A medical group's organizational efforts have improved its electronic medical record's user friendliness.
At Gould Medical Group, a multipronged effort to ease the use of its electronic medical record has contributed to physician satisfaction and low burnout rates.
The physician group contracts exclusively with Sacramento, California–based Sutter Health, which features 20 acute care hospitals.
"Internally within Sutter, which has eight medical groups, we consistently have the highest or second-highest physician satisfaction score, and we have the lowest physician burnout score," says Martin Pricco, MD, MBA, president of Gould Medical Group.
Related: Beating Clinician Burnout
In recent American Medical Group Association survey data, Gould has ranked at about the 75th percentile for physician satisfaction. A decade ago, the ranking was about the 55th percentile.
In addition to enhancing the EMR for ease of use, Gould has taken several actions in recent years to boost physician satisfaction. "We did individualized rounding with physicians and board members, changed the organizational structure within the group, and added leadership talent at the department level," Pricco said.
Enhancing the electronic health record at Gould, which employs 360 clinicians, has boosted physician satisfaction and quality of care, he says. "We're pleased that we have an efficient and satisfied medical group when it comes to the EHR. It contributes to having more satisfied patients and better quality of care, and that is hard to put a price on."
Learning the ropes
Robust training is essential for physicians using an EHR, Pricco says. "Research shows that onboard training is the most important predictive factor in provider success and satisfaction when using the EHR."
Gould provides both classroom instruction and on-the-job training for the EHR. "We realize the value of initial training in our own organization. We typically provide about four hours of classroom training, then about one week of at-the-elbow support," he says.
A key point in the training is data retrieval.
"One of the biggest frustrations that we have heard over the years from physicians is that they can't find what they are looking for in the EMR, and that often happens when they are working directly with patients," Pricco says.
Individual attention
Personalization settings increase a physician's speed and efficiency using an EMR.
"Generally speaking, the less time a physician has to spend on the EHR and gets other work done, the higher the satisfaction and the lower the risk of burnout," Pricco says.
Gould, which uses Epic as its EMR, has launched several personalization setting efforts, such as:
- Documentation templates
- Text macros for shortcuts
- Chart review filters
- Customization of EMR pages such as removing unused tabs and features to reduce clutter
Specialty configuration
Specialty-specific customization in the EMR drives significant ease of use for physicians, Pricco says.
"They have the data they need to take care of their patients in their specialty. The other data throughout the EHR is still available but it isn't in the way. This really streamlines the view of a patient from a specialty perspective."
Gould rolled out specialty-specific customizations from 2015 to 2017. It used a team approach to roll out the customizations that included physicians from the specialties, EHR build specialists that included Epic representatives brought on-site, and Sutter and Gould EHR analysts, Pricco says.
The customization efforts had a structured development plan.
"Each team used an iterative process of designing, building, and testing over a three-week period before going live. After the builds went live, there was a six-week follow-up on each build to make sure everything was working properly," Pricco says.
In cardiology, Gould's customized version of the EMR includes snapshot windows such as a lab testing display with test panels, specialty-specific notes, and recent progress notes. The EMR's problem list has cardiology-related problems at the top of the list, with other specialty problems dropping lower.
In-basket management
Gould's EMR in-basket includes several tasks and messages, such as lab results, prescription refills, patient phone calls, and emails.
A cluttered in-basket can overwhelm a physician, Pricco says. "In our internal survey data, physicians who get more than 100 in-basket messages per week are at double the risk of burnout."
One method to taming a physician's in-basket is help from nurses and medical assistants, he says. "They can review the messages and oftentimes take care of them without burdening the physician. For example, on medication refills, we have an RN refill system."
Another key to in-basket efficiency is folder removal or consolidation, he says. "We look at the different folders that compose a physician's in-basket and see which ones can be eliminated altogether or combined to reduce clutter."
Gauging impact
Finance is not foremost in Gould's accounting for its EMR enhancement work, Pricco says.
"We've always viewed the benefits from the perspective of physician satisfaction, physician efficiency, and reduction in burnout. From that perspective, the initiative has been very successful—we've had good physician satisfaction scores and relatively low physician burnout," he says.
Other benefits include higher physician productivity and lower physician turnover, Pricco says. Costs are mainly in the labor category, including training and personalization staff time. In addition, redesigning in-baskets requires analyst and physician time.
Christopher Cheney is the CMO editor at HealthLeaders.