The Value of the Arch Collaborative
As is evident in their Arch Collaborative case study, John Muir Health is an organization dedicated to improving the EMR for their physicians. With their first initial survey done in just the hospitalist group, John Muir Health was in the ninety-seventh percentile for provider engagement. We sat down with Helen Lu, FNP-BC and Medical Informaticist, and Stacy Ly, MD and a physician informaticist, to find out more about their approach.
What value do you get from participating with the Arch Collaborative?
Helen: It is important to understand how satisfied or unsatisfied our users are with the system and to let them respond to a survey that specifically asks about their EMR experience. We have done surveys here, but we have done nothing pertaining to the EMR.
Stacy: The value is in seeing how we compare to other EMRs. When I looked at the data from previous years, I felt that it wasn't comparing apples to apples; the data that we did have wasn't really that meaningful. In the past, it seemed like surveys were focused on outpatient practices. So it was nice to see where we stood with all the other organizations.
Helen: The survey focused on the hospitalist group. In 2017, only seven hospitalists responded to that survey. Going forward, we will have better representation, more survey responses, and better comparisons. Benchmarking is important to understand where we are.
What led to the decision to participate in the Arch Collaborative?
Stacy: Being a physician informaticist was a completely new role for me. It was challenging to figure out how to serve my group. But I saw a theme in the complaints that were brought to me: people didn't know who to talk to, and if they did talk to someone, the issues didn’t get fixed. The turnaround was also long. We now have a person to receive all the complaints. But at the time, I didn't have a way to gather everything in an efficient manner and to implement a solution. I didn't have a sense of the overarching problem.
One of my goals was to check in with every doctor. But whenever I asked whether I could help with anything, nobody wanted to bombard me with issues. So I decided to use the Arch Collaborative survey and just get as many people to participate as possible.
How does the informatics physician become an advocate? How do they put forward the physician concerns in a way that creates change?
Helen: We have a meeting to review items requested by the end users and discuss issues with each group. We sometimes bring in IT folks and analysts so that they can understand how the issues affect our end users. It's also great for the IT analysts and the informaticist person who is working on the issues to have one person whom they can ask questions. On the informatics and IT sides, we don't know every way that end users use the system and who is submitting tickets. We have representation for acute care, ambulatory, anesthesia, nursing, critical care, pediatrics, and the ED.
Stacy: I don't want to take credit for all the high provider engagement. It is multifactorial. My workflow as a hospitalist is very different from the other subspecialty workflows. Having a go-to person makes things much more efficient. I am much closer to the physicians than the IT people are, so I can reach out quicker and get better responses.
How would you like to continue to improve? What results do you expect to see from the upcoming survey?
Helen: I'm interested to see what the perception is, how we are doing with EMR satisfaction, and how we compare to the rest of the country. We had about 100 responses for the first survey. I think we scored pretty high because we were one of the first organizations to do the survey. Our benchmark has since dropped.
I want to make the upcoming survey inclusive of all clinician roles. I'm a nurse practitioner by trade, and I want to include the nurse practitioners and PAs because they're also clinicians; they feel what the physicians feel, especially on the ambulatory side. And I really want nursing input. I've been reading all the KLAS learnings and seeing that nurses outnumber physicians and actually use the system way more than physicians. I am looking forward to seeing their responses.
Anything else to share?
Helen: With the results, we are in the process of revamping our training and have implemented a few programs with the results. We started a revamp of our credentialed-trainer and superuser programs so that practices out of our area can actually get training from someone within their practice. We will be offering advanced Epic classes at every outpatient location with the hopes of inviting our Community Connect practices to join. The classes will also be open to clinical staff.
Even though we're still implementing, there is more focus on ongoing training. We will start to offer the advanced Epic class at least quarterly at each outpatient location. I think that will really help. Everything we're implementing is a direct response to the 2017 results. We need to implement new functionality, but there's no way of retraining people to utilize the new functionality.
Stacy: People still don't know how to use some functionalities of the EMR. So even though we are doing ongoing and advanced training, we are really going back to the basics.
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