A little over a year ago, CT Lin, CMIO at UCHealth, asked “How might we reduce physician burnout associated with the use of the electronic health record?” as part of an initiative he coined: EHR 2.0. Through collaboration with physician informatics, Epic-certified analysts, and trainers, the optimization sprint pilot was quickly out of the starting blocks. Would the experience be the 100-meter sprint or the 110-meter hurdles?
The team accelerated quickly generating ideas. They sent out surveys, evaluated provider efficiency profiles, created checklists, investigated prior optimization requests, and observed providers interacting with the system. The team included ambulatory analysts, trainers, a scrum master, nurse informaticist, and physician informaticist. They had two weeks to accomplish as much as possible through interaction in the provider’s clinic, establishing a medium for collaboration in real time.
The hurdles could be anticipated: “everything is critical!” — governance, change control, communication, capacity constraints, time, trust, and differing opinions. Next, too much work in progress could create a residue effect as the analysts bounce between ideas instead of focusing on immediate next steps towards completion. Finally, how do we identify and address assumptions, inferences, and facts?
The team leveraged agile methodologies in running the sprint to help address some of these obstacles. They used a Kanban board (Backlog, To Do, Doing, Done) as a way to visualize their work and agree to the work in progress, a Burn Up chart to show their accomplishments, and a Daily Scrum (Huddle) to discuss challenges, priorities, next steps, and context for the upcoming work.
The key to the sprint became stakeholder participation in prioritizing what was important to them and assisting with trade-offs. Instead of ideas having a static prioritization of critical, they float relative to other ideas. There was also simultaneous exploration of the problem and solution domains as the immersion provided immediate feedback loops. The focus quickly shifted from linear/more is better to high value deliverables.
The team was thinking through doing, as expressed best by the Chinese proverb,
“What I hear, I forget; what I see, I remember; what I do, I understand.” – Confucius
Early results across the finish line demonstrate high impact to Epic flow sheets, SmartLinks, note templates, In Basket efficiency, Synopsis, and Med Rec along with positive net promotor scores.
The experience was neither a 100-meter sprint nor a 110-meter hurdle; it was a Tough Mudder!
The fastest way to the finish line was to lower hurdles through collaboration, and provide performance enhancing features that minimized mundane clerical activities, streamlined charting time, and stimulated the cognitive clinical art of practicing medicine.
Originally published as a guest post on CT Lin’s blog, this piece was written by Brian Redig, Director of IT and Project Portfolio Management at University of Colorado Health. Redig, a Lean Six Sigma Black Belt and Board Certified Nuclear Pharmacist, provides his thoughts on EHR 2.0 Sprint, an initiative launched last year.