Learn how to dramatically cut the number of clicks in the electronic health record (EHR) each day and improve efficiency of electronic administrative tasks with an intensive information technology (IT) special weapons and tactics (SWAT) effort.
In 2015, Steve Strongwater joined Atrius Health as CEO. One of his top strategic priorities was to restore “joy to the practice of medicine.” This initiative focused on improving the well-being and professional fulfillment of the clinicians and team members. One of the major drivers of dissatisfaction among clinicians was the onerous EHR, so the Atrius Health IT department was called on to make changes that would help reduce physician burnout and improve overall satisfaction.
Developing the Intervention
The IT department collaborated with internal medicine leadership and began planning a SWAT intervention. The SWAT team consisted of a cross-section of roles, including trainers as well as technical analysts. This collaboration resulted in a multi-faceted plan, which consolidated isolated efforts and combined them with a standard IT package of services and configurations. The full plan is comprised of a 5-component intervention directed at reducing clinician burnout and improving satisfaction associated with the use of the EHR.
The plan started with improving the performance of the devices that team members rely on at their workstations, such as computers and printers. IT performed an evaluation of network capacity, which standardized hardware throughout the practice to improve workstation performance across the practice.
Widescreen view deployment
Using the widescreen view setting in the EHR allows for more information to appear on a single screen, which reduces cognitive workload, time, and clicks. Prior to the SWAT intervention, only 10% of clinicians adopted the widescreen view, due in large part to the differences in monitor size between clinician offices and exam rooms. Widescreen view is optimal for the 24-inch monitor; when used on a smaller monitor, it can have a different appearance, which presented challenges as the clinicians switched between the 24-inch monitor in their office and smaller monitors in the exam rooms.
As a result, all monitors smaller than 24 inches were replaced throughout the clinics. The hardware standardization was complemented by elbow-to-elbow support and comprehensive training for each clinician.
Provider efficiency program
Atrius Health is a participant in their EHR vendor's beta provider efficiency program. This program approximates an efficiency score based on the provider's workload and system usage in relation to their peers. This assessment helps identify areas of inefficiency within the EHR and where additional support and/or training could be helpful. The assessment also provides insight into exactly how each provider utilizes the EHR. Data available in this tool includes time spent in the system (including after-hours and weekends) and areas for distribution of work amongst their team. Paired with onsite observation, this tool allowed the SWAT team to focus on areas of inefficiency with each clinician, and create individualized training plans.
A workflow assessment was completed through multiple pilot phases at separate clinical practices. The SWAT team observed significant workflow variations across the practices and worked with clinical leaders to determine where standardized processes had the potential to improve efficiency.
Electronic prescribing of controlled substances (EPCS)
Two-factor authentication enabled clinicians to e-prescribe controlled substances, which can save a significant amount of time for clinicians. This functionality eliminates the need to print the script on tamper-proof paper, thus removing the need for the patient to visit the practice to obtain the paper script. Atrius found that EPCS is a quick win for clinicians, and also considerably increases patient satisfaction. (Please refer to your state regulations, as this may not be permissible in every state.)
Clinical leadership and operation leadership engagement
Collaboration between IT team members and clinical and operational leadership allowed Atrius Health to create a morale booster and avoid relationship silos that can develop and contribute to adversarial interactions across departments. Most importantly, IT leadership considered this an IT-facilitated project, not an IT-led project, which was another significant key to the success of these interventions.
A significant key to success has been the speed at which the “IT bundle” can be deployed for a department. This bundle included installing hardware (eg, widescreen monitors), optimizing WiFi, and enabling EPCS. The use of multiple pilot locations and departments allowed the IT team to gather data from a cross-section of practices and decrease the amount of time required on site in a clinical unit. For example, there was less variation between the sites than originally anticipated, so the SWAT team was able to modify what was originally planned as a 6-week intervention to 2 weeks through lessons learned at the pilot locations. This quick turnaround allows for minimal interruption to the practice and rapid improvement of the work-life balance for clinicians and team members.
“The SWAT team was patient and receptive, and responded quickly to our requests. The widescreen helped with visits and the team learning built collegiality. This increased my joy of practice.” – Physician participant
The 5-component intervention was tested and refined through multiple pilot phases at several practices, and is now in widespread implementation across the health system.
There was significant adoption of the widescreen view. The number of clinicians using the more efficient widescreen view increased from 14% to 68%. As a result, the EHR vendor estimates that this change resulted 1500 fewer clicks per day per clinician.
Implementing EPCS through dual-factor authentication resulted in more than $100,000 in savings in tamper-proof paper across the system.
Atrius Health saw a statistically significant increase in clinician efficiency scores (from 4.3 to 4.5) from the interventions, indicating that clinicians are spending less time in the EHR and more time with their patients and on their personal lives.
“All weekend, my kids kept asking me ‘don't you have work to do?' My kids will be sending you a thank you card.” – Physician participant
To assess whether the SWAT intervention made a qualitative impact to the internal medicine department, the 3-question survey below was distributed to the participating clinicians after SWAT:
The SWAT team was beneficial to me personally.
The SWAT team was beneficial to my department.
The SWAT team experience increased my “joy” of practicing medicine at Atrius Health.
Clinicians have overwhelmingly reported positive benefits from the SWAT team implementation. 80% of the clinicians reported that it was beneficial to them personally, and 50% reported an increase in joy following these interventions.
Atrius Health, an innovative nonprofit health care leader, delivers an effective system of connected care for more than 745?000 adult and pediatric patients at 31 medical practice locations in eastern Massachusetts. Atrius Health's 715 physicians and primary care providers, along with 425 additional clinicians, work together with the home health and hospice services of our VNA Care subsidiary and in close collaboration with hospital partners, community specialists, and skilled nursing.