Not all physicians dislike EHR data entry

by biolushskincare

In November 2023, Healthcare IT News ran a success story highlighting Phoenix Children’s homegrown data warehouse and apps. But there’s more to the story, says Dr. Vinay Vaidya, the health system’s chief medical information officer.

Vaidya says the key to the organization’s successful dashboards and apps development happened way on the front end of the process. Before he and his team were able to deliver impressive results from the dashboard and apps, he first had to convince the clinical staff that if they took the time to enter the necessary data into the electronic health record – typically a process most physicians consider to be cumbersome and a waste of time – his team would provide valuable results that would positively impact their patients.

So, following up on the previous profile story, we interviewed Vaidya on the subject of changing physician perceptions of data entry and motivating them to participate fully – a big hurdle many healthcare organizations are still unsuccessfully trying to surmount.

Q. EHRs are commonly perceived to be a burden on physicians, contributing to early burnout and cynicism. What is your opinion on this important issue?

A. EHRs often have been seen as an additional burden imposed on providers with very little direct benefits to them or their patients. Quite often, EHRs are attributed to be a significant reason for physician burnout.

Such a narrow, one-sided view easily can lead hospitals, health systems and providers to lose sight of the real reasons for moving from archaic, paper-based charting to EHR documentation and the immense potential these systems offer to enhance patient outcomes.

However, “potential value” of EHRs does not magically translate to realizing actual clinical benefits. Transforming this untapped potential to meaningful impact on patient outcomes requires a carefully crafted strategy with active involvement by health IT leadership as well as clinical leadership and frontline physicians working in tandem.

Having actively engaged and implemented such an approach at Phoenix Children’s, now both our physicians and administrators are reaping value from EHR data. We moved beyond the endless cycles of “EHR optimization” that yield minimal results. Instead, we focus on documenting only the most essential data elements in the EHR that can provide valuable insights, helping our providers identify care gaps and optimize patient care.

When used effectively, EHRs transcend their reputation as a necessary evil, becoming a robust electronic foundation for coordinating care, stratifying patient risk and managing patient populations holistically rather than individually.

Q. You say your physician colleagues don’t feel burdened by your EHR. They feel empowered. Why such a big difference in what most physicians feel?

A. Like many healthcare organizations, we too experienced growing pains during the initial stages of our EHR implementation more than a decade ago. There is hardly any doubt or debate that EHR documentation most often requires more time and effort. Doing the right thing often involves extra effort, whether it be eating healthy or choosing to take the stairs.

But to continue doing the right thing, one needs to receive positive feedback in terms of tangible results that justify the extra effort – and EHR usage is no different. To expect providers to put in extra efforts without a meaningful clinical return on investment is a losing proposition.

Right from the onset, our aim was not only to meet basic operational needs but to exceed them by turning the EHR into a tool that significantly enhances clinical decision making.

About seven years ago, we committed to a focused effort to realize the full promise of the EHR. This meant not only collecting data, but making sure it was clinically meaningful, easily accessible and optimally organized to support healthcare excellence.

During this period, we launched more than 50 clinical dashboards that delivered real-time, actionable data to frontline physicians and care coordinators. This approach transformed our EHR system from a perceived burden into a powerful asset for our medical staff. When healthcare providers see clear, tangible benefits from the tools they use, such as improved patient outcomes and streamlined processes, the value of investing extra effort becomes evident.

Therefore, the difference in attitudes toward the EHR within our organization compared to others might stem from our proactive stance on continuously enhancing the system’s relevance and utility, ensuring our providers feel empowered rather than burdened.

Q. Please share one big example of physicians at Phoenix Children’s asking for specific custom insights on their patient populations and how the team delivered those insights, even with more data entry involved.

A. Our team started chronic disease management with juvenile idiopathic arthritis. Collaborating very closely with the clinicians, I embedded myself into their pre-visit weekly planning to understand where we could inject ourselves to improve their insights and outcomes.

Previously, they had entered all their data in the EHR, but their information was not easily accessible and did not look across the patient population for insights into gaps in care, severe versus non-severe diagnoses, or how well we were controlling arthritis by provider location and across the system.

We started by extracting data in simple reports, which was more efficient than going through the EHR one patient at a time. Then we added visualization tools with our data that launched our initial dashboards.

This was in 2017, and since then we have built more than 50 of these dashboards across the enterprise and have expanded the program so we are using these dashboards for almost every aspect of the organization from operations to clinical care.

Q. Please share one more such example to prove your data entry point.

A. More recently, we helped solve a complex issue to improve outcomes for premature babies by involving not only Phoenix Children’s physicians, but also physicians working at many other hospitals and clinics in our service area.

All premature babies who spend time in the NICU undergo the retinopathy of prematurity (ROP) screening, including one to three exams at one-to-three-week intervals, since most complications from ROP do not arise until as many as four weeks after birth.

There is a small window of danger and an equally small window of opportunity. This screening helps determine if the baby needs additional treatment to prevent scarring, stretching and even retinal detachment that can lead to blindness.

Doctors used to bring in paper screening documentation to the ophthalmology nurse, who was responsible for digesting those notes and updating a manual process to track which patients needed screenings and when.

We created a dashboard to eliminate that manual process and the possibility of a missed screening through alerts and an automated email sent to neonatologists showing which patients meet the criteria for the screening, when exams have been scheduled for each patient and the number of days since they were last examined.

Since this is available for neonatologists at Phoenix Children’s and other hospitals, it analyzes data not only from our EHR but also from eight others.

We launched this in October 2023, and it has been well received by our physicians because once again they approached us with the issue and trusted us to develop a more efficient process that improves care.

This solution is a win-win because it reduces potential missed screenings and saves physicians’ time. By all accounts, we delivered, and we find that more often now, doctors are approaching us with the big idea instead of the other way around.

Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

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