Continuously improving physicians’ EHR efficiency
Ambulatory Healthcare Services (AHS), a SEHA HealthSystem facility, was formed to facilitate and furnish a unique combination of the diagnostic and treatment services of a hospital with the personalized care that a healthcare center offers. The organization manages the following community-based services across the Emirate of Abu Dhabi: ambulatory care centers, disease prevention and screening centers, school health services and mobile health clinics.
Through the 38 ambulatory care centers, AHS provides easily accessible medical and dental services to about two million patients every year, enabling SEHA hospitals to focus on their core expertise of tertiary care management. Patients in remote areas are particularly appreciative, as AHS facilities are widespread throughout the emirate’s Middle and Eastern Regions where full-scale hospitals can be several hours away.
The ten disease prevention and screening centers are specialized units offering communicable disease screening and prevention services across the Emirate of Abu Dhabi, while school health services are responsible for providing a comprehensive and coordinated school health program for all public school students. In 2012, AHS was the first organization of its kind in the world to be accredited by Joint Commission International.
For an organization that serves around 160,000 patients per month, resource management and efficiency of operations are certainly top priorities. Maintaining workflows in the EHR that are as efficient as possible not only saves physicians’ time and efforts, but most importantly ensures that appointment times are dedicated as much as possible to attend and communicate empathetically with patients to improve the quality of the service. Hence, improving physicians’ efficiency in the EHR is an ongoing process that requires fully dedicated resources, solid plans and flawless execution.
Established organizational structure and programs for continuous improvement
Ambulatory Healthcare Services has established an effective organizational structure to support the continuous improvement process, covering more than 40 ambulatory healthcare facilities across the Emirate of Abu Dhabi. With a fully dedicated health informatics team for each region within the emirate, continuous improvement plans are designed to drive forward the corporate-level goals and imperatives on an annual basis. In order to be able to cover the vast number of facilities within each region, two or more super-users are assigned per facility to ensure full, on-the-ground guidance and support for the end-users.
Robust training and communication programs are implemented to drive the continuous improvement plans. Such plans start with building solid skills base for end-users through a comprehensive three-day onboarding training program that covers basic and advanced EHR skills, and Revenue Cycle-related skills.
Only upon the successful completion of the program will an end-user be granted access to the system and gain the privilege to start seeing patients in the facility. From there, end-users have direct access to on-site super-users for at elbow support, guidance, troubleshooting, and driving adoption and efficiency within the EHR. Additionally, on an annual basis, sessions are conducted as refresh training and for communication of new updates and changes to the system and/or workflows.
Since a significant responsibility of driving the plan lies on the shoulders of the super-users, the regional health informatics teams have established open communication and support channels for them to deploy the responsibilities and roles at the utmost proficiency. An active instant messaging channel is open between the health informatics teams and the super-user community for ongoing knowledge transfer and for immediate troubleshooting. Furthermore, on a biweekly - or maximum monthly - basis, online sessions are held for the super-user community for open discussions, sharing any newly-introduced changes to the system, and, most importantly, to drive the continuous improvement plan forward. The outcomes of all these communication channels cascade regularly to the end-users at each facility.
Continuously improving physicians’ EHR efficiency
Utilizing the structures and programs in place, the ongoing drive for efficiency improvements is a relentless pursuit at Ambulatory Healthcare Services. The most efficient workflows within the system are continuously encouraged, monitored, fed back upon and celebrated throughout the organization. For example, by the end of June 2017, 70.7 percent of all physician documentation sessions were conducted using pre-completed notes, and 36.2 percent of all new order sessions were initiated from personal favorites.
In order to gauge the collective impact of such ongoing efforts, AHS’s Cerner Lights On Network® and Advance datasets from Q2 2016 and Q2 2017 were analyzed for statistical significance using Wilcoxon Rank-Sum Test. For a total of 684 physicians that were active during both periods in AHS’s EHR, the median total time in the EHR per patient seen was 10 minutes and 56 seconds for the first period, while during the second period it was found to be 10 minutes and 4 seconds. The difference was found to be highly significant (p value < 0.001). Such gained efficiency equates to more than 2,300 hours per year that are potentially spent interacting directly with patients rather than interacting with the EHR. The below table depicts the percentage improvement of these EHR activities between Q2 2016 and Q2 2017.