Transformational Principles for EMR Deployment

Packing representatives from 50 health systems, 9 vendors and firms, CHIME, the Scottsdale Institute, and the ONC into a single room is bound to lead to learning experiences. At least, that’s what KLAS thought when we hosted the Arch Collaborative Summit in May.

After a day of breakout sessions and a “science fair” of organizations sharing their best practices related to the EMR, we finished with a closing keynote from Mark R. Neaman of NorthShore University Health System. It was an inspiring end to a fascinating day.

NorthShore’s results in the Arch Collaborative survey clearly mark the health system as one that has achieved EMR success. The organization fell in the 85^th percentile for provider EMR satisfaction, the 99^th percentile for nurse EMR satisfaction, the 99^th percentile for nurse efficiency, and the 98^th percentile for their EMR being easy to learn. Naturally, other provider organizations want the recipe to NorthShore’s secret to success. Neaman obliged the Summit attendees with at least a peek.

Basic Principles

First, Neaman outlined several foundations of the NorthShore culture that has helped them achieve such high satisfaction with their EMR:

• Top-down leadership with bottom-up tactics is most effective.
• Improving the EMR is not a project; it is a way of life, and everyone should be all in.
• Initiatives must be hardwired into workflows.
• The EMR must produce measurable value in terms of finances, quality, and ease of use.

Neaman then told the Summit attendees about three specific NorthShore missions born of the culture they worked hard to establish. These included the “Home for Dinner” initiative, efforts toward increasing Medicare Annual Wellness Visits, and the creation of their Clinical Analytics Prediction Engine (CAPE).

Home for Dinner

In order to combat physician burnout, improve employees’ work-life balance, and increase happiness in their organization, NorthShore began searching for ways in which to increase efficiency—and thereby the hours that employees could spend with their families. First, NorthShore identified how much EMR training each physician had received. Some of them had received quite a bit, and others almost none. From there, trainers (all with clinical backgrounds) began offering training personalized to each physician’s needs.

In addition to some details about smart sets and an EMR-based efficiency tool, Neaman also referenced efforts not directly related to the EMR. The NorthShore leadership determined that they could increase their physicians’ efficiency by decreasing the amount of time spent reading emails and entering unnecessary information. First, they eliminated all nonessential information from their physicians’ inboxes. Then they eliminated the requirement for physicians to enter their passwords for ordering non-opiate prescriptions. The combination of these and other efforts led to an average efficiency improvement of 5%-10% per physician!

Medicare Annual Wellness Visits

Despite their touted importance, the national average for Medicare Annual Wellness Visits (AWVs) completed each year is only 15%. At NorthShore, however, the percentage has increased to a full 30%. This improvement is the result of both technology- and people-focused efforts made by NorthShore.

First, NorthShore dealt with the overwhelming number of needed data elements for AWV payments. They automated 22 of these data elements, greatly increasing efficiency and reducing the internal efforts required for AWVs. NorthShore also intensified their patient outreach efforts, and their work paid off—literally. The organization almost doubled the number of AWVs completed per year and more than tripled their revenue for these visits.

Clinical Analytics Prediction Engine (CAPE)

NorthShore understood the fact that they needed to focus on intervening quickly for 10% of hospital patients: those with high risk for in-hospital mortality, post-hospital mortality, and/or readmission. But the leadership also knew that this was easier said than done. Their employees struggled with predictive-modeling fatigue. Bombarded by information, physicians were not sure how to prioritize their patients or tasks.

The leaders at NorthShore decided to put their predictive-modeling engines into a system and transform them across four domains: mortality, morbidity, utilization, and engagement. In the newly created CAPE, interventions were assigned based on segments and tasks were prioritized by urgency. This led to a decrease in “noise” and fewer interventions. Instead of screens full of various “High risk!” warnings, physicians now get specific checklists like the one pictured below:

Clearly, NorthShore’s recipe for success involves more than a short list of ingredients. The organization had to put years of work into various areas and make many adjustments along the way. And yet, accomplishments like NorthShore’s inspire hope. If there was one message that stood out most at the Arch Collaborative Summit, it was that by personalizing the principles that have brought others success, any dedicated health system can make significant improvements. If you’re ready to learn more about best practices and some specific tactics of other health systems, join the Arch Collaborative today.