Engaging clinicians requires smarter tech

September 13, 2019
By Dianne Fowler

Nurses, physicians and other clinicians have more insight available today about their patients than ever before. Whether it is in a clinical data analytics application, a payer portal or a health information exchange, information that could help patients achieve a better outcome is likely stored somewhere in some database.

Imagine their frustration knowing that this information exists, but then having to leave their electronic health record (EHR) and go searching for it in those different electronic silos. Worse yet, after several minutes of searching and scanning documentation, they do not find any relevant information and eventually abandon the search due to the tremendous time and productivity pressures they are under at most organizations. Meanwhile, their patient at the point of care is growing concerned and irritated that the physician is spending so much time clicking and staring at a screen.

Surfacing meaningful data at the point of care
This frustration is part of the reason why, in 2018, physicians ranked “electronic health record (EHR) design and interoperability” as the least satisfying aspect of practicing medicine, and why they feel like they are at-capacity or overextended.

Overcoming this lack of clinician engagement in health information technology (IT) software is so crucial that the rating organization KLAS ranked it one of the six verticals, or core functionalities, that population health IT platforms must have so provider organizations can effectively manage risk. This was based on a KLAS finding that only 8% of population health organizations are satisfied with their clinical engagement from an IT perspective.

Fortunately, contextually aware technology exists today that provider organizations or vendors can add to existing technology that does not force them to rip and replace systems. Rather, the technology serves as a bridge between the EHR and other software so that information is automatically surfaced within providers’ current workflow, without leaving their EHR and without the need for time-consuming and expensive point-to-point interfaces.

Engaging clinicians requires automation and relevance
The recent health IT interoperability standard proposed by the Centers for Medicare and Medicaid Services (CMS) is certainly a step in the right direction in improving provider access to siloed patient data. However, while the proposed rule confronts the key interoperability issue of efficiently sharing information between organizations, it does not address the much more important issue of delivering relevant data to providers within their workflow. This could result in providers being even more inundated with an abundance of irrelevant information that does nothing to help them make higher quality, safer patient care decisions.

Interoperability’s goal should not be to simply generate more data to slow down providers. A much better objective is to surface only meaningful information within providers’ workflow at the point of care. KLAS recognizes this essential piece of the population health management puzzle for its Provider Population Health IT Framework, contending that software that elicits clinician engagement must demonstrate the following basic qualities:
• Supports single sign-on integration
• Integration/ability for a care provider working in the population health tool to efficiently take action in the electronic medical record (EMR)
• Integration/presentation of care gaps to providers within the provider (EMR) workflow.
• Ability to integrate with multiple EMR platforms
• Ability to track clinician usage and activity

The first, second and third bullets about viewing information and taking action within the EMR workflow without multiple sign-ons would be major improvements for most healthcare organizations today. Too often, providers are required to jostle between multiple applications and portals to find meaningful information. If an organization is able to deliver patient-specific analytics data to providers at the point of care it is often superfluous and/or irrelevant. Nonetheless, the documentation still requires precious time to scan so providers can make that determination.

That is likely why, in its Framework criteria, KLAS recommends advanced functionality for clinician engagement to include “timely integration of population health tool data and alerts to be displayed within the EMR workflow and stored within the EMR” and “presentation of care gaps to providers within the provider workflow with the ability to act within the provider workflow.”

Contextually aware technology that enables this ability to view meaningful information and act within the EHR workflow is being used today in our health system. Although it has only been used a short time, clinicians have already stated that they would never want to return to practicing medicine without this capability.

Contextual awareness eliminates burden
The platform our providers use to view meaningful clinical insights at the point of care is not creating or analyzing data; we already have several other systems that perform those functions. Rather, the software gathers predefined information from our numerous EHR systems, clinical data analytics platforms, and payer portals, and then surfaces at the point of care as soon as the provider opens a chart. These data points, for example, could include care gaps associated with one of our organization’s value-based care payment programs.

Our providers do not need to tell the platform which patient is being treated because the software’s sensor technology is contextually aware, so it automatically identifies the patient when their electronic chart is opened and surfaces only the desired information in an unobtrusive ribbon next to the EHR window. The software is also aware of which provider is looking at a patient’s chart, where they are (in a primary care office, specialists’ practice, etc.) and surfaces information for that specific provider at that location, even based on the workflow within their EHR.

Of course, the software does not read our providers’ minds. Our health system’s leadership collaborated with providers beforehand to determine which pieces of information they would want to see at the point of care, which can be customized as needed. Such a data-metric selection process would need to be undertaken by any organization wanting to implement the solution.

Although we are conducting formal timesaving studies now, early estimates show that providers are saving at least five minutes per patient thanks to eliminating repetitive searching, typing and clicking, which yields hours saved every week. What’s just as important, clinicians are having a vastly improved experience and becoming more engaged with the EHR and other IT systems all thanks to this electronic bridge that connects them to the important data points they care about in less time and with less effort, which eliminates their burden and helps deliver better outcomes for patients.

About the author: Dianne Fowler, BSBM, RN is a practicing clinician and administrator at Arizona Center for Internal Medicine located in Mesa, Arizona.