“We Need to Get Better”: How CIOs Are Working to Extract More Value from EHRs

When it comes to investments, it doesn’t get much bigger than the EHR. Beyond the costs relating to hardware, training, and consulting fees — which often exceed the original budget, there’s the emotional toll on clinical and IT teams.

The challenge for leaders is that the education piece never really ends. In an ideal world, interfaces would be so intuitive that retraining would be unnecessary, and updates would be sent automatically, said Lee Milligan, CIO at Asante Health System. But in reality, “we’re not there.”

Instead, organizations like Asante spend more than $3 million per year to ensure systems like Epic are being used as effectively as possible. “It’s the last mile of getting everything you need from your investment,” he said during a recent panel discussion, which also featured Donna Roach (CIO, University of Utah Health) and Ryan Seratt (Director of Training and Development, 314e). “I’ve jokingly told my team that they’re really the ‘full value extraction’ team.”

Although Milligan’s comments were intended to be tongue-in-cheek, it’s more critical than ever for healthcare organizations to continuously optimize systems and educate users — and it has to be done right. During the webinar, the panelists discussed the biggest hurdles in reaching that goal, and shared insights on how they’re working to overcome them.

The barriers

Not surprisingly, at the top of the list is time — or, more accurately — lack thereof, according to Milligan. “Pulling people out of their clinical scenario is always a dog fight, and operations folks don’t always understand the value of the training.” And even if physicians, nurses, and others are able to carve out time, it’s hard to determine whether they’ve ingested the material, said Roach. “That’s one of the things we struggle with. We need to get better at that.”

For CIOs, one of the most frustrating situations is to watch clinicians grapple with the very solutions that are intended to make their jobs easier. “You can see that they’re trying to make it work, but this is not what we wanted.”

The solutions

And so, Roach — whose experience includes organizations of varying size and scope — and Milligan, who spent years as an ER physician, consider it a priority to make the training process as smooth and beneficial as possible. Below are some of their suggestions:

• Speak the language. A common misstep with vendors, noted Milligan, is devoting too much time to showcasing new features. “Docs and nurses don’t care,” he said. “They want to understand within their workflow what is going to change and how they can navigate that change.” As a result, when training plans are released, “we adapt them specifically to the workflow of the individual. For us, that has made a big difference.”
• Make it personal. At Utah, there are more than 3 dozen FTEs devoted to training, through virtual and in-person classrooms, phone support, and other methods. “We have a lot of different ways in which we do outreach,” said Roach. “It’s not one-size-fits-all.” Seratt concurred, adding that using different modalities to reach people “is definitely one of the keys to success.”
• Stay close. Another key is making sure training doesn’t end in the classroom, according to Roach. “We’re not perfect; people fall through the cracks, and so having at-the-elbow support at go-live is critical.” Having informaticist teams on the floor can also help leaders gauge whether frontline workers are “using suggested workflows or new tools in the way they’re designed,” said Seratt. “Just because there’s a new feature, it doesn’t mean it’s being applied the way analysts built it.” On the other hand, having coaches say, ‘if you click on this, it will bring up these screens,’ can help build knowledge and confidence, he noted.
• Use dashboards. In addition to assigning physician and nursing informatics teams to floor duty, Utah also leverages a learning dashboard to guide users. “We try to approach it in a multi-tier way so that we can capture people during, before the upgrade goes in or before there’s significant changes in the system.”
• Communicate regularly. Another common gaffe, noted Roach, is failure to keep users in the loop. “Communication prior to an upgrade or change is really important. You want your physician and clinician population to know what’s happening.” Doing so can help improve engagement, she has found. On a similar note, Milligan suggested that instead of demanding more time from physicians’ packed calendars, a useful approach is to incorporate training into previously scheduled meetings.
• Don’t be afraid to customize. Although Epic customers are encouraged to stick to a quarterly schedule for updates, it’s not always the best approach, according to Milligan, whose team does two updates per year. “We try to strike a balance. We want people to have access to new features, but without upsetting the apple cart. We feel that’s reasonable.” Otherwise, teams can feel like they’re constantly doing upgrades, which leaves less time for other critical initiatives.
• Round, round, round. “I do a lot of rounding with my CMIO. I’m always astonished when I get out there and I hear how they’re using the system,” said Roach. Milligan, also a proponent of rounding, took it a step further by developing a template that can be used to share findings with executive leaders. This way, “They can clearly see what clinic was visited, what provider was interacted with, what complaint they may or may not have had and what the plan of action is associated with that.”

He believes it’s the most effective way for leaders to understand the pain points that exist within EHR systems. “When you have executives out there willing to spend time in the trenches with folks who are doing the work, you’ll gain credibility and you’ll gain insights.”

It can also spread the word to others who may be reluctant to seek assistance, said Milligan. He recalled a story in which a physician finally asked for help after admitting she had been struggling with Epic’s Notes function. By assigning a trainer to sit with her and review her processes, Asante was able to shave off a significant chunk of time, freeing her up to spend more time with patients. “It’s a nice example of how great training can impact the organization.”

Identifying those who are struggling is paramount, according to Roach, who recommended leveraging tools like Epic’s Signal to monitor how physicians compare with their peers in terms of usage and satisfaction. “It’s really key to make sure you’re monitoring that,” and especially keeping an eye on the “quiet ones,” she added. “They’re the ones who are getting burned out. We need to make sure we’re reaching out to them.”

The most difficult aspect is realizing that the system — and the way in which it’s used — is never going to be perfect. Or even close to perfect, for that matter. “Doctors and nurses are always trying to find something,” said Milligan. Instead, “they should be thinking about what to do with the information they have; what it means clinically and how they should act on it.”

Roach agreed, adding leaders should set their sights even higher. “We have to give clinicians the tools to support them, and that includes educating patients and their families so that they’re part of the caregiver team,” she said. “That’s where we want to go.”

To view the archive of this webinar — Strategies for Keeping Clinicians Trained Up on Key Apps (Sponsored by 314e) — please click here.