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Is Your EHR Contributing to Physician Burnout?

Posted on September 28, 2016 I Written By

The following is a guest blog post by Sara Plampin, Senior Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Sara Plampin - The Breakaway Group
It’s finally come, the day you’ve been working toward for years – Go Live. Thousands (or even millions) of dollars, hundreds of hours planning and calculating and going back to the drawing board, and it’s about to pay off. You sit back and take a breath, proudly watching as your organization takes its first steps into the future.

And then the complaints start to trickle in. The Electronic Health Record (EHR) feels clunky, it doesn’t match current workflows, documentation takes too long, and the physicians refuse to use it.

Frustrations over EHR functionality and increased documentation time are a leading cause of burnout among medical workers. Physician practices, in particular, are showing a decrease in EHR use over time. Physicians say hefty documentation requirements take away valuable face-to-face time with patients, making them feel more like scribes than doctors.

The issue has led to physician groups reviving the ‘Quadruple Aim’ movement, in which physician wellness is more emphasized.


While many are quick to attribute this dissatisfaction to the EHR itself, it is more likely the result of a poor implementation plan that focused more on technological requirements and less on long-term adoption needs. There are three ways to ensure the needs of physicians and clinical staff are met and you have a successful EHR adoption.

Involve Clinical Staff from the Get-Go
One of the biggest mistakes you can make is failing to include clinical staff in the initial decision-making process. Before choosing an EHR vendor, assemble a team of representatives from all areas of your organization – not just physicians and nurses. Ancillary departments such as therapy, radiology, and pharmacy are often overlooked when it comes to EHR design and training. Each representative will be aware of the specific needs and workflows for their department; they can compile requests from their colleagues and help research different vendor options to determine which EHR is the ideal match for your organization.

Once the EHR is selected, clinical staff members become an integral part of the design team. Although vendor representatives can help identify best practice workflows, ultimately your employees are the experts on how the EHR will be used in their department. HIMSS physicians cited five factors that contribute to EHR usability issues: navigation, data entry, structured documentation, interoperability, and clinical decision support. Involving clinicians in the design and testing phases allows them to identify solutions to some of these common issues, making the EHR more intuitive for future users.

Including members from all areas of the organization not only ensures better EHR selection and design – it also improves morale. When staff feel like their voices are heard, the project becomes a joint initiative rather than a regulation from upper management. Representatives from the design team act as a go-between, communicating their peers’ requests to executives, while in turn reinforcing the importance of the transition and garnering excitement for go live and beyond.

Realistic, Time-Effective Training
Once the EHR design is solid, the next step is to make sure all staff are properly trained and comfortable using the application. While this may seem obvious, training is another area where many organizations fall short. It is not just the amount of training that matters, but also the type and timing of training. Full-day classroom training sessions can be ineffective for adult learners. Additionally, planning training days around complicated shift schedules is difficult, as is finding replacement staff. This is particularly an issue at small physician practices, where physicians may have to sacrifice patient time in order to complete training.

A more modern, time-effective approach to training is online simulation. Learning is chunked into modules based on small tasks users may complete throughout their day. Thus, learning can be spread over days or weeks, whenever the physician has a free moment. Simulations allow learners to practice using the EHR, giving them the chance to fail without repercussions and develop muscle memory for daily tasks. By go live, using the EHR should feel like second nature.

A lot of the frustrations users feel about navigation and documentation requirements result from their unfamiliarity with the application. When they receive the right training, they will feel confident using the EHR, thus reducing documentation time and increasing face-to-face time with patients.

Constant Feedback/Reevaluation
As with all large-scale projects, even the best laid plans are bound to hit a snag or two. If you’ve established a solid communication channel with all department representatives, you will be prepared to handle any complaints that come your way after go live. It is important that all staff have a clear path to communicate problems and suggestions, and that they are comfortable doing so. The best way to avoid dissatisfaction among your employees is to hear their complaints and proactively fix these issues.

If you’ve already implemented an EHR and are now dealing with the types of complaints outlined above, this is the place for you to start. Create testing and measurement procedures to determine how users are currently using the EHR, where they are getting stuck and where their actions deviate from prescribed workflows. Then, work with each department to determine where EHR functionality can be tweaked, workflows redesigned or a combination of both. Effective adoption requires a constant cycle of communication, design, training, evaluation, and redesign.

If you want to make sure your employees are happy with the EHR and physicians avoid burnout, go live is just the beginning.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

The New Healthcare Consumer – Engaging Patients through Technology – Breakaway Thinking

Posted on February 17, 2016 I Written By

The following is a guest blog post by Sara Plampin, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Sara Plampin - The Breakaway Group
When you get sick, where is the first place you turn for help? In today’s technology-driven world, most people look up their symptoms online before they even consider contacting their doctor. In fact, Pew Research has shown that almost 75 percent of patients use the internet as their first resource for questions about their health. And why not? Online, there’s no need to schedule appointments or spend time in the waiting room – the answers are available instantly.

As the healthcare industry becomes increasingly consumer-driven, technology is one of the critical factors patients consider when choosing a provider. You can use many different tools to increase patient engagement, including patient portals, mobile apps, wearable devices, and social media. Because healthcare consumers are actively involved in all of these areas, a savvy organization will use several different means to engage new and existing patients.

Patient portals and mobile apps
One of the most important things to consider when adopting new engagement technology is your patients’ needs and expectations. Simply setting up a mobile app or patient portal is not enough if it does not provide the information or functionality that the patient is seeking. A recent survey suggests most hospital mobile apps fail because they do not address patients’ top three desires: electronic prescription refills, appointment scheduling, and access to their medical record. Successful apps appeal to consumers because they give patients and their families more control over their health. For instance, if patients have access to their medical record through a patient portal or EHR app, they can make sure the information is up to date and inform the provider of any mistakes. Families of elderly patients can use apps to check up on their relative’s health and communicate with their caregivers. These technologies will become a deciding factor for patients seeking a new provider.

Health and fitness trackers
Health and fitness trackers are another great tool to increase patient engagement. While providers recognize the benefits of increased physical activity, they tend to have mixed feelings about the amount and quality of data these devices collect. However, wearables can be a valuable engagement tool simply for their ability to get patients actively thinking about their health. Calorie trackers and step counters are useful tools for patient education, helping patients learn to improve their health by making small changes in their daily routines. There are also trackers to help patients manage chronic conditions such as heart disease or diabetes. These apps can help ease the burden of health management by providing reminders and suggestions to patients, while allowing providers to keep track of their patients’ health remotely.

Social media
Consumers increasingly expect their favorite brands to have an online presence where they can share their feedback, ask questions, and learn more about the company. Healthcare should embrace social media as a tool to connect with and educate their community. Providers can use it to remind patients of the importance of sticking to their medication schedule or publish videos explaining common procedures and treatments. If patients see an organization as a relatable and trustworthy source of information, they are more likely to approach them with health questions and concerns. Social media gives your organization the opportunity to communicate directly with patients and help them discover the appropriate channels for their feedback.

Unfortunately, sometimes EHRs and other technology can actually become a barrier to patient engagement. A study conducted by JAMA Internal Medicine showed that patients are less satisfied with their care when providers use computers during the patient visit. Providers and clinicians must find a way to harmonize patient care and computer documentation. One of the best ways to do this, as suggested by Dr. Melissa Lucarelli at Medical Economics, is to “address the elephant in the room” by showing the patient the EHR. Instead of a wall dividing provider and patient, the computer can become a link between them, facilitating valuable conversations and empowering the patient to take charge of their health. Most of all, patients will feel more trusting of their provider, who made them a partner in their care.

No matter what methods your organization chooses to increase patient engagement, HIMSS recommends that all changes go through the analysis-implementation-optimization model. It’s not enough to simply set up a patient portal; you need to analyze your organization’s and patients’ needs, implement the application accordingly, review how it is being used, and make improvements. Make sure both staff and patients receive the proper education they need to get value out of the new system. As with all technology, new patient engagement tools require time, effort, and careful planning to achieve adoption.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

The Education Game: Engaging HIT Learners for Successful Adoption – Breakaway Thinking

Posted on October 14, 2015 I Written By

The following is a guest blog post by Sara Plampin, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Sara Plampin - The Breakaway Group
Your hospital is transitioning to a new EHR, and you are responsible for organizing training. To accommodate your staff’s busy schedules, you arrange several interdepartmental classroom sessions. However, after providers complete training, they tell you that they still do not feel ready to use the new application. They complain that much of the instruction was not relevant to their role, and their time would’ve been better spent caring for their patients.

It’s a common dilemma in healthcare – how can you make EHR education effective and engaging? E-learning is one alternative to traditional classroom training. However, for e-learning to be successful, it must do more than simply transfer classroom materials to an online format; it must utilize the technology in new and innovative ways to make learning more engaging. One of the most effective e-learning techniques is simulation. Clinicians frequently use simulations to practice new techniques on “patients” without putting real people at risk. The same principle can be applied to EHR applications; simulations mirror the live application, allowing providers to enter orders and document patient data just as they would with live patients. This interactive, hands-on learning method has been shown to improve clinicians’ proficiency while simultaneously reducing the amount of time spent in training.

To increase learner engagement, many simulations employ the concept of gamification. Gamification is the incorporation of game principles into traditional learning and e-learning methods. Not to be confused with game-based learning (the use of actual games to teach concepts), gamification identifies the elements of games that make them so compelling – including rewards, goals, and progress tracking – and integrates them into simulations to grab learners’ attention and keep them engaged.

Reward is one of the most common elements of games. Extrinsic rewards such as leaderboards, badges, trophies, and prizes can trigger a learner’s sense of competition and provide motivation to complete their learning. These elements can easily be incorporated into simulations for a game-like experience, encouraging friendly competition among providers or between departments. However, critics of gamification complain that competition and badges aren’t enough to improve learning outcomes. Studies have shown that intrinsic motivation is more effective for learning than extrinsic rewards alone. Intrinsic rewards are the positive feelings associated with playing a game. After all, you don’t just play for the prize; you play for fun. In addition to providing entertainment, games can improve self-confidence as users overcome mental and physical challenges. Learners who enjoy their education are more likely to return to it, reinforcing their knowledge of application workflows and best practices.

For healthcare professionals, one of the biggest intrinsic motivators is the patient’s wellbeing. Simulations satisfy providers’ natural care instincts by incorporating another common game element – the story. Stories transform abstract concepts into concrete goals that directly relate to the learner’s job. For instance, instead of lecturing a clinician about every allergy function in the application, a gamified course might present the following scenario:

While recovering from orthopedic surgery, patient Ashley Jones has a mild allergic reaction to her morphine. You need to add morphine to her allergies and communicate this to the rest of Ashley’s care team.

Adding a human element allows learners to connect with the subject matter on a more personal level. The course is no longer just a module they have to complete – it is a realistic scenario that they might encounter every day. According to an eLearning Industry article, “successful learning is a combination of three elements: 70% from real-life and on-the-job experiences, tasks, and problem solving; 20% from feedback and from observing and working with peers and role models; [and] 10% from formal training.” Story-centric simulations allow us to transform the 10 percent into the 70 percent, making learning more effective by mimicking real-life situations and problem solving. By focusing on tasks and goals, simulations also reduce the amount of time clinicians spend learning about extraneous features and workflows that do not relate to their job roles.

Simulation also makes it easier to measure learners’ proficiency. Classrooms often rely on paper tests to evaluate the success of training. While these types of tests are useful for assessing a learner’s understanding of workflow and policies, they do not evaluate whether the learner can actually use the application. Organizations may not notice issues until weeks after go live, when clinicians start using workarounds to complete tasks they didn’t fully understand in class. On the other hand, simulations can track clinicians’ progress throughout the course of learning, enabling organizations to identify common issues and trends before go live. Progress tracking also serves as a motivational tool for learners. New tasks, badges, and leaderboard rankings provide instant positive feedback; the more successful the learner feels, the more motivated they will be to complete their training. Negative feedback can be motivating as well. When learners feel a goal is clear and attainable, they are more likely to repeat the task until they get it right.

The healthcare industry is constantly innovating, and its education methods should follow suit. Research from companies like The Breakaway Group has shown that simulation and gamification have the power to revolutionize healthcare education, increase proficiency in EHR applications and other technology, and save time. Better education means that providers can adopt technology quickly and get back to what they do best – caring for patients.

It’s time to move on from traditional training methods and embrace technology to improve learning. Consider your own EHR training. How could you incorporate simulation and gamification principles to improve adoption?

Xerox is a sponsor of the Breakaway Thinking series of blog posts.