With documentation workloads increasingly becoming a significant contributor to clinician burnout, many health systems are adopting innovative solutions to help optimize clinical workflows. However, with so many responsibilities to manage, busy clinicians cannot always find time to learn how to take full advantage of their new productivity tools—especially without the proper support.
This was the exact challenge facing Temple University Health System. Temple Health is a major Pennsylvania-based academic health system, with more than 1,550 clinicians and staff working together across five hospitals and a network of research institutions in Philadelphia to drive clinical innovation.
Like teams at many other healthcare providers, Temple Health’s clinicians were spending hours of their workday completing documentation. So, the system’s leaders implemented Dragon Medical One , Nuance’s conversational AI workflow assistant and documentation companion, and Nuance PowerMic Mobile to augment its Epic EHR. For many of its clinicians—including Ahmed Foda, MD, a cardiologist, and CMIO for Temple Health’s Ambulatory Practices—this introduced a dynamic new way of working in the EHR. But after a while, Dr. Foda noticed that some of his colleagues weren’t experiencing the full advantages of speech recognition. “What my colleagues needed was the support to learn how to use Dragon effectively,” he explained.
For a year, Dr. Foda provided training himself using his workflow as an example before establishing EPOCH—the EHR Provider Optimization, Competencies, and Happiness program. It’s a dedicated five-person team that trains clinicians to use their EHR more effectively, including DMO for dictation and step-by-step voice commands, helping even the busiest clinicians make the most of their new tools.
From 1-on-1 training to “flash mobs”
The EPOCH team delivers training for attending physicians, residents, fellows, nurse practitioners, and physician assistants in four stages, starting with basic dictation before moving on to step-by-step commands, inserting SmartPhrases, and voice navigation for Epic.
Basic dictation allows clinicians to complete post-encounter notes using their voice, which is more than three times faster than typing. And once they are confident with dictation, EPOCH then teaches them voice commands they can use to complete structured forms, insert common phrases or templates, and navigate through Epic. At advanced levels, clinicians are trained to use and design their own multi-step commands for Epic and beyond.
EPOCH delivers this training through a variety of different channels, encouraging clinicians to sign up for one-on-one training, attend group sessions with up to 15 colleagues, and access videos through its intranet. “All our sites have QR codes on posters and banners, everywhere. You can just quickly scan it and set yourself up for a session,” explained Dr. Foda. Once clinicians have signed up, EPOCH uses Dragon Medical Analytics to identify where they will benefit from support and plans the session accordingly. “No two sessions are the same,” he added.
For clinicians who don’t have time for one-on-one training or group sessions, EPOCH organizes what Dr. Foda calls “flash mobs.” Visiting clinicians’ offices in between appointments, EPOCH’s trainers can deliver a full Dragon Medical One demo in under five minutes, showing them how to dictate a script of complicated medical terminology in just 20 seconds— something that would take four minutes to type. “The clinician’s jaw usually drops to the ground,” said Dr. Foda. “Once you connect with someone and clearly show them the real-time benefits of Dragon Medical they’re sold instantly.”
A commitment to continuous improvement
So far, EPOCH has completed around 300 training sessions. More than 650 clinicians now use Dragon Medical One regularly—a 297% increase in adoption since the program was launched in 2019. With more clinicians receiving the support they need to be productive in Epic, Temple Health now saves 3,635 hours monthly and is aiming for its clinicians to reclaim at least 43,000 hours annually.
By tracking usage and productivity in Dragon Medical Analytics, Temple Health has seen the number of voice commands used increase significantly, from 5,646 in April 2020 to 30,310 in April 2022. On top of dictation, voice commands can save an extra six seconds per interaction. To maximize productivity, Temple Health’s goal is to reach 50,000 voice commands per month, saving up to 1,000 additional hours annually.
Team members are also continually offering positive feedback on Dragon Medical One. Family Medicine Physician Delana Wardlaw shared, “Dragon Medical One has changed my life. This was the first week in a long time that I was able to leave the office on Friday without any open encounters.”
And this is only the beginning of EPOCH’s journey with Dragon Medical One. Soon, the team will start delivering training in parallel with Epic onboarding to ensure every clinician is supported from day one. Temple Health has also committed to ongoing training, with refresher sessions for all clinicians six weeks after their initial onboarding, then every six months, to ensure everyone has the opportunity to grow their knowledge and dictation skillset.