Multidisciplinary Sprint Program Achieved Specialty-Specific EHR Optimization in 20 Clinics

OBJECTIVE  The objective of the study was to highlight and analyze the outcomes of software configuration requests received from Sprint, a comprehensive, clinic-centered electronic health record (EHR) optimization program. METHODS  A retrospective review of 1,254 Sprint workbook requests identified (1) the responsible EHR team, (2) the clinical efficiency gained from the request, and (3) the EHR intervention conducted. RESULTS  Requests were received from 407 clinicians and 538 staff over 31 weeks of Sprint. Sixty-nine percent of the requests were completed during the Sprint. Of all requests, 25% required net new build, 73% required technical investigation and/or solutions, and 2% of the requests were escalated to the vendor. The clinical specialty groups requested a higher percentage of items that earned them clinical review (16 vs. 10%) and documentation (29 vs. 23%) efficiencies compared with their primary care colleagues who requested slightly more order modifications (22 vs. 20%). Clinical efficiencies most commonly associated with workbook requests included documentation (28%), ordering (20%), in basket (17%), and clinical review (15%). Sprint user requests evaluated by ambulatory, hardware, security, and training teams comprised 80% of reported items. DISCUSSION  Sprint requests were categorized as clean-up, break-fix, workflow investigation, or new build. On-site collaboration with clinical care teams permitted consensus-building, drove vetting, and iteration of EHR build, and led to goal-driven, usable workflows and EHR products. CONCLUSION  This program evaluation demonstrates the process by which optimization can occur and the products that result when we adhere to optimization principles in health care organizations.

[1]  S. Swensen,et al.  Physician‐Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience , 2016, Journal of healthcare management / American College of Healthcare Executives.

[2]  S. Burge,et al.  A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era. , 2018, Family medicine.

[3]  Deena J. Chisolm,et al.  Moving from Good to Great in Ambulatory Electronic Health Record Implementation , 2010, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[4]  Kenneth E. Robinson,et al.  Novel electronic health record (EHR) education intervention in large healthcare organization improves quality, efficiency, time, and impact on burnout , 2018, Medicine.

[5]  Christine A. Sinsky,et al.  Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. , 2016, Mayo Clinic proceedings.

[6]  Christine A. Sinsky,et al.  Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties , 2016, Annals of Internal Medicine.

[7]  C. Chew‐Graham,et al.  Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis , 2018, JAMA internal medicine.

[8]  Joan S. Ash,et al.  Research Paper: Types of Unintended Consequences Related to Computerized Provider Order Entry , 2006, J. Am. Medical Informatics Assoc..

[9]  Dominick L. Frosch,et al.  Frontline Perspectives on Physician Burnout and Strategies to Improve Well-Being: Interviews with Physicians and Health System Leaders , 2019, Journal of General Internal Medicine.

[10]  Wei Wang,et al.  Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine. , 2017, Health affairs.

[11]  Philip J. Kroth,et al.  Physician stress and burnout: the impact of health information technology , 2018, J. Am. Medical Informatics Assoc..

[12]  Sally A. Kraft,et al.  Approaches and challenges to optimising primary care teams' electronic health record usage. , 2014, Informatics in primary care.

[13]  Rajiv Leventhal Trend: EHR optimization. Post-implementation advancements. Leaders from various healthcare organizations explain how they have been moving forward with their EHRs following implementation. , 2014, Healthcare informatics : the business magazine for information and communication systems.

[14]  Chen-Tan Lin,et al.  Optimization Sprints: Improving Clinician Satisfaction and Teamwork by Rapidly Reducing Electronic Health Record Burden , 2019, Mayo Clinic proceedings.

[15]  D. Heisey-Grove,et al.  Physician Opinions about EHR Use by EHR Experience and by Whether the Practice had optimized its EHR Use , 2016, Journal of health & medical informatics.

[16]  Usability Considerations in Oncology Electronic Medical Records. , 2017, Journal of oncology practice.

[17]  George Demiris,et al.  Understanding optimisation processes of electronic health records (EHRs) in select leading hospitals: a qualitative study , 2018, BMJ Health & Care Informatics.

[18]  Dean F. Sittig,et al.  New Unintended Adverse Consequences of Electronic Health Records , 2016, Yearbook of Medical Informatics.

[19]  D. Jackman,et al.  Implementation to Optimization: A Tailored, Data-Driven Approach to Improve Provider Efficiency and Confidence in Use of the Electronic Medical Record. , 2018, Journal of oncology practice.

[20]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[21]  T. Payne,et al.  Taming the EHR (Electronic Health Record) - There is Hope. , 2016, Journal of family medicine.

[22]  Designing An Individualized EHR Learning Plan For Providers , 2017, Appl. Clin. Inform..

[23]  Shannon M. Dean,et al.  Local Investment in Training Drives Electronic Health Record User Satisfaction , 2019, Applied Clinical Informatics.

[24]  Michael A Tutty,et al.  The complex case of EHRs: examining the factors impacting the EHR user experience , 2019, J. Am. Medical Informatics Assoc..

[25]  Christine A. Sinsky,et al.  From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider , 2014, The Annals of Family Medicine.

[26]  Spencer S Jones,et al.  Unraveling the IT productivity paradox--lessons for health care. , 2012, The New England journal of medicine.