CHIME23: Tips for Reducing Tech Stress on Support Clinicians

Rethinking Approaches to Technology for Clinicians

The EHR can be a pain point for many clinicians, beginning with the initial training. Dr. CT Lin, chief medical information officer at UCHealth in Colorado and a 2023 HealthTech IT influencer, said that clinicians at his organization previously had to sit through hours of classroom training.

“We had 20 to 30 learners at a time, and everyone was at a different pace. No one was happy with the pace of training,” said Lin. He added that he was not surprised that the EHR was only being used at 15 to 20 percent of its capacity. “Classroom training had been a disaster even though it was a required element,” he said.

The situation led leaders at UCHealth to rethink the classroom experience and deconstruct training.

“We took eight hours of content and blew it apart,” Lin said. “Now we do self-paced learning.”

The training process begins with a half-hour setup period with a coach to ensure that the clinician can navigate the basics of the program. That is followed by one to three hours of self-paced EHR simulation training, an hour and a half of advanced specialty customization with a coach, and up to two hours of self-paced “pothole training,” when a clinician spends more time on areas in which they feel less confident.

“The clinicians don’t have to sit through eight hours. They can skip what they know and review what they don’t.,” said Lin, who added that clinicians said that they preferred self-paced learning and reported feeling more prepared to use the EHR.

To complete the training, UCHealth has added “road signs” to the EHR to provide quick refreshers and just-in-time knowledge training as clinicians use the system.

EXPLORE: Four ways to improve mobile device management and reduce clinician burnout.

IT and Clinician Collaboration Is Key to Successful Tech Implementation

At the Guthrie Clinic, senior vice president and chief digital officer Terri Couts said her team got excited about implementing MyChart Bedside and purchased iPad devices for every bed. However, no one was using the devices.

“There wasn’t a single activation,” she said. “So, we had to go to the floor.”

Her team discovered that the iPad devices were plugged in at the end of the beds because that is where power plugs are located. The patients had no idea the devices were available, and the nurses didn’t know how to navigate the situation. Couts said that because her team didn’t involve and educate nurses about the technology or ask the users questions, the implementation failed.

“It didn’t matter how awesome the technology was,” she said.

The organization learned the importance of listening.

“When hired at Guthrie, our new CIO said clinicians were leaving and saying it was because of Epic. We listened to the why,” Couts said, adding that clinicians felt like IT was giving them too much instruction without hearing clinicians’ input or explaining why certain choices were made. Clinicians reported they felt unsupported by IT.

In response, Guthrie implemented concierge rounding with trainers. They listed to pain points and provided education on the spot. “We kept building on that,” said Couts, who explained that that her team could analyze data to see where clinicians were struggling with the EHR and determine how to help them.

“We built relationships so that clinicians had a person to connect with,” she said. “They had a voice and were seen as a person. That was the biggest win. We personalized this for them. Trainers went out and helped them save clicks and time in their days.”

For Couts, a major takeaway is that it’s important that trainers and the IT team are embedded in the organization’s mission. She noted that being seen as a barrier is a very different work experience than being seen as an enabler and part of a solution.

DISCOVER: Focusing on integrated clinical automation platforms can mitigate nurse burnout.

Tips for Improving Experiences in the Electronic Health Record

In another session, Lin gave an overview of eight ways healthcare organizations can reduce “pajama time” for clinicians through a “wholesale reimagining of interactions with patients and each other.”

Pajama time, or time off the clock that clinicians spend on documentation in the EHR and responding to messages, can take up a significant amount of a nurse or physician’s time and lead to burnout. Lin said that during the pandemic, UCHealth saw a 350 percent increase in MyChart messages, which resulted in increased pajama time.

Here are eight ways UCHealth addressed this ongoing challenge:

1. Choose a grand gesture. Lin emphasized the importance of getting teams excited about EHR work by creating a vision. UCHealth set a SMART goal to “reduce the burden of messages by 90 percent by focusing on today’s work today and keeping it simple, fostering high performing teams and outstanding patient care.”
2. Expire In Basket messages. Some of the messages in UCHealth’s EHR system (Epic) dated back to the 2011 program launch. One user had 18,000 messages, and over 400 users had more than 5,000 messages. Lin said there was no chance they could even make a dent. “It’s no wonder people open it and close it,” he said. The organization’s solution was to delete all messages older than six months. UCHealth deleted 12 million messages. Going forward, all messages will be deleted once they are older than three months. “We’ve had zero complaints in the two years since,” said Lin. He pointed out that records will be stored in the EHR itself, and that clinicians can save messages.
3. DC (discontinue) the CC. According to Lin, a typical primary care provider at UCHealth receives up to 16 automated CC emails a day. The organization implemented the auto-CC in order to improve communication between specialists and primary care physicians, but it resulted in an enormous increase in message volume. The organization decided to discontinue the auto-CC, resulting in 100,000 fewer messages per month.
4. An Rx for prescriptions. Lin said that the organization changed its prescribing defaults to 90-day prescriptions with four refills for noncontrolled prescriptions. Doing so reduces the number of balances an organization holds on one prescription. For controlled substances, the organization eliminated the password requirement, enabling the clinician to access the site with their already approved two-factor authentication, reducing the number of passwords typed per year by 7 million, Lin said.
5. Patient self-service for the win-win. Automating follow-up scheduling saves the organization time and improves the patient experience, Lin said, making it a win-win situation. Since automating the process, 39 percent of all primary care appointments at UCHealth are self-scheduled, 12 percent of specialty care appointments are self-scheduled and 40 percent of radiology appointments (mostly mammography) are self-scheduled.
6. Message appointments. There are billing codes for asynchronous e-visits of more than five minutes. Many patients are reluctant to use asynchronous e-visits because they are worried about being nickel and dimed, Lin said. The organization set up an internal e-visit tool that gives relative value unit credit for appointments but doesn’t bill the patient’s insurance. This way, patients don’t need to make full appointments for issues that can be handled asynchronously.
7. PAM chatbot. UCHealth has implemented a patient advice message chatbot that answers patient questions using generative AI. The tool requires ongoing training but saves clinicians time. Lin said that the organization is transparent about its use. The tool is now being used in three of the organization’s clinics.
8. Desktop medicine time. The organization implemented a new tactic to give physicians more autonomy: One appointment slot per half-day session is defined as asynchronous In Basket work but can be converted to a video or in-person visit if the physician wants to have a quick follow-up with a patient. This reduces patient wait times for appointments and reduces pajama time, improving physician retention.

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