Improving EHR Efficiency Through Individualized Optimization Sessions

It has been more than 15 years since the Health Information Technology for Economic and Clinical Health (HITECH) Act ushered in a new era of electronic health records (EHRs), yet many health systems are still grappling with how to most effectively implement them. EHRs were intended to improve care coordination, safety, and efficiency. But they've also caused substantial administrative burden that significantly contributes to burnout among primary care physicians.¹

Much of physicians' EHR-related burden is due to systemic problems that require systemic solutions — such as those pro­posed by the American Medical Informatics Association's 25x5 initiative, which aims to slash documentation burden to 25% of its current level within five years.² But some EHR burden is due to insufficient training, which is easier to address. Few health systems provide ongoing EHR training for physicians after onboarding, even though EHRs are dynamic systems that are periodically updated to provide additional functionality and stay compliant with federal and state regulations.³ Given the potential for EHR-induced burnout, it is especially important for practices to develop a system for individualized training to improve physician well-being.⁴ Think of it as CME for the EHR.

Our organization piloted a training program that used individual EHR metrics (e.g., “pajama time,” chart closure time, and note length) to enhance clinicians' understanding of EHRs, minimize their individual pain points, and teach the use of new documentation tools that have the potential to increase efficiency and reduce burnout.

First, informaticists in our family medicine department worked alongside the department's director of well-being to determine the set of standard EHR competencies for each session. These included things such as using department-specific templates for notes or orders common in primary care. We then recruited volunteer participants from academic outpatient practices with 3–10 years of EHR experience across several clinical sites. Prior to each session, we shared participants' individual EHR data with them and asked them to identify their EHR pain points. We had our informaticists tailor advice to those points and add it to the individual sessions alongside the department-standard competencies we wanted everyone to develop.

During each two-hour training session, an informaticist first briefly observed the participant interacting with the EHR during routine patient care. Then, they led the participant through the series of predefined EHR competencies and suggested mitigation strategies for the pre-identified pain points (see Table 1 for details). Lastly, they introduced the participant to an ambient dictation program powered by artificial intelligence (AI) and showed them how to integrate it into clinical practice. In the months following these optimization sessions, we contacted participants to provide feedback and assess whether they implemented the teaching points.