Clinician Rounding

Building IT-Clinician Relationships through Effective Rounding

Continual updates, ineffective governance, and a lack of ongoing support leave too many physicians feeling powerless to improve their satisfaction with the EHR. The truth is that there are many ways for provider organizations to improve the EHR experience. Attendees of the 2019 Arch Collaborative Summit gathered to discuss some of those methods.

One key to creating an effective culture is by cementing relationships between the IT and clinician sides of the facility. Every clinician should have a trusted friend who can offer understanding, a listening ear, and help in optimizing the EHR.

With this in mind, KLAS arranged a breakout session at the Summit about clinician rounding. Expert panelists included H.C. Eschenroeder Jr. of OrthoVirginia; Corey Joekel, CMIO of Children’s Hospital; David Kaelber, CMIO of MetroHealth System; and Paul Testa, CMIO of NYU Langone Health.

Connecting the Right People                                              

According to our panelists, the first step to helping EHR users at one’s organization may be deciding which people need to be put in the same room. One of Testa’s methods of relaying the right information to those who need help is to get his crew on the agendas of the service chief meetings. “I told the service chiefs, ‘The moment we have nothing valuable to say at your meetings, we need to worry about our jobs.’”

Joekel likes to make connections himself with the end users of the EMR. “I go to a lot of meetings with people and spend time in the physician lounge, which is an incredible place to find out what’s going on in the hospital.”

Peer-to-peer interactions are also highly valuable. MetroHealth Systems’ informatics team has 100 members, many of whom are physicians. “The hope is that everyone knows a member of the informatics team; that personal touch is key for two-way information flow,” Kaelber said. We also hired two expert trainers that we call provider liaisons. They meet with about 200 providers per year. The time a provider spends in the EMR can drop by as much as one-third after one of these meetings.”

Building Trust

Many of Kaelber’s providers ask him about previously submitted tickets while he is on rounds; he suggested to attendees of the breakout session that transparency helps his clinicians learn to trust his team. “The big comment I got from providers is, ‘When we submit a ticket, it goes into a black hole.’ It helps them to hear us say, ‘You have a great idea, but we’re not going to do it right now.’ Then at least the providers know that they’ve been heard, and we can circle back later.”

One audience member said that many physicians whose requests don’t get worked on tend to wonder what the IT department is working on. “Do some marketing and let people know what your priorities are,” the audience member suggested. “Get the word out about positive changes in the works.”

Simply making an effort to assist providers can be a helpful start to a relationship. “The fact that I try to round gives me credibility,” said Eschenroeder. “If people don’t want to talk to me at the moment, they’re more likely to talk to me later.” Joekel agreed, noting that “even an elevator conversation can be impactful to an end user.”

OrthoVirginia has also introduced a more intense effort to get their providers help right when they need it. “Doctors are so busy chopping wood that they feel they can’t stop to sharpen their axes,” Eschenroeder said. “Whenever someone gets stuck, they hit a Help button, which sends a screenshot directly to an analyst. That has won the hearts and minds of our doctors.”

Rounding with a Purpose

One attendee of the breakout session asked the panelists, “We do a lot of crisis management at our organization. How much time do you spend rounding without a specific purpose?”

“We never round without a purpose,” Kaelber responded. “The value of purposeless rounding is low. We entertain any questions during our rounds, but the main purpose of our rounds is always something like telling people about a new function. Our trainers are booked only about 50% of the time; the rest of the time is used for rounding.”

Eschenroeder described a similar approach. “I go on rounds with members of our Physician Support Services group. They know people, and they use rounds to introduce new tools, measure adoption, and so on. Keeping track of adoption metrics helps us get to know our teachers and students. We know which doctors pick up on things quickly.”

Testa’s method (which he dubbed “opportunistic rounding”) can solve several problems in one fell swoop. “I bring an analyst or someone like that with me,” Testa said. “I can kill a few projects that aren’t good ideas when I meet with a department chair in an opportunistic-rounding setting.” He suggested that providers who tend to submit unrealistic requests often benefit from going on rounds. “They go from saying, ‘I told you ____ was wrong’ to saying, ‘Oh—that change would hurt the ICU. Let’s take another look.’”

Worth the Effort

While the panelists had various rounding techniques and no one-size-fits-all answers, the results of their work speak to the value of connecting to EHR end users on a regular basis. To learn more from other leading providers, check out KLAS’ posts about additional breakout sessions of the Arch Collaborative Summit or join the Arch Collaborative yourself.




     Photo cred: Shutterstock, wavebreakmedia