Cleveland Medical Center, which has some of our oldest facilities, we will be spending $89 million, which includes some research infrastructure that we are planning.

You also cited “staffing improvements.” To address these larger needs, we have created three new positions:

1. Career Development Officer, to which Dr. Marjorie Greenfield has been appointed. Among many other duties, she will engage UH faculty to support career development and promotions; help faculty build personal career paths and prepare for academic promotion; and advocate for faculty interests linked to career development.
2. Dr. William Annable as UH Clinician Engagement Officer. Dr. Annable will serve as an ombudsman for physicians, nurses and care providers to discuss your – their - concerns and suggestions. Dr. Annable recently retired from the position of UH Chief Quality and Medical Officer and is already active in his new position. He will assist with the many physician, provider and nurse engagement initiatives already underway across our system.
3. Dr. Goutham Rao, who as the first medical director of our new UH Office of Provider Wellness, heads UH clinician well-being efforts. He has created Quarterly Wellness Seminars, as well as implemented a Science Conference on Provider Wellness; and has developed a broad menu of options to help our clinicians cope with professional and personal challenges.

This month, we will introduce the latest innovation: University Hospitals will be the first institution in the country to offer a smart-phone based wellness-measuring meter.

Better communication is also something our providers felt strongly about. As a result, Dr. Dan Simon and I have held 39 town halls with providers since November; and Tom Zenty continues his systemwide biannual visits to our entities.

We saw you, we talked with you, we listened – and we continue to do so. One way is by doubling down on having physicians have more seats at the table here at UH. As a result, we now have physicians at leadership forums at every level of our organization. This includes the system board of directors and the UH Cleveland Medical Center Board - and now every week physicians sit shoulder-to-shoulder with senior leaders at the executive committee meetings.

This pattern continues through the UHMG board of directors and the UHMG compensation board. Similarly, physicians are on Senior Leadership Council as well as on the boards of all of our hospitals. Physician CMOs are part of the triad of leadership at every one of our system’s hospitals. And, physicians populate the UHMG and UHMP Advisory Groups.

Many of our physician leaders have achieved these levels of influence through training here at UH, within our Leadership Institute as well as through our online leadership training, such as the Leadership Academy.

But I also want to recall another very important takeaway from the survey, a heartening one. It showed us what our physicians thought is the very best about UH: at the top was the pride they felt in working for and at University Hospitals. The results also showed that our physicians have a great deal of trust that UH is the best place for their patients to receive care.

They also appreciate the sense of camaraderie they have with fellow physicians around the system and with the physicians and nurses they work with each day.

And finally, our physicians have tremendous pride and satisfaction when it comes to their individual clinical offices, departments and the institutes at which they work.

We have a fantastic infrastructure and hospital system, one that continues to grow and evolve. This is what we build on.

You told us what you wanted. We listened, we acted and we will continue to do more of the same – with the consistent feedback we seek from you, through all the avenues we have created in the past months.