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EMR ‘happy hour’ improves efficiency, efficacy
Hour-long monthly sessions where health care professionals shared best electronic medical record practices with their peers — dubbed by the session creators as “EMR Happy Hours” — often improved physician efficacy and efficiency in maintaining those records, according to a recent report in Annals of Family Medicine.
“The challenges of EMR training are twofold: (1) even the most easily adopted EMR innovations and features must be communicated effectively to existing users, and (2) time pressures result in an inertia with regard to workflows and habits of existing users,”
Margaret A. Day, MD, MSPH , and Jeffrey L. Belden, MD, professors of family and community medicine at the University of Missouri Health System, wrote.
During EMR Happy Hour, health care professionals discuss how they reduced their documentation burden, then rearrange the EMR of the other participants. In one session, they created a Google document consisting of frequently used text expansion phrases so that the information could be copied, changed as needed and easily accessible, according to Day and Belden.
“An unexpected outcome is that all participants, clinician and EMR trainer facilitators included, learn something new during the sessions. Surveying participants, we learned they valued peer support in particular, feeling less isolated while learning alongside others who share their plight,” they wrote.
Belden explained other benefits to EMR Happy Hour in an interview with Healio Primary Care.
“We learn little time-savers together. We each can feel delighted to know that ‘I knew something even my super user peers didn’t know’ about EMR efficiency steps. One tip learned might save 20 minutes a day for the rest of a record-keeping career. We also discover issues like bugs or misconfigurations that need the information technology department to repair or we discover that the physician user has a software setting that’s not right, making life much harder. We fix those problems on the spot, in a minute or 2,” he said.
“Sometimes we have a Happy Hour agenda and sometimes we drop that agenda to meet the needs that are brought to the session. That flexibility is key, and shows we are there to meet the attendees at their level of need. All of this can help alleviate burnout systems,” Belden added.
The biggest barrier to implementing EMR Happy Hour was finding a time that suited all participants, but this was overcome by holding the session in conjunction with faculty or staff meetings, he said. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.
Perspective
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I read with interest the article in Annals of Family Medicine entitled, “EMR Happy Hour: New Approach to Electronic Medical Record Continuous Learning.” I know the team at the University of Missouri, as they have done some great work on how to better design the electronic health record. Burnout within family medicine (and medicine at large) is at epidemic levels and at the heart of the issue is the EHR. The EHR is to blame but it is not the only root cause. The EHR has been commandeered by health care administrators, health plans and the government to enforce policies that shift work to the physician, many times at the point of care. Atul Gawande, MD, MPH, touched on this in his piece in The New Yorker. To boil it down, the EHR has not been designed to help the physician care for patients but rather to automate the business of health care. Poor EHR usability is a consequence of this plus additional real technical issues in design (eg, not following user-centered design principles and not taking advantage of modern technologies). Creating a process to increase training and share tips and tricks is like using an antipyretic for a fever; it makes one feel a lot better, but it does not address the underlying cause. That is fine if the cause of the fever is self-limiting, but unfortunately the challenges with current EHRs are not self-limiting and are in fact quite life-threatening to the body of medicine. We should applaud the authors of this Annals article for their work to improve the EHR experience. It is a very tangible effort that can provide some relief to physicians. This process could be easily replicated in larger organizations that have the resources to devote to standing up such programs, but it would be more difficult for smaller sized practices.
The American Academy of Family Physicians is taking aim at addressing the underlying issues fueling poor EHR usability and at accelerating the introduction of new innovations to address the shortcomings of the current EHRs. One of the key underlying issues is administrative complexity, and the AAFP has an aggressive advocacy agenda, both within the government and with health plans, to significantly reduce the administrative burden on physicians and their practices. In October 2018, the AAFP established a new effort to optimize the family medicine experience by driving innovation into family medicine with proven technologies. We are testing emerging solutions for their efficacy and adoptability within family medicine. We are supporting new development within the arena of machine learning through our partnership with the CMS’s Innovation’s AI Health Outcomes Challenge. Lastly, we are working on improving interoperability, namely semantic interoperability, through our membership within Logica Health (formerly Health Services Platform Consortium). With true semantic interoperability, physicians would be able to switch EHRs more easily, leading to more competition, and developers would be able to create smarter health IT to support the cognitive work of clinicians. The industry must have a two-prong attack to improve EHRs: (1) establish solutions that create relief today and (2) rectify the underlying root causes.
Reference: Gawande, A. Why doctors hate their computers. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers. Accessed July 19, 2019.
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