Not all doctors hate entering EHR data
In November 2023, Healthcare IT news had a success story centered on Phoenix Children’s own data warehouse and apps. But there’s more to the story, says Dr. Vinay Vaidya, the health system’s chief medical information officer.
Vaidya says the key to the organization’s successful development of dashboards and apps was at the front end of the process. Before he and his team could deliver impressive results through the dashboard and apps, he first had to convince clinical staff that if they took the time to enter the necessary data into the electronic health record—a process that most physicians typically consider considering a process cumbersome and a waste of time – his team would deliver valuable results that would have a positive impact on their patients.
As a follow-up to the previous profile story, we interviewed Vaidya on the topic of physicians’ changing perceptions of data entry and motivating them to fully participate – a major hurdle that many healthcare organizations are still trying to overcome in vain.
Q. EHRs are typically seen as a burden on physicians because they contribute to premature burnout and cynicism. What is your opinion on this important issue?
A. EHRs are often seen as an additional burden on healthcare providers, with very little direct benefit to them or their patients. Very often, EHRs are attributed as a major reason for physician burnout.
Such a narrow, one-sided view can easily cause hospitals, healthcare systems, and providers to lose sight of the real reasons for switching from archaic, paper-based charts to EHR documentation and the enormous potential these systems offer to improve patient outcomes.
However, the “potential value” of EHRs does not magically translate into realizing actual clinical benefits. Transforming this untapped potential into meaningful impact on patient outcomes requires a carefully designed strategy with active involvement from healthcare IT leadership, as well as clinical leadership and primary care physicians working together.
Because we have actively engaged and implemented such an approach at Phoenix Children’s, both our physicians and administrators are now reaping value from EHR data. We have moved beyond the endless cycles of “EPR optimization” that yield minimal results. Instead, we focus on documenting only the most essential data elements in the EHR that can provide valuable insights, helping our providers identify gaps in care and optimize patient care.
When used effectively, EHRs transcend their reputation as a necessary evil and become a robust electronic foundation for coordinating care, stratifying patient risk, and managing patient populations holistically rather than individually.
Q. You say that your physician colleagues do not feel burdened by your EHR. They feel empowered. Why such a big difference in what most doctors feel?
A. Like many healthcare organizations, we experienced growing pains during the early stages of our EHR implementation more than a decade ago. There is little doubt or discussion about the fact that EHR documentation usually requires more time and effort. Doing the right thing often involves extra effort, whether it’s eating healthy or choosing to take the stairs.
But to keep doing the right thing, you need to get positive feedback in the form of tangible results that justify the extra effort – and using EHR is no different. Expecting providers to put in extra effort without a meaningful clinical return on their investment is a losing proposition.
From the beginning, our goal has been to not only meet but exceed basic operational needs by making the EHR a tool that significantly improves clinical decision making.
About seven years ago, we committed to a focused effort to realize the full promise of the EHR. This meant not only collecting data, but also ensuring that it was clinically meaningful, easily accessible and optimally organized to support excellent healthcare.
During this time, we launched more than 50 clinical dashboards that provided real-time, actionable data to primary care physicians and care coordinators. This approach transformed our EHR system from a perceived burden to a powerful asset for our medical staff. When healthcare providers see clear, tangible benefits from the tools they use, such as improved patient outcomes and streamlined processes, the value of investing in additional effort becomes apparent.
Therefore, there may be a difference in attitude towards the EPD within our organization compared to that of others stem from our proactive attitude towards continuously improving the relevance and usability of the system, leaving our suppliers feeling empowered rather than burdened.
Q. Please share a great example of physicians at Phoenix Children’s asking for specific, tailored insights about their patient populations and how the team delivered those insights, even if more data had to be entered.
A. Our team has begun treating chronic diseases with juvenile idiopathic arthritis. Working closely with the doctors, I embedded myself in their weekly planning prior to the visit to understand where we could inject ourselves to improve their insights and results.
Previously they had already entered their data in the EHR, but their information was not easily accessible and it was not looked across the patient population for insights into gaps in care, serious versus non-serious diagnoses, or how well we were controlling arthritis by provider location and throughout the system.
We started extracting data into simple reports, which was more efficient than going through the EHR patient by patient. We then added visualization tools with our data that launched our first dashboards.
This was in 2017, and since then we’ve built more than 50 of these dashboards across the enterprise and expanded the program so that we use these dashboards for almost every aspect of the organization, from operations to clinical care.
Q. Please share another example to prove your data entry point.
A. More recently, we helped solve a complex problem to improve outcomes for premature babies by involving not only Phoenix Children’s physicians, but also physicians who work at many other hospitals and clinics in our service area.
All premature infants who spend time in the NICU undergo screening for retinopathy of prematurity (ROP), including one to three examinations at one- to three-week intervals, as most complications of ROP do not occur until up to four weeks after birth.
There is a small window of danger and an equally small window of opportunity. This screening helps determine if the baby needs additional treatment to prevent scarring, stretching, and even retinal detachment that can lead to blindness.
Historically, physicians would bring paper screening documentation to the ophthalmology nurse, who would be responsible for processing those notes and updating a manual process to track which patients needed screenings and when.
We created a dashboard to eliminate that manual process and the possibility of a missed screening through alerts and an automated email sent to neonatologists indicating which patients meet the criteria for screening, when to screen for each patient are planned and the number of days since they were last examined.
Because this is available to neonatologists at Phoenix Children’s and other hospitals, data is analyzed not only from our EHR, but also from eight others.
We launched this in October 2023 and it was well received by our physicians as they approached us again with the issue and trusted us to develop a more efficient process that would improve care.
This solution is a win-win because it reduces potential missed screenings and saves physicians time. We have achieved results in every respect, and we notice that doctors are now increasingly approaching us with the big idea instead of the other way around.
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