Many people have the understandable tendency to think “innovation” means technology. They reflexively associate the word with new IT systems, new capabilities, and hoped-for benefits. This association is valid in healthcare and many other areas of life and work. But no matter how innovative or inspired technology is, meaningful innovation requires holistic thinking that considers a multitude of factors and effects.
Innovation requires you to think about how people and organizations will use and adapt to new technologies, sometimes in unexpected ways. In other words, innovation is technology-based but not just about the technology.
A current example of technology-driven innovation comes from our ongoing work in optimizing the use of certified electronic health record (EHR) systems. EHRs are used by 96 percent of acute care hospitals in the US for accessing medical records, documenting treatment, and coordinating billing. EHRs are essential to the operation of the healthcare system, especially as it shifts from fee-for-service billing to value-based reimbursements. But they impose a heavy time burden on physicians simply to access or enter EHR data. For every hour they spend with patients, doctors can spend 2 hours on the EHR, often outside of clinic hours, “contributing to work–life imbalance, dissatisfaction, high rates of attrition, and a burnout rate exceeding 50%.”
Voice recognition and other technologies can do a lot to speed and simplify routine interactions with EHRs, but technology alone can’t address the greater impacts on physician burnout and patient care. Instead, KLAS Enterprises found in a survey of more than 7,600 physicians that strong initial training, personalization, and responsiveness to needs and preferences significantly improve physician satisfaction with EHRs.
Nuance last year launched an EHR optimization pilot program to improve the effectiveness and value of current EHRs. A Nuance team, led by Dr. Bret Shillingstad and Dr. Rizwan Pasha, worked on the pilot with Brigham Health Outpatient Services’ CMIO Dr. Michael J. Healey. As part of Partners HealthCare, Brigham Health has approximately 1,500 physicians using its Epic EHR and included about 180 of them in the two-month pilot. They first reported the results of the pilot last week in a Scottsdale Institute webinar titled, “Optimizing the EHR to Prevent Burnout and Obtain Better Outcomes.”
The pilot looked at EHR usability in fine detail. It examined the specific needs of different departments and medical specialties and which tasks could be completed by physicians or by administrative staff. It counted the numbers of clicks and screens it would take a physician to access or enter required data and how templates could be used for entry of narrative data using speech recognition. The pilot showed that physician satisfaction and efficiency rose through simple changes such as:
- ensuring that EHR tasks were handled by appropriate department physicians or staff;
- consolidating multiple data screens into one and eliminating 31,000 EHR clicks each day across 20 physicians in a single gastroenterology clinic; and
- using speech recognition and personalized note templates for after-hours chart completion to save physicians 40 minutes each evening.
The pilot even determined when and in which settings EHR coaching and support sessions were preferred and most effective. That ranged from groups of nurses during regular shifts, to small groups of physicians in the same area of medicine, or to individual doctors during one-on-one “Genius Bar” type sessions. The initial results from the program at Brigham Health are very promising.
Nuance is leading healthcare technology development for EHR usability, AI, and speech recognition. We’re also using that technology to think holistically – driving innovations that create meaningful improvements in physician- and patient-centered outcomes across the care continuum.