Better Together: Optimizing Solutions for Documentation Transformation Efforts

Program Goals

• Reduce clinician burnout related to documentation inefficiencies.

Organization Outcomes

• Physicians using 3M™ M*Modal Fluency Direct at Baylor Scott & White Health have a Net EHR Experience Score (NEES) of 53.6, which is 7.3 points higher than the score of nonusers.
• Physicians using 3M™ M*Modal Fluency Direct at Baylor Scott & White Health report 14 percentage points higher agreement than nonusers that the electronic health record (EHR) enables quality care.

Collaborative-Verified Best Practices

• Clinician Wellness and Reducing Burnout
• Recognized Improvement

Keys to Success

• Involving the provider voice by getting input on changes and training around those changes.

What Baylor Scott & White and 3M Did

Baylor Scott & White Health initiated a medical group transformation project in 2022 to review all aspects of their organization and find ways to increase operational efficiencies on all levels. During the organization’s presentation at the KLAS Arch Collaborative Summit in 2023, Baylor Scott & White Health focused on one of the initiatives from the larger mission—to lower documentation burden among their providers. Baylor Scott & White Health has measured three times with the Arch Collaborative using the EHR experience survey since 2018, and they have seen continual improvement throughout the measurement period.

Based on data captured from Epic, the average note length of Baylor Scott & White Health’s providers has more than tripled since 2009. Due to accumulating regulatory changes and clinicians who have grown accustomed to their existing ways of documenting, notes have continued to increase in length over time, which has caused patients to be confused in their reviews of the notes. Baylor Scott & White Health used two different approaches to reduce their providers’ documentation burden: re-ordering Assessment, Plan, Subjective, Objective (APSO) notes and increasing and optimizing their use of 3M™ M*Modal Fluency Direct. They got the idea of the APSO note approach from a UW Health webinar, where it was explained how UW Health initiated a project with their clinicians to flip the sequence of their note sections. This enabled UW Health’s physicians and patients to see the most crucial pieces of information at the top rather than having to scroll to the end of the notes to get to that information. After seeing what UW Health had done, the Baylor Scott & White Health team created an initiative to tackle note bloat (extraneous information commonly placed in notes that includes information contained elsewhere in the patient record) and utilized their results from the Arch Collaborative EHR experience survey to further expand the project.

Note Bloat Initiative

The primary goal of the note bloat initiative was to help providers to learn new documentation skills by acquiring more proficiency with the tools already available to them and to achieve higher performance standards. From the beginning, the team for the note bloat initiative involved representatives from across the organization, including individuals from the coding, compliance, and regulatory departments to ensure that any changes made wouldn’t negatively impact those downstream areas. The team designated 10–12 provider champions who represented each region of Baylor Scott & White Health and who helped develop the new note structure to pilot with primary care providers. The champions served as vocal cheerleaders for the project within their regions. The provider champions also helped gather user feedback so they could enhance the notes throughout the pilot period. During phase one of the project, Baylor Scott & White Health’s regional medical director led many town halls, delivering information and training on the use of this new APSO note type and soliciting from the 100 primary care providers piloting the project any feedback to further refine the process. One major cultural challenge the Baylor Scott & White Health team confronted as they sought to reduce the provider documentation burden was helping providers understand which pieces of information were no longer needed within each note; many aspects of their notes were already captured elsewhere in the EHR .

As Baylor Scott & White Health piloted the APSO note initiative with primary care providers, they embedded a link in the EHR to track who was using the APSO notes and how the note structure was impacting their time spent documenting in the EHR. The pilot group of primary care providers was not mandated to use the APSO notes, but there were over 98,000 uses of the new APSO notes in primary care as of August 2023 . The organization is in the process of developing tracking tools that are inclusive to specialist uses of the APSO notes, so those numbers have not yet been reported.

Prior to the APSO note initiative, Baylor Scott & White Health was in the 75th percentile of Epic users for note length; after the initiative, the organization is now below Epic’s average for note length. Baylor Scott & White Health has noted the following phase-one outcomes :

• 8 fewer minutes of pajama time per day per provider.
• 21% shorter progress notes on average for participating providers.
• 7% reduction in time in notes per note per provider.
• 34 fewer seconds spent in notes per provider per appointment.
• 2 fewer minutes spent in notes per provider per day (those who did not adopt the APSO notes into their workflows saw an increase of 4.5 minutes spent in notes per provider per day on average).
• 166.6 estimated minutes saved writing notes per provider per month.
• 16,327 estimated total provider minutes saved per month.
• 272.1 estimated total provider hours saved per month.

Increasing use of 3M™ M*Modal Fluency Direct

Baylor Scott & White Health recognized that a new note type alone wouldn’t achieve the desired results for end-user satisfaction or accomplish the mission to reduce the provider documentation burden. To this end, the organization collaborated with 3M to train their clinicians more deeply on how to optimally utilize 3M™ M*Modal Fluency Direct, a front-end speech recognition solution that was already available to their clinicians.

3M Fluency Direct was embedded within Baylor Scott & White Health’s EHR system, but too few providers were using it . 3M sent an in-house solution advisor whose sole role was to augment the adoption of 3M Fluency Direct and work closely with Baylor Scott & White Health’s Epic Efficiency Program (EEP) team members, a team of analyst trainers who work on EHR proficiency and efficiency skills with providers. 3M’s solution advisor and Baylor Scott & White Health’s EEP trainers conducted scheduled sessions with providers to assess their current workflows and to teach them how to best utilize 3M Fluency Direct. Baylor Scott & White Health’s EEP trainers consist of a team of seven employees designated to improve the work lives of providers at their health system by leveraging best-practice uses of Epic’s products. Interfacing with EEP leaders enabled 3M to scale education and training to optimize the use of technology across an organization of Baylor Scott & White Health’s size. This level of engagement was critical to the success of the 3M solution advisor charged with driving better adoption, EHR experiences, and clinician satisfaction.

When the 3M solution advisor reviewed Baylor Scott & White Health’s data after the advisor’s visit and training sessions, Baylor Scott & White Health saw a significant increase in 3M Fluency Direct users and an increase in the volume of minutes per month of use. The 3M solution advisor credited the one-on-one sessions and word-of-mouth promotion as the reasons for higher adoption and usage of 3M Fluency Direct. KLAS’ Arch Collaborative conducted an analysis of providers using 3M Fluency Direct and of those not using it in Baylor Scott & White Health’s 2023 EHR experience survey. Those using 3M Fluency Direct achieved a higher overall NEES and reported decreased after-hours charting. The group leveraging 3M’s speech understanding solution also agreed more often (than those not using the 3M technology) that the EHR enabled the delivery of quality patient care.

3M has a well-defined path to incrementally delivering artificial intelligence–powered, innovative solutions with an eye for responsible change management, starting with real-time speech understanding to proactive computer-assisted physician documentation (CAPD) and conversational virtual assistant and ambient clinical documentation. With Baylor Scott & White Health, 3M accomplished the following key project deliverables:

1. Redesigned governance of the deployment and optimization of 3M Fluency Direct, namely through engaging with EEP leaders.
2. Deployed a prescriptive technology package.
3. Planned the 3M Fluency Direct adoption expansion, strategic onboarding, and a scale-up plan alongside the EEP team’s educational efforts.
4. Applied 3M Fluency Direct efficiencies to efforts around medical group documentation transformation.

Physician endorsement of 3M Fluency Direct 

One physician specifically enthused by their use of 3M Fluency Direct created a video of them completing a Medicare annual wellness note within 60 seconds using natural speech, demonstrating to their peers what could be achieved with 3M Fluency Direct. In the short video, the physician explained how they completed visit notes using Epic smart tools with 3M Fluency Direct and finished their notes within the same day of the visit. The physician covered four achievements through their process:

1. Increased use of Epic smart tools to become more efficient with documentation.
2. No violations of the “OHIO Principle” ( “only handle it once”), because the more a physician goes in and out of office visits without completing documentation, the longer it will take them to get it all done.
3. Noticeable improvement in patient satisfaction since the physician was on time more often with their appointments.
4. Increased personal EHR satisfaction by completing charts during the same day the visit occurred.

During the video, the physician walked viewers through a real visit where the physician had pre-charted things and then, while in the room, completed their wrap-up documentation, decided on the correct billing codes, and placed information in the after-visit summary. The physician accomplished everything conversationally using 3M Fluency Direct. This enthused physician encouraged other interested providers to reach out to the right people at Baylor Scott & White Health to better understand what efficiencies are possible to improve their own documentation. Such endorsements by organizational and clinical leaders can help meaningfully drive interest among clinicians in the use of new and existing informatics solutions.