Craig Joseph

The Arch Collaborative and Physician Builders

The KLAS Arch Collaborative recently generated survey data that showed a correlation between physicians who have extra training in their electronic health record (EHR) and user satisfaction. Sound like old news?

Sure, it seems obvious that if a physician knows how to utilize many of the bells and whistles in her EHR, she’ll be a happier user and a more efficient practitioner. But the Arch Collaborative data to which I refer regard physician builders and their impact on their less-tech-savvy colleagues.

To understand what a physician builder does, it helps to appreciate how most EHRs are kept working. Hospitals and health systems have Information Technology (IT) departments staffed with analysts who know how to build and maintain the system.

These IT analysts know the ins and outs of Epic, Cerner, Allscripts, and the rest. It’s complicated stuff, and as the vendors release new and updated software, it only gets more complicated.

A physician builder is a doctor who receives focused training on some of the behind-the-scenes configuration options for complicated EHRs. While such a physician doesn’t know everything there is to know, he can do common things like create and maintain documentation templates or order sets.

The physician builder might be able to configure reports or change the way data are presented in certain areas of the record.

The KLAS Arch Collaborative studied physician satisfaction data at hospitals both with and without physician builders. Guess what?! Doctors were happier users of their EHRs if physician builders were present.

More intriguing was that researchers could predict the specialties of the physician builders by examining overall physician satisfaction. If the cardiologists and endocrinologists were statistically happier EHR users, then  it’s quite likely there were cardiologists and endocrinologists among the physician builder team.

I have some thoughts on why physician builders are so effective. Is it because they’re cheap labor? Nah. In fact, a major reason that many hospitals don’t leverage physician builders is cost. <Insert your CFO’s name here> wants to understand why she should pay a doctor $X an hour, when she can pay an IT analyst a lot less to do the same work.

That argument makes sense if we’re just using docs the same way we use analysts. If we just assign a doctor a ticket to change a documentation template in a very specific way, then the argument holds water: it’s much cheaper to have people do that work who didn’t go to medical school and finish a residency and perhaps even a fellowship.

But that’s not how we should utilize physician builders.

Physician builders can read through a helpdesk ticket request and cut to the chase pretty quickly. I imagine hearing responses like this:

  • “Yeah, we’re not going to do that. Dr. Smith knows he is supposed to enter those values discretely in the navigator. He keeps trying to circumvent our workflow. I’ll speak with him and close this ticket.”
  • “Dr. Brown is asking for an order set to help her with admissions for a specific kind of pneumonia. She doesn’t really need a whole new order set. We can add a group of orders onto the existing order set that will achieve the same goal but not add all that clutter.”
  • “I just got a ticket from a neurologist to modify a report that she uses to monitor anti-epileptic drug adverse effects. She’s got a great idea to tweak the report so that it surfaces trends more obviously. I’m going to make the changes, but there are also similar cardiology and oncology reports that would benefit from this tweak. I’ll make the changes to those reports also. If the cardiologists or oncologists ask how I came up with the idea, I’ll just say I thought it up and take full credit!” 

Practicing doctors can often deal with requests more directly than analysts. Also, they can generalize requests to other physicians due to their clinical experience.

Another benefit of physician builders is that they’re just around. They tend to be where other physicians are! They hear the complaints or ideas being bandied about the surgical lounge or Medical Executive Committee meeting. They can act on good suggestions without asking physicians to submit helpdesk tickets or e-mail IT analysts. 

I’m always amazed at the goodwill that is generated by fixing little things that drive anal-retentive doctors crazy. A physician builder can easily fix that typo in the third sentence of the fourth paragraph of that documentation template that the gynecologic surgeons use all the time. It takes all of five minutes to fix, but earns you a decade of “Hey, it’s Dr. Cerner!” 

Finally, physician builders give their colleagues peace of mind. This allows the medical staff to give IT the benefit of the doubt. When new EHR functionality goes live, we used to hear “What is this crap? Where’d my button go? Why do they keep changing this?”

Yet when a thriving physician builder team is on the case, instead we often hear “We better go ask Deb what’s up with the new screen. It seems confusing, but she’ll probably show us how it’s better . . . just like last time.”

Does your health system have a physician builder program? If so, are all your specialties represented? If you can’t answer yes, you better get on that!


Want to learn more about the Arch CollaborativeEmail us!