EHR Engagement

EHR Engagement and Ownership: Keys to Clinician Success

The Arch Collaborative has shed light on exactly how much control provider organizations have over their own success with the EHR. The data says it loud and clear: EHR success is not about reducing clicks or whether the vendor has created the perfect UI; culture plays a much bigger role in physician satisfaction.

What does a healthy culture consist of? How can healthcare leaders strengthen those components in their organizations? Some organizations have tried to make a difference by optimizing the IT or informatics teams only to find that no significant changes follow.

Why is that? I believe it is because we too often overlook a crucial aspect of culture: physician ownership and engagement. A healthcare organization can place a few physicians in key roles to raise the engagement of all their fellow clinicians, thereby improving the EHR as well as their satisfaction with their jobs and technology.

Step 1: The Role

Ideally, every specialty in a healthcare organization should have a physician with some degree of “ownership” as well as extensive knowledge of the EHR.

Customize Roles to Your Organization

Every successful physician-owner program will include some key components, but one size will never fit all. While preparing to build a clinical informatics team at one organization, I did some research by asking some HIT friends if I could see their organizational charts. I learned that each health system had its own “flavor” of engagement. Each provider organization should feel free to find out, by trial and error if necessary, which roles and procedures will best meet their needs.

For example, some vendors and provider organizations are really into physician builders. This role has indeed worked wonders for many health systems. However, some organizations find it too expensive or otherwise unrealistic to have a crew of physicians spending so much time on the build process.

A number of these organizations have instead adopted a role that I like to call the “physician architect”. This person may not be involved in the actual hammers-and-nails work of building the EHR but is instead responsible for helping design clinical decision support and other solutions to support quality and process improvement endeavors.

There are other roles that may be less labor and time intensive but still ensure physician satisfaction for their specialty area.

At one organization, we had an Epic Medical Lead role. This was a 0.1 physician FTE who had robust knowledge of Epic functionality, owned the medical content for their specialty (i.e. preference lists and order sets), and could assist in the development of advanced training as well as tools to enhance provider efficiency and the quality of clinical care. These Epic Medical Leads also played a role in “advanced provider training”.

It’s important to note that the physician roles do not necessarily need to be the same across the organization—there can be some mixing and matching in different areas or specialties.

Step 2: Who to Recruit

I have learned the hard way that a physician who is recruited to such a position isn’t always fully committed to the mission behind it. For the best results, volunteers are the way to go. These people are excited about making the EHR the best it can be and helping their fellow providers use tools effectively. They should have a passion for improving the status quo and want to be part of the solution!

In addition, they should have the support and/or recommendation of their physician leader. If the division head or department chair doesn’t support them in this role, success is much less likely.

How can HIT leaders know that an employee’s enthusiasm won’t fade in the trenches? They may find it helpful to set up a few relevant steps and requirements that candidates must complete before qualifying for their new positions. After all, only candidates who really care are willing to jump through hoops.

In addition to a good process for finding and selecting the right people, these doctors also need to be given the time to do the job! Typically, this means that some percentage of their role is dedicated to informatics. In some organizations, they are compensated for the additional time spent on informatics.

Step 2: Set Expectations

While working in the ED at one of my former hospitals, the only physicians who ever submitted tickets for preference-list errors or much needed improvements were myself and one other physician who also worked in quality control.

Other physicians didn’t push for changes because no one had express ownership over improving the EHR. No expectations had been set about who could or should be taking part in improving and/or correcting the EHR content.  

Giving a physician a shiny new badge and title isn’t enough, no matter how qualified the candidate. It’s important that HIT leaders clarify what goals these physicians need to accomplish, how to accomplish them, and what victory will look like. On the other hand, micromanaging isn’t helpful.

Those in physician roles need to feel needed and need to understand that if they don’t do their jobs, nobody will. In short, these physicians must feel accountable for the success of the EHR.

Step 3: Empower the Physicians

In order to fill their new roles well, these physicians with ownership and engagement of the EHR will need education. This may come in the forms of training, coaching, and mentoring, as well as some advanced education about their EHR.

They have to understand the difference between small issues that can be fixed without much ado and bigger problems that will take outside help. They need to know the chain of command as well as your IT processes. This knowledge will imbue them with confidence.

It’s also important that these physician champions get enough tools and decision-making power to do some good. If they are trained well enough, they should be able to do quite a lot on their own. Of course, there will always be cases that require further consensus or approval from a higher power. Empowered physician owners create more empowered physicians.

A Few Will Benefit Many

Some might say, “Sure, turning a few doctors into physician builders, architects, or medical leads might get those physicians more involved with EHR improvement. But will that really get all of our physicians more engaged?” My opinion is a resounding “Yes!”

When physicians know they have a fellow physician as a resource—someone who knows the EHR, shares some of their personalization tools, shows their peers some easy wins, is connected with the IT team, and is familiar with IT processes—they feel much better about the EHR.

Even better, they’ll know that one of their fellow doctors will advocate for the changes that really matter and then help train their peers on how to apply those changes. All of the physicians will want to jump into the EHR improvement process instead of just complaining, and that will yield a better EHR and higher satisfaction.

I think the same concept is what makes the Arch Collaborative so powerful. Just as an organization’s clinicians can all be inspired to take action by a few physician champions, health systems around the world can follow the example of the Collaborative’s most successful organizations. That’s why I’m excited to continue engaging with the Arch Collaborative—a few bright spots really can light the way.