I have spent most of my career (until the recent past) focused on the field of Healthcare Information Technology (HIT), including a nearly 10-year stint working for a large healthcare provider. I recently had the opportunity to visit the campus of my former employer to take my older son to a physician’s appointment.
It’s always exciting to see your old stomping ground, but that excitement didn’t last long as my reminiscence was brought down by the paperwork! The office handed me three sheets of paper (“only fill out two-and-a-half,” I was told). On these pages I entered several pieces of redundant information, including our home address three times and his primary care physician’s name and address twice.
The experience left me thinking, “There is a better way.”
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On the heels of this visit I had the opportunity to chat with Josh Holzbauer, leader of the Physician Well-Being team at Epic. Epic is the most widely used electronic health record (EHR) in the United States and has customers all over the world. Josh and his team are focused on helping Epic users be more efficient, get more out the software and reduce clinician burnout. “My focus since I started has been on physician efficiency and happiness with our software,” Josh told me. Helping users better implement and utilize technology is a focus for us here at Trilix, too, so I was eager to chat with him about what he is seeing in the HIT landscape.
Josh told me that Epic has long had a team focused on physician efficiency but added an emphasis on “well-being” a few years back when the issue of physician burnout became more recognized.
Technology can be empowering in so many ways and can revolutionize the way people work. In medicine, this has allowed people to do more with less resources and better manage patient conditions. Of course, technology needs to be implemented in a planful way to make sure we take full advantage of it. Unfortunately, technology can lead to stress for clinicians as they are often forced to spend time in systems documenting rather than interacting with patients. The issue is aggravated by the fact that many HIT systems a designed for data entry and to capture as much information as possible. These activities are often at odds with allowing the clinician to focus on patient care.
The Progress Note
One major example of this, a topic of discussion during my conversation with Josh, is the progress note. The progress note is used by clinicians to record data on a patient’s condition and treatment and related observations. Josh pointed out some interesting ways in which the progress note is used in the United States versus other areas of the world. In many places the note is a short and straightforward. “worldwide the progress note is written to communicate the assessment and plan of care to clinicians,” Josh indicated. In the US, it is often excessively long and geared to meet the needs of various audiences.
Josh pointed out some of those audiences to me, billing (to ensure proper reimbursement), compliance (to ensure the physician is meeting regulatory requirements), and attorneys (to protect against lawsuits). Unfortunately, the US guidelines that cover progress notes were written when paper was more prevalent than electronic records, so outmoded requirements drive much of the issue.
Considering these conditions, I asked Josh how Epic addresses the issues with the voluminous progress note considering many are recorded in their systems. Epic has introduced improvements to progress notes in their systems to alleviate the “cut and paste” method that could clog the note with potentially outdated information. Their systems automatically indicate whether a physician has reviewed the patients’ medication list with a few short words, rather than the physician entering that entire list (which will soon be outdated) in the note. This is certainly a good way to partially address the issue, but there is only so much good technology can do to help outdated processes.
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But Josh counts himself as “cautiously optimistic” as the Centers for Medicare & Medicaid Services (CMS), the Federal Agency who wrote the outdated documentation rules over 20 years ago, has acknowledged the guidelines need to change. Process and culture change would certainly help!
Go to the Gemba
Of course, no one thing can help elevate healthcare here in the US, but every bit helps because it adds up. As a major player in Healthcare Information Technology with significant market share in the US, what Epic does matters. I asked Josh what they are doing to exert positive change. Josh reflected that as a rule he and his team spend a fair share of time in the field observing and learning from those who use Epic products, “I’m a firm believer in ‘go to the Gemba,’” (he said referencing the lean term).
Any Epic customer that is struggling with process and technology has access to his team. Josh spoke excitedly about his team’s interactions and experiences. He and his team relish the opportunity to connect with customers because they know how important it is to meet them where they are. These interactions not only allow the customer to take a step back, “stop the swirl” of their day-to-day, and examine their process, but it builds great relationships with Josh and his team that yields, according to josh, “honest feedback.” This in turn allows his team to provide their honest assessment for a solution for their customers, whether it be hardware, software or a process change.
It is impressive that Epic has a team focused on physician wellness; it is an indication of their willingness to embrace and understand their end users and their processes.
This is a great way to approach finding the best solution for a user group: meet with them where they are, understand their needs, wants and goals and don’t just push more technology their way. I wish I could take Josh with me to my next office visit to help me fill out patient paperwork! Good news is he let me know that Epic has solutions for the patient paperwork issue at office visits. Hopefully coming to a doctor’s office near me soon.