scholarly journals Reducing electronic health record-related burnout in providers through a personalized efficiency improvement program

2020 ◽  
Author(s):  
Eli M Lourie ◽  
Levon Haig Utidjian ◽  
Maria F Ricci ◽  
Linda Webster ◽  
Carola Young ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Health Record ◽  
Efficiency Improvement ◽  
Improvement Program ◽  
Improve Efficiency ◽  
After Hours ◽  
The Mean ◽  
Net Promoter ◽  
Electronic Health ◽  
The One

Abstract Objective To give providers a better understanding of how to use the electronic health record (EHR), improve efficiency, and reduce burnout. Materials and Methods All ambulatory providers were offered at least 1 one-on-one session with an “optimizer” focusing on filling gaps in EHR knowledge and lack of customization. Success was measured using pre- and post-surveys that consisted of validated tools and homegrown questions. Only participants who returned both surveys were included in our calculations. Results Out of 1155 eligible providers, 1010 participated in optimization sessions. Pre-survey return rate was 90% (1034/1155) and post-survey was 54% (541/1010). 451 participants completed both surveys. After completing their optimization sessions, respondents reported a 26% improvement in mean knowledge of EHR functionality (P < .01), a 19% increase in the mean efficiency in the EHR (P < .01), and a 17% decrease in mean after-hours EHR usage (P < .01). Of the 401 providers asked to rate their burnout, 32% reported feelings of burnout in the pre-survey compared to 23% in the post-survey (P < .01). Providers were also likely to recommend colleagues participate in the program, with a Net Promoter Score of 41. Discussion It is possible to improve provider efficiency and feelings of burnout with a personalized optimization program. We ascribe these improvements to the one-on-one nature of our program which provides both training as well as addressing the feeling of isolation many providers feel after implementation. Conclusion It is possible to reduce burnout in ambulatory providers with personalized retraining designed to improve efficiency and knowledge of the EHR.

scholarly journals Optimizing the electronic health record: An inpatient sprint addresses provider burnout and improves electronic health record satisfaction

2020 ◽  
Author(s):  
Jennifer R Simpson ◽  
Chen-Tan Lin ◽  
Amber Sieja ◽  
Stefan H Sillau ◽  
Jonathan Pell
Keyword(s):  
Confidence Interval ◽  
Electronic Health Record ◽  
Health Record ◽  
Advanced Practice ◽  
Log Data ◽  
Net Promoter Score ◽  
Net Promoter ◽  
Electronic Health ◽  
Emotional Recovery ◽  
Very High

Abstract Objective We sought reduce electronic health record (EHR) burden on inpatient clinicians with a 2-week EHR optimization sprint. Materials and Methods A team led by physician informaticists worked with 19 advanced practice providers (APPs) in 1 specialty unit. Over 2 weeks, the team delivered 21 EHR changes, and provided 39 one-on-one training sessions to APPs, with an average of 2.8 hours per provider. We measured Net Promoter Score, thriving metrics, and time spent in the EHR based on user log data. Results Of the 19 APPs, 18 completed 2 or more sessions. The EHR Net Promoter Score increased from 6 to 60 postsprint (1.0; 95% confidence interval, 0.3-1.8; P = .01). The NPS for the Sprint itself was 93, a very high rating. The 3-axis emotional thriving, emotional recovery, and emotional exhaustion metrics did not show a significant change. By user log data, time spent in the EHR did not show a significant decrease; however, 40% of the APPs responded that they spent less time in the EHR. Conclusions This inpatient sprint improved satisfaction with the EHR.

scholarly journals Electronic Health Record Use among Ophthalmology Residents while on Call

2020 ◽  
Vol 12 (02) ◽  
pp. e143-e150
Author(s):  
Christopher P. Long ◽  
Ming Tai-Seale ◽  
Robert El-Kareh ◽  
Jeffrey E. Lee ◽  
Sally L. Baxter
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Chart Review ◽  
Health Record ◽  
Physician Burnout ◽  
Single Institution ◽  
Clinical Exposure ◽  
Future Studies ◽  
After Hours ◽  
Electronic Health

Abstract Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours. Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks. Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents' on-call EHR activities. Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.

The Surgical Risk Preoperative Assessment System: Determining which predictor variables can be automatically obtained from the electronic health record

2019 ◽  
Vol 24 (6) ◽  
pp. 230-237 ◽  
Author(s):  
Robert A Meguid ◽  
Michael R Bronsert ◽  
Karl E Hammermeister ◽  
David P Kao ◽  
Anne Lambert-Kerzner ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Electronic Health Record ◽  
Preoperative Assessment ◽  
Assessment System ◽  
Predictor Variables ◽  
Health Record ◽  
Improvement Program ◽  
Surgical Quality ◽  
Surgical Risk ◽  
Electronic Health

Introduction The Surgical Risk Preoperative Assessment System is a parsimonious, universal surgical risk calculator integrated into our local electronic health record. We determined how many of its eight preoperative risk predictor variables could be automatically obtained from the electronic health record. This has implications for the usability and adoption of Surgical Risk Preoperative Assessment System, serving as an example of use of electronic health record data for populating clinical decision support tools. Methods We quantified the availability and accuracy in the electronic health record of the eight Surgical Risk Preoperative Assessment System predictor variables (patient age, American Society of Anesthesiology physical status classification, functional health status, sepsis, work Relative Value Unit, in-/outpatient operation, surgeon specialty, emergency status) at the patient’s preoperative encounter of 5205 patients entered into the American College of Surgeons National Surgical Quality Improvement Program. Accuracy was determined by comparing the electronic health record data to the same patient’s National Surgical Quality Improvement Program data, used as the “gold standard.” Acceptable accuracy was defined as a Kappa statistic or Pearson correlation coefficient ≥0.8 when comparing electronic health record and National Surgical Quality Improvement Program data. Acceptable availability was defined as presence of the variable in the electronic health record at the preoperative encounter ≥95% of the time. Results Of the eight predictor variables, six had acceptable accuracy. Only preoperative sepsis and functional health status had Kappa statistics <0.8. However, only patient age and surgeon specialty were ≥95% available in the electronic health record at the preoperative visit. Conclusions Processes need to be developed to populate more of the Surgical Risk Preoperative Assessment System preoperative predictor variables in the patient’s electronic health record prior to the preoperative visit to lessen the burden on the busy surgeon and encourage more widespread use of Surgical Risk Preoperative Assessment System.

scholarly journals Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

2020 ◽  
Vol 11 (01) ◽  
pp. 130-141
Author(s):  
Sally L. Baxter ◽  
Helena E. Gali ◽  
Michael F. Chiang ◽  
Michelle R. Hribar ◽  
Lucila Ohno-Machado ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
High Volume ◽  
Health Record ◽  
Patient Centeredness ◽  
Face To Face ◽  
Single Sign On ◽  
Timing Data ◽  
After Hours ◽  
Electronic Health ◽  
Physician Patient

Abstract Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

Abstract MP12: Electronic Health Record-Based Assessment of Cardiovascular Health

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Randi E Foraker ◽  
Abigail B Shoben ◽  
Albert M Lai ◽  
Philip R Payne ◽  
Marjorie Kelley ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Cardiovascular Health ◽  
Normal Weight ◽  
Health Record ◽  
Visualization Tool ◽  
Obese Women ◽  
Intervention Period ◽  
Post Intervention ◽  
The Mean ◽  
Electronic Health

INTRODUCTION: An electronic health record (EHR)-based visualization tool was developed to facilitate patient-provider communication around the American Heart Association’s (AHA) Life’s Simple 7™ for cardiovascular health (CVH). The tool automatically populates with patient data from the EHR and utilizes a stoplight color scheme to indicate “ideal” (green), “intermediate” (yellow), and “poor” (red) CVH. METHODS: CVH was defined for smoking, body mass index, blood pressure, and cholesterol according to AHA criteria. For this analysis, diabetes was characterized as either yellow (treated) or green (untreated), as most patients were missing fasting glucose values. An overall CVH score was calculated and ranged from 0 (worst) to 10 (best) by summing across behaviors and factors as follows: poor, 0; intermediate, 1; and ideal, 2. The CVH tool first launched within the EHR of our outpatient intervention clinic in October 2013. The change in CVH of female patients ages 65 and older seen in the clinic during the pre-intervention period (May 1 - July 31, 2013) and the post-intervention period (May 1 - July 31, 2014) was described. RESULTS: One hundred nine women (average age 74 years; 35% black), seen pre- and post-intervention, were enrolled in the study. The mean CVH score was 6.0 and the mean fractional score (actual score/maximum possible) was 0.63 at both time points, and neither differed significantly by race. Figure 1 shows the distribution of ideal, intermediate, poor, and missing CVH values for each behavior and factor in 2013 and 2014. From 2013 to 2014, the proportion of obese women decreased from 47% to 43%, and the proportion of normal-weight women increased from 15% to 19%. Favorable changes were also seen for diabetes. CONCLUSIONS: This is the first study to develop and implement an EHR-based CVH visualization tool. Our study demonstrates that it is feasible to implement patient-centered EHR-based tools at the point-of-care in the primary care setting. Future work is needed to assess how to best harness the potential of such tools.

One System of Care, One Electronic Chart

2013 ◽  
pp. 55-69
Author(s):  
Jennifer Gholson ◽  
Heidi Tennyson
Keyword(s):  
Electronic Health Record ◽  
Electronic Record ◽  
System Of Care ◽  
Health Care Facilities ◽  
Health Record ◽  
Electronic Chart ◽  
Electronic Health ◽  
The One ◽  
Area Health

Regional Health made a commitment as part of quality and patient safety initiatives to have an electronic health record before the federal government developed the concept of “meaningful use.” The “One System of Care, One Electronic Chart” concept was a long-term goal of their organization, accomplished through electronically sharing a patient’s medical record among Regional Health’s five hospitals and other area health care facilities. Implementing a hybrid electronic record using a scanning and archiving application was the first step toward the long-term goal of an electronic health record. The project was successfully achieved despite many challenges, including some limited resources and physician concerns.

One System of Care, One Electronic Chart

2015 ◽  
pp. 1052-1063
Author(s):  
Jennifer Gholson ◽  
Heidi Tennyson
Keyword(s):  
Electronic Health Record ◽  
Electronic Record ◽  
System Of Care ◽  
Health Care Facilities ◽  
Health Record ◽  
Electronic Chart ◽  
Electronic Health ◽  
The One ◽  
Area Health

Regional Health made a commitment as part of quality and patient safety initiatives to have an electronic health record before the federal government developed the concept of “meaningful use.” The “One System of Care, One Electronic Chart” concept was a long-term goal of their organization, accomplished through electronically sharing a patient's medical record among Regional Health's five hospitals and other area health care facilities. Implementing a hybrid electronic record using a scanning and archiving application was the first step toward the long-term goal of an electronic health record. The project was successfully achieved despite many challenges, including some limited resources and physician concerns.

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