The Missing Link – Integrating Clinicians into EHR Governance

By Matt Cook and Jackie Sumner, Managing Consultants, Health IT Solutions

Provider burnout is a nationwide healthcare emergency as the American Medical Association (AMA) and Surgeon General warn against the devasting effects on our clinical teams and patients. Sixty-three percent (63%) of providers are reporting symptoms of burnout and many are leaving their jobs and / or medicine completely, costing healthcare organizations $4.6B annually. The configuration of the Electronic Health Record (EHR) has been attributed as a leading cause of burnout by imposing preventable, time intensive documentation tasks and lengthy chart reviews upon providers.?

Guidehouse has identified nine areas of these inefficiencies in Epic that can be remedied though proven short and long-term solutions to reduce time in the EHR and improve provider satisfaction. Consider converting burnout into best practices for your providers today!?

Buried deep and often left unidentified in a sea of EHR woes, disengagement of clinicians in organizational governance is a silent, but foundational, cause of burnout. Clerical burdens of financially driven contract models including the Medicare Access and CHIP Reauthorization Act of 2015, Meaningful Use, and ACO participation diminish autonomous judgement in clinical decision making. IT and operations-led design and roll-out of new technology overburdens clinicians with cumbersome workflows that steal genuine patient interaction and after shift hours. With twice the amount of time spent on the computer than with patients and lackluster reporting results to justify their work, purposefully embedding clinicians in strategic planning and organizational governance are essential to activating shared engagement and ownership.

“…make sure that the computer is not making policy before people know what the policy is and that people have a reasonable place to come back with feedback with something that’s not working well.” – Dr. J. M. Teich, Brigham and Women’s Hospital, Harvard University

Follow these five principles to achieve leading practice EHR Governance:

#1 - Active Participation

Beyond engaging a singular and seemingly random “clinical champion” in various areas of governance, seek to synergize medical and business expertise by including clinical representation from all locations and at various levels throughout the organization. Expand the business lens from provider-focused to clinician-focused during project planning, outcomes and key results launching, and change management to realize far greater impact. Proven successes in adopting these principles and activating equal parts clinical and administrative board representatives with a widened clinical buy-in have resulted in a 25% reduction in staff departures and top-performance provider engagement, financial performance, and patient experience at both Providence in California and BJC HealthCare of Missouri.

#2 - Change Accountability

Getting governance right starts at the top. Executive leaders should clearly communicate the organizational priorities and emphasize where attention and resources should be focused. Additionally, leaders must empower committees and participants to be decisive, while grounding their decisions in data and leading practice. Lastly, they must walk the walk by reinforcing the governance structure. If people know they can escalate around the appropriate governing body, the committee will lose influence and respect.

While effective governance requires collaboration across your organization, a strong informatics program can be the catalysts for action. With a firm understanding of clinical and technical processes, informaticists are well suited to lead your teams through change, translating technical and operational requirements, engaging the right stakeholders, and driving toward standardized, data-driven workflows.

#3 - Iterative Charter

Time is precious. Therefore, it's critical to ensure meetings are spent on high value activities. Just like a great project plan defines what is, and is NOT, in scope, clarify what will NOT be reviewed by this governance committee. For example, eliminate time spent discussing simple requests by ensuring all parties understand what qualifies as fulfillment work authorized to be completed without any additional review. This will also increase the velocity at which routine requests can be delivered.

It's important to note that not all changes are initiated by end users. Software updates from vendors can impact functionality, regulatory changes can necessitate a change, and so too can dependencies of other projects. Regardless of how a request is initiated, it should be reviewed by the appropriate governance channel.

Lastly, as milestones are achieved, this group should be able to ask and answer the question, “Did we do what we set out to do?” We live in a busy time, and all too often are guilty of moving directly from one project to the next. Fight this urge. Spending a small amount of time to properly close a project will yield huge dividends for future work and outcomes.

• Monitor KPIs from prior releases to measure success. Remediate where necessary.
• Capture lessons learned – incorporate these insights into policies and procedures and leverage in future projects.
• Celebrate and communicate successes! “When customers, clients, and patients describe how a company’s product and services make a difference, they bring a leader’s vision to life in a credible, memorable way. Employees can vividly understand the impact of their work, see how their contributions are appreciated by end users, and experience stronger concern for them.” Additionally, communicating successes throughout your organization will lend credibility to the departments involved and your governance structure as a whole.

You aren't going to nail it on you first attempt. Taking action is critical. You can make adjustments as you grow. Guidehouse’s Health IT Solutions team can partner with your organization to accelerate your maturity and drive leading practices.

#4 - Transparent Meetings

Healthcare is complex, and the EHR modules and workflows between departments are highly integrated. It's common that an end user could be impacted by decisions made, or participate in, multiple workgroups. Design for a consistent, enjoyable experience by developing a standard methodology and resources to be used across your governance structure. This includes project management methodologies, consistent timelines and release cycles, and your communication and training plans.

Don’t let those great documents sit hidden on a virtual shelf. Promote transparency and communication across your organization by leveraging a centralized site where all users can visit to understand the governance structure, identify their representatives, highlight accomplishments, access resources, and prepare for upcoming changes. Making these resources accessible for all employees will foster collaboration by engagement of frontline staff and educating them on who to speak with if they have questions or feedback.

#5 - Champion Communication

The constant influx of change requests, emails, meetings, voicemails, and documentation requirements plague IT analysts and strip away essential build time. Meanwhile, end users are burdened with months of lag time from change request to fulfillment. By the time the change is granted, many have already found a workaround.

Reconfigure this broken change management cycle by infusing real-time, effective communication strategies that benefit both clinicians and analyst within the governance structure. Replace large and generic change management sessions full of “taking it as a follow-up” tasks with more intimate settings and definitive action plans. Consider a 1:1 consultative approach to addressing technical issues by implementing observation hours – time for the technical staff to sit with the end user. This approach validates to the end user something is wrong, promotes hands-on knowledge for both parties, and encourages cross-functional empathy (Hoffman, 2023).

This article is the fifth in our “Alleviating Provider Burnout” LinkedIn series of 10. Read the first four articles here:

1.??? Overcoming Technical Inefficiencies Impacting Provider Well-being

2.??? Utilize Epic as a Step to Clinical Automation

3.??? The Last Click

4.??? Eliminating EHR Message and Alert Overload