What is Holding You Back from an EHR Revolution? Session PE4, February 11, 2019 Taylor Davis, VP of Innovation, KLAS Christopher Sharp, CMIO,

Transcription

1 What is Holding You Back from an EHR Revolution? Session PE4, February 11, 2019 Taylor Davis, VP of Innovation, KLAS Christopher Sharp, CMIO, Stanford Health Care 1

2 Conflict of Interest Taylor Davis, KLAS Manages the KLAS Arch Collaborative and is an employee of KLAS. Christopher Sharp, Stanford University School of Medicine Has no conflicts of interest. 2

3 Agenda Impact and scope of burnout on medicine Framework for combatting burnout How the EHR impacts burnout (and visa versa) Variation drivers in EHR success Framework for EHR success 3

4 Learning Objectives Inspect the learnings of both the Stanford WellMD and KLAS Arch Collaborative research efforts to understand the common principles that lead to decreased physician burnout and greater EHR success. Review specific case studies of successful provider organizations who have created greater EHR mastery in their EHR users, connecting this greater mastery to better clinician fulfillment. Debunk many of the common myths that organizations have regrading creating EHR success and decreasing burnout. Review a checklist that organizations can use to measure their own EHR success readiness and progress towards decreased burnout. 4

5 What s Happening to Doctors? 5

6 What is Burnout? Burnout is a syndrome of depersonalization, emotional exhaustion, and low personal accomplishment that leads to decreased effectiveness at work. 6

7 Burnout by Specialty 2011 N=7288 Shanafelt et al, JAMA Int Med 172:1137 7

8 Burnout in the U.S.: Physicians & Population Shanafelt TD et al. Mayo Clinic Proceedings :1600 8

9 9 Stanford Physician Well-Being Trockel and colleagues

10 Well Physicians = Higher Performance Physicians Who are Well: Higher patient satisfaction (Beach, et al. 2013) More likely to support preventive health practices in patients (Duperly, et al., 2009; Frank, et al., 2008; Frank, et al. 2013) Lower medical error rate (Fahrenkoph, et al. 2008; Shanfelt, et al. 2010; West, et al. 2006) Better patient outcomes, e.g. decreased post-hospital discharge recovery times (Halbesleben and Rathert, 2008) Less likely to leave their organization 10

11 11 What is the value ($$) of wellness? The Business Case for Investing in Physician Well-being. Shanafelt T, Goh J, Sinsky C. JAMA Intern Med Dec 01;177(12):

12 Achieving our mission is no longer possible without addressing wellness Improved Patient Care Lower Costs Better Outcomes Fourth Aim Clinician Well-being Bodenheimer, Ann Fam Med 12:573 12

13 Aiming for Professional Fulfillment Leadership Values Alignment Voice/input Meaning in work Community/collegialit y Peer Support Appreciation Flexibility Culture compassion EHR usability Triage Scheduling Patient portal Documentation method Team-based care OR turnaround times Staffing Bohman, NEJM Catalyst

14 What is the role of health information technology? 14

15 How the EHR Contributes to Burnout Usability / User Interface Shift in Workload to Providers Built-in Regulatory & Documentation Requirements Effect on Interpersonal Interactions Toll, E. The Cost of Technology. JAMA. 2012;307(23):

16 It s About Time For every hour physicians provide direct clinical face time, nearly 2 additional hours is spent on EHR and desk work EHR time while face-to-face is equal to Desktop Medicine (patient messages, refills, ordering tests, reviewing results) While in the room with patients, physicians spent ~50% on direct clinical face time and ~40% on EHR and desk work Sinsky C, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016;165: Tai-Seale M, et al. Electronic Health Record Logs Indicate That Physicians Split Time Evenly. Health Aff (Millwood) Apr 01;36(4):

17 Minutes per Day (Unscheduled Days) 17 My Internal Medicine Clinic Minutes per Day (7pm-7am Activity on Scheduled Days) 17

18 18 Ambulatory Physician Optimization Program 18

19 19 Participation Offered to 600+ providers with 84% participation 94% of participants are likely to recommend Includes faculty and community physicians Mona Sidhu Matthew Hiller 19

20 Impacts Satisfaction with EHR 32% 38% 30% Initial Survey Data - Satisfaction (N=343) Proficiency Using EHR 29% 46% 25% Initial Survey Data - Competence (N=343) Satisfaction with Clinical Work 49% 32% 19% Post 30 Day Follow-up Survey - Satisfaction (N=86) 51% 34% 15% Post 30 Day Follow-up Survey - Competence (N=86) Excellent / Very Good Good Poor / Fair 4% 24% 72% 17% 2% 80% Initial Survey Data Clinical Satisfaction (N=101) Post 30 Day Follow-up Survey Clinical Satisfaction (N=101) 20

21 Looking forward Usability / User Interface Team-based Care Regulatory & Documentation Requirements Enhanced Interpersonal Interactions 21

22 Key Finding: The EHR is often perceived as a driver of burnout. 22

23 Click Burnout to edit Master vs. Net title EHR styleexperience Score 23

24 167 organizations Over 70,000 clinical responses Same EHR questions... 24

25 Do you agree that your EHR enables you to deliver highquality care? 25

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28 28 Click to edit Master title style Where Does the Variation Come From? Improve EHR Development From the EHR Vendor? Improve Implementation & Configuration From the Provider Organization? Engage Deeper With Individual Clinicians From the Clinician Users? Copyright KLAS

29 29 Click to edit Master title style Where Does the Variation Come From? Copyright KLAS % From the EHR Vendor? 18% From the Provider Organization? 60% From the Clinician Users? 29

30 73% of organizations have two physicians of the same specialty using the same EHR One physician STRONGLY DISAGREES the EHR enables them to deliver high-quality healthcare. One physician STRONGLY AGREES the EHR enables them to deliver high-quality healthcare. 30

31 31 Click to edit Master title style You have reported high satisfaction. What do you believe you do differently from some of your peers that enables you to be highly successful with the EHR? Copyright KLAS

32 32 Click to edit Master title style KLAS Team Favorite Answer: I am smarter than they are. Copyright KLAS

33 33 Click to edit Master title style Second Favorite Answer Maybe lower expectations? Copyright KLAS

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35 Click to edit Master title style What Makes a Successful EHR User? 35

36 36 Click Initial to edit Master Training title vs. styleehr Experience Copyright KLAS

37 37 Click to Personalization edit Master title style Adoption vs. EHR Experience Copyright KLAS

38 38 Organization Trust vs. EHR Experience Click to edit Master title style Copyright KLAS

39 Case Study: OrthoVirginia Sees Huge Satisfaction Improvement 39

40 Questions Please complete an online session evaluation 40