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Optimizing and Using the EHR in Oakland, CA: A Case Study

The implementation of the Electronic Health Record (EHR) forever altered the dynamics between patients and physicians.

Simply put, the relationship was no longer a binary doctor-patient relationship but a triangle: a doctor-patient-systems relationship, with the EHR becoming a cumbersome third wheel compared to the more elegant, but ineffective, piece of charting paper.

Kaiser Permanente, Southern California Permanente Medical Group (SCPMG), is at the leading edge of the EHR wave and is distinguished as having among the best systems. But, to an individual practitioner, the strain was showing up in service surveys that showed this new system rated among the highest, if not the highest, stressor on the physician's practice. This stress conflicts not only with the quadruple aim but also with SCPMG's goal of systematically and intentionally creating a culture of wellness.

In short, doctors were having relationship problems with this system, known internally as KP HealthConnect, and the relationship was impacting the physician/patient relationship as well as the providers' wellness, and joy.

As a result, Dr. Ed Ellison, the CEO, and Dr. Todd Sachs, the COO, sponsored a group of expert physicians, trainers, and support staff to create a program called Kaiser Permanente HealthConnect Essentials (KP HCE), a course designed to maximize the effectiveness of our greatest resource: the physician. The elements were to address the following, with a focus on restoring time back to the physicians:

  • Give physicians the skills necessary to achieve efficiencies at each and every system interaction with a realization of up to an hour of time back per day.

  • Break/Prevent silos of expertise, allowing best practices to easily spread across specialties and across centers by incorporation into the regional Essentials program.

  • Improve the quality, efficiency, readability, and clinical accuracy of documentation.

  • Send a clear message that the organization supports their physicians and their wellness.

In the design process, the new KPHC Essentials team decided that the following foundational issues would need to be addressed at each step:

  • Utilizing only peer-based training. This is, after all, relationship training, and physicians are more likely to retain information taught by people they know or trust.

  • Providing protected time, away from the clinic schedule to either learn skills for new physicians or break maladaptive imprints from legacy users of the system.

  • Having passionate, expert peer-level champions who are a resource at every step

  • Making available a real-time question/response tool

  • Distributing follow-up surveys to get feedback from participants


In just 3 years, 4068 physicians have completed KP HealthConnect Essentials, and the program has been expanded to include Advanced Practice Providers (PAs, NPs, Midwives), in large part due to a survey of the first 1690 physicians who attended the Adult Primary Care, Medical Specialties, and Pediatric Essentials since the program began. When asked the following questions, responses have been outstanding:

The training I received today has equipped me with critical skills that I can use in my daily operations.98.9% Agreed
Today was a productive use of my time.99% Agreed
Do you think your documentation will improve by what you have learned here?97% Agreed

The results are remarkable and seem to be sustaining as the program matures with exit surveys of participants giving similar reviews. In addition to the positive responses above, 81.5% of the physicians feel that they will save 4-5 minutes per hour in new efficiencies after the Essentials course, which equates to 32 - 40 minutes in an 8 hour day. Assuming a 5 day/40 hour workweek = 160 - 200 minutes per week. In 52 weeks, this represents 138 - 173 hours, or almost 3.5 – 4.3 weeks, per year in time saved.

While the survey responses and time-savings calculations may not be representative of the whole tale, the stories, anecdotes, and letters from the physicians tell the complete story. The following are a sampling of unedited feedback responses from anonymous physicians who completed an Essentials course:

“I had already cashed out my retirement funds. After only two days of Essentials, I now feel like I have another 10 years work left in me!”

“This course is a true action to improve our lives and reduce physician burnout. Letting us get through our day earlier due to the automation and efficiency taught in this course allows us to go home on time and actually use the gym, and do the things that we have not been doing when we get burned out. So thank you so much to those whom make this course possible. Might be a life saver for one or two of us.”

“I think physicians should come every 2-3 years because just like the art of learning medicine, there is an art of learning the computer. This will help save burn out. Thank you so very much!”

“Today was really great. I really was dreading coming to this conference but have really learned so much. Time passes so quickly.”

“Well organized with a high spirited teaching staff. As a Wellness Champion, I really liked the little extra touches like yoga, healthy food and stretching with our ergonomics staff.”

“I have been at Kaiser now for 6 years and feel I was the type of person who was already documenting pretty well in HC. I was also very efficient and able to close all my charts prior to leaving work. For these reasons, I have been reluctant to attend this course, but decided to give it a try. I have felt these last 3 days have been “essential” to my daily practice and so happy I attended. I liked every part of the course.”

“SCPMG spends a lot of money on physician wellness and trying to prevent physician burnout. Of all the programs they have, I think this is the most effective. Being efficient in the office reduces stress on the provider, creates a positive atmosphere and ultimately makes for happier patients. Every provider should experience this.”

“The faculty staff was AMAZING. The information and time to work on the taught material was invaluable BUT the course content, format and faculty made it even more invaluable. I cannot express how much this is needed- especially in a time we need to work more efficiently and prevent burn out.”

“This course was significantly better than I anticipated. I did not think that I would find it interesting or all that useful--I did it because my colleagues endorsed it. I was wrong, they did a great job keeping it interesting and I think it will help me deliver better care going forward. Thank you for supporting it.”

These types of sentiments are shared by the majority of physicians who provide feedback, with over 99% of the physician participants saying that they would recommend the course to a colleague, which is a primary reason the program continues to have wait lists to attend. If a physician's clinic colleagues recommends the course and suggests to “just go”, many do. And 99% are glad they did.

As a result, leadership continues to endorse this organizational intervention in the form of systems-based relationship therapy and believes that this program is a vital component in their physicians' journey towards wellness.

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