Improving Physician Well-Being through EHR Enhancements

Added on Sep 12, 2018

By Andrea Fitzgerald, Staff Writer

Intended to revolutionize health care, electronic health records (EHRs) have become a major source of discontent for many physicians. The results of a recent Stanford Medicine poll indicate that 40% of primary care physicians believe there are more challenges with EHRs than benefits, and 59% want a complete overhaul. Nearly half of the respondents said that using an EHR detracts from their professional satisfaction and clinical effectiveness, and almost three-quarters reported that EHRs increase their daily workload and “greatly contribute” to physician burnout.

This discontent can lead to lower engagement and suboptimal experiences of care. Press Ganey research cited in a 2017 white paper shows that physician engagement is critical to organizational success. Highly engaged physicians lead to improved teamwork, coordination of care and outcomes—ultimately driving positive patient experiences.  

ehr-1476525_960_720For this reason, organizations seeking ways to improve physician well-being and advance patient-centered care have begun setting their sights on the EHR. Specifically, they are seeking ways to optimize the technology to better meet clinicians’ needs, reduce their frustrations and allow them to spend more time interacting with their patients than with their computer.

“EHRs are not the enemy, although they are frequently perceived that way. The ‘enemy’ is poor EHR implementation—insufficient support, lack of training and no change in the office workflow, so the data entry burden falls squarely on physicians, reducing the amount of time they can spend nurturing their relationships with patients and providing care,” said Joseph Cabral, chief human resources officer and president of Workforce Solutions at Press Ganey. “To reverse this, health systems should look closely at the EHR challenges faced by their clinicians—data fatigue, workflow misalignment, insufficient interoperability—and engage all stakeholders, including leaders, end users and IT, in the development of strategies to overcome them.”

This is the approach adopted by Cleveland Clinic. In 2016, after the organization’s 2015 physician satisfaction surveys identified the EHR as a major pain point, the Clinic developed a series of EHR enhancements as part of its multipronged initiative to improve physician well-being.    

The EHR improvement efforts were spearheaded by Dr. Amy Merlino, enterprise chief medical information officer at Cleveland Clinic, and the Clinic’s IT department. “We were challenged by our Office of Professional Staff Affairs to make our EHR more user-friendly to help advance the organization’s commitment to physician well-being,” Dr. Merlino said in an interview.

In response to clinician feedback on items that influenced provider workflows, the Clinic rolled out several enhancements, including

  • Two apps that allow viewing and interacting with the EHR remotely and on handheld devices;
  • Tools to improve in-basket functionality, especially to refill requests and reduce administrative burden; and
  • Clinical Visit Navigator solutions tailored to specific types of users.

“Once the system was updated, it was crucial for our training team to reeducate clinicians about the new and old tools,” Dr. Merlino said. This at-the-elbow clinician support comes in a variety of forms. Users may participate in classroom training, or request a trained professional to spend time with them during care hours to observe and then make suggestions on streamlining their daily documentation. The objective for these changes is to give physicians more face time with patients and less with their computer monitors, she said.

These expanded efforts to address well-being were quickly successful. By 2017, several key measures for physician satisfaction, including engagement, continuous improvement, well-being, trust and communication, had improved.

“The success of these efforts is not surprising,” said Cabral. “When physicians feel listened to and supported they are better prepared to implement change, and when they have a hand in designing the change they are more engaged in the process and invested in its success.”