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NCH Healthcare System

NCH Healthcare System decreases physician time in EHR by more than four minutes per patient

In late 2015, Naples Community Hospital (NCH) Healthcare System leaders were unsatisfied with the amount of time their physicians needed to chart patient information within the electronic health record (EHR).

Leaders at the former Cerner ITWorks client in Naples, Florida — which includes an alliance of more than 700 independent physicians and dozens of medical facilities throughout southwest Florida — wanted to cut back on review and chart time.

NCH thus began an 18-month assessment and strategic implementation for a voice-recognition technology called Dragon Medical One and Cerner’s Dynamic Documentation™ solution. NCH leaders also took several steps to improve the charting experience and gradually implement adoption at clinics associated with the health system.

Through this work, from October 2015 to April 2017, the organization saved more than four minutes per patient through improved governance, standardization and coaching.

“Four and a half minutes per patient adds up,” said David Linz, MD, chief medical informatics officer. “That’s two date nights, 30 extra bedtime stories, four soccer games, eight workouts, four pool parties and a graduation ceremony.”

Several months before the transition from PowerNote™ to Dynamic Documentation began in October 2015, providers averaged 16 minutes and 27 seconds of charting per patient in the EHR. As of April 2017, providers were only charting 12 minutes and one second per patient — freeing time they can use on direct patient care or out of the office.

Improving governance, adoption coaching

In June 2016, Dr. Linz helped create an EHR committee with a group of nine individuals, including physicians, adoption coaches and Cerner ITWorks associates. The committee’s goal was to determine what processes would be necessary to begin making a successful transition to Dynamic Documentation from PowerNote.

The adoption coaches heavily used the Cerner Advance tool to establish a baseline and help decide which specific providers were struggling with the technology. This helped the transition to Dynamic Documentation — which helps providers review patient charts while completing their note.

“It has improved workflow and provided a professional, completed note, which is important for consultants,” said a pulmonologist, Douglas Harrington, MD. “You also can change workflow on the page, which is very helpful.”

In October 2016, the committee began transitioning its providers from network edition Dragon Enterprise to cloud-based voice recognition software — Dragon Medical One. About one-third of the ambulatory providers previously used Dragon Enterprise.

Implementing this voice-recognition software prior to Dynamic Documentation helped increase adoption of the technology and significantly reduce the overall documentation time, said Jenna Blyholder, a Cerner physician alignment lead who helped lead the product.

‘Painless by day three’

In December 2016, Dynamic Documentation rolled out to the rest of the ambulatory clinics and providers, who are now using the solution in inpatient settings. The average monthly time savings is close to 29 hours per provider.

“The adjustment to Dynamic Documentation was hard on day one, better on day two, and painless by day three,” Dr. Linz said. “It has changed the way I structure my visit, which took some getting used to, but now things flow well. It has made me structure my office visits differently.”

“I review data easier and avoid toggling between as many screens. I am documenting more during my visit,” he said. “Overall, it made my day more efficient.”

As of April 2017, providers were charting 33 percent of all documents through Dynamic Documentation, and time savings is approaching five minutes saved per patient. Additionally, 85 percent of providers are now using Dragon Medical One.

“I found Dynamic Documentation to initially be extra steps compared to PowerNote,” said David A. Stone, MD, FACC, medical director, NCH Nuclear Cardiology. “However, once I was used to it, I do feel the workflow is more efficient and in line with the way I ‘think’ as I am working through a patient evaluation.” 

“In addition, the final product office note is better organized and much more pleasing to review,” Dr. Stone said.

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.