Originally Published: Feb 2, 2023
YouTube Video: https://youtu.be/FOLZdVp_GD0
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Safety, mental health, culture, shame, and regulation all influence the complex question of physician and clinician well-being. Healthcare worker burnout harms individual workers and highlights a lack of public health infrastructure. Caring for patients and the nature of healthcare will always have aspects of stress, but we must confront the long-standing drivers of burnout among our health workers. Join us for a discussion of the: •
Speakers:
Mr. Tom Cushing, Principal Advisor, Product & Solution Delivery, Northwell Health
Josh Holzbauer, Director, Physician Well-Being, Epic Systems Corp
Tina Shah, MD MPH, Principal, TNT Health Enterprises
Janae Sharp, Founder, The Sharp Index
The Burnout Problem - It’s Not a Resiliency Deficit - It’s Time to Rebuild the Broken System
Janae Sharp: I am really looking forward to this discussion right now. I'm a little bit nervous because a lot of people identify their electronic health records and technology as something that doesn't bring them joy in healthcare and as we know from television, if it's something doesn't bring you joy, you get rid of it.
However, in healthcare that doesn't really work cuz you actually should probably record what you're doing. So we invited some experts in this space to talk about technology, to talk about where we are at, how things are going. Which is probably great, and also what needs to happen to make sure technology is an asset for clinicians, for nurses, for physicians.
Our panelists could introduce themselves to everyone, they're all experts and people who are very personally involved in technology and experts at clinician burnout and technology. All right.
Josh Holzbauer: Hi everyone. My name is Josh Holzer. I'm on the Physician Wellbeing Team at Epic. My background at Epic is I, did installs for about 10 years, implementing the system in a number of places across the country.
Then starting about 2014, we started the Physician Wellbeing Group at Epic. I was the founding member, and still going strong eight, nine years later. So I'm really happy to be here with you today.
Tom Cushing: Tom Cushing. Little bit of my background. I've been a nurse for 30 plus years emergency management volunteer fireman EMS for 20 plus years and then for the last 15 of my career, I've been in healthcare technology. I was hired about six years ago onto the corporate level because my CIO and chief application officer didn't have a clinician on that kind of high level looking at a lot of the strategic initiatives that were going on.
And what was interesting, you mentioned it before about bringing joy, you know, she said, I want you to bring a new style of thinking to the team. I'm an individual contributor, but I do a lot of projects and strategy for all 19 of our own hospitals and the 800 and something plus physician partner group that is part of Northwell.
So, I, like to kind of think out of the box and get excited about stuff that most people don't get excited about.
Janae Sharp: Well, that's great.
We'll have to talk more about what thinking outside of the box means.
Sure. And Tina, would you like to,
Tina Shah: and I'm just in the box, , I'm just kidding. My name is Tina Shah.
I'm a practicing pulmonary and critical care doc and have actually had the pleasure to work both at the policy level and the operational level when it comes to transforming healthcare. I've actually served in both the Obama and Trump in the White House. And more recently, last year was the senior advisor to the Surgeon General and really brought on to set the nation's strategy on addressing the great resignation across the healthcare workforce and really addressing burnout.
And on the operational level. Aside from feeling the pain and the joys of being a, doc on the front lines, I actually served as acting Chief Medical Information Officer standing up telemedicine, the beginning part of the pandemic in a large health system called WellStar in Georgia.
Janae Sharp: Amazing. So I would love if you could start us out with describing what is that connection between the usability or electronic health records and clinician burnout?
Clinician burnout?
Tina Shah: All right. So I guess I would give this kind of example in that we all brush our teeth every day, right? Okay. That's
hopefully, you know, that's a high bar in theory. Yes.
Tom Cushing: Okay.
Tina Shah: So, I put it, I put it this way. I think about the EHR or I sort of think about big technologies like this. We brush our teeth every day, but we don't really get a pat on the back.
But if we don't brush our teeth, then people really notice and it doesn't work well. And I think that's really where we are with the ehr. It doesn't work so well and we all gripe about it and this is the foundational, I think, major driver of burnout. Now, there are some variations in how, senior or junior you are in the health professions.
In fact, when I was in training, we actually led a study and it turned out for resident and fellow physicians. The E H R wasn't a huge source of burnout, but again, It doesn't help bring you joy, but it can often pull you down, at least at the current state of where EHRs are right now. And so when you have this constant frustration when you are a trained athlete, also known as a nurse or a doctor or a technician, and you can't do your job, but you know exactly how to do it and the tech limits you, that's what causes frustration and burnout.
Janae Sharp: All right. That's a great point. Josh, what would you like to add? ,
Josh Holzbauer: Yeah. The teeth brushing analogy certainly hits home. I, you know, I would say what happens in a lot of cases is EHRs and just software in general. Technology in general is good at following rules. And I think all the EHR vendors do end up playing this role of, a referee.
We have code that we can use to check certain rules, and some of them are, you know, regulations that are put in place at the state level or the federal level. Some of them are put in place by the local institution. And so yeah, the ehr for better or worse is good at enforcing And so, yeah, absolutely, and I completely empathize with the people, all the clinicians who are using it and are, they're saying, I just need to do my job here in this, I'm getting, you know, some alert that says I need to do something.
So, yeah. And so what we're trying to do is, as much as possible, find the, those things that are in the system that absolutely do not need to be there and we can help find those types of things and then sort of move the technology to the background so you could, you know, move on with what you really care about, which is taking care of the patients.
Janae Sharp: Exactly. I think that's interesting too, cuz you're talking about like regulations. , they might be a great way to highlight regulations that aren't great at the point of care. Sure. Um, Tom, do you have anything to add to
Tom Cushing: that? Yeah, I think a lot of the stuff that I concentrate on, you know, I, I have a mentor we started in cardiothoracic together.
He's a physician's assistant, I'm a nurse and you know, so we have this kind of provider, you know, clinician kind of symbiosis together. And one of the things. , you know, we always talk about, you know, is, is, you know, I played a lot of team sports and it's about the ground balls and the singles, right? So a lot of the stuff that I try to concentrate on, because I know I'm not gonna be able to change code because I know I'm not gonna change the EMRs or the frustrations with the clinicians because, you know, I started when everything was in paper and you could basically open up a chart, take a look and figure out what the story was within a minute or two, you didn't have to hunt and peck and go to a different places.
You had a story, right? And we've kind of gotten away with that within the electronic process to be able to adhere to a lot of the standards that we have. But one of the things that I've been trying to do is figure out ways to automate what gets put in to serve up the ability to make an easier story.
So, , one of the things that I've been concentrating on a lot lately is medical device connectivity. I think, you know, when we get into the sexier areas of, you know, how do you kind of serve up the best way to put in, you know, a level five, you know, history, physical assessment, things of that nature to make sure you get optimum billing.
But how can we serve up enough of that stuff and put it right in front of your face? So say, hey, I see in your problem list, you put chest pain. Did you prescribe X, Y, and Z? And kind of use the technology to automate the choices that the physicians have to make that on the nursing and clinician side, a lot of what I've been doing is figuring out.
To connect every single medical device we can and automate that so that you're really just looking at it to approve what's being served. Not manually typing in, not looking at the monitor, looking at here, but basically saying, Hey, all of these vital signs, however big or small they are based on med-surg.
It's a few things, and icu, it's a ton of things. Does this look right to you? Does this go along with your thinking? Because the, one of the reasons why when I got in, I went straight into critical care is, I wanted to learn how to think critically, think I wanted to learn how to figure what was going out with the patient.
I didn't wanna spend a lot of time learning how to do time management, which is what I see on a lot of the high acute floors and the med-surg floors where you're just overwhelmed with patient movement and activities and you don't really get the opportunity to think. So automating a lot of that stuff when your staffing is a problem so that you know the med-surg nurses have what they need and they can just approve.
And also then in the ICU, kind of serving up a lot of these trends and ways that you could use technology to overlay EKGs to try to see am I having st wave elevation or depression or changes of that nature? And using a lot of that cool kind of tech I'm a visual person, I like to see things. I don't know why.
I mean, that's why I also got into electrophysiology. I could look at this huge 80 inch screen and see these tiny little, you know, micro kind of jewel tracings and figure out, ooh, that's where the arrhythmia is over there. You know what I mean?. . So that's the kind of stuff that we need to really leverage and hit those ground balls so that the ICU nurses and the med surg nurses aren't doing a lot of that transcription.
You know, if you automate a lot of these vital signs and connect these things in, we're actually working on something right now. It's not published yet, but we're saving, you know, nurses aid somewhere in the neighborhood of anywhere between 50 to like 90 minutes a shift. Because if you have a vital sign machine at every single spot, and you automate those vitals based on intervals based on the diagnosis.
Based on the procedure and you basically pop it into the records for the nurse to say, yep, that's it. It's a one click thing instead of like four activities to try to take it, transcribe it, approve it, and then kind of put it into the record. So that's really what, if we concentrate on those ground balls and singles, I think a lot of the stuff will help and allow you to kind of think more and spend more time with the patient.
Janae Sharp: I like that. I like that you focused on, on a problem you could solve and technology that , could help with that. I'd love to hear if either of you have had examples, Josh and Tina, like what are other opportunities that healthcare technology has to improve clinician burnout , or in this case, like you're literally saving people so much time.
Josh Holzbauer: Yeah, I, can go first just cuz I'm closer. . I, think a lot of things. So one thing I would say is healthcare, since I sort of joined it , in 2004, has always sort of touted the next big thing in technology. When this happens, we're gonna solve. These pro, these systemic problems that we have. And just as someone who's has worked on a lot of those projects, both with Epic , and with organizations that have come up with their own creative solutions, it's never enough to just drop in tech and expect that to solve what, turns out to be, as I had mentioned before, some really systemic challenges and, and people challenges as well.
So we are absolutely working on things that I think are exciting. One of them is one of the panelists from I believe it was yesterday, talked about the ambient listening we're, definitely years into that project. Now we're partnering together with nuance also exploring it with 3M m.
And just having a device in the room that listens to the conversation between the patient and the physician or the a p p and is able to actually fill in based on that, fill in some discreet fields and, and present here, here's your progress. Not, you're probably gonna have to change it a little bit.
It's probably not gonna be perfect. So that's real tech that's being used right now. I, think it's fair to say that it's in the early adoption stage, there's still a long way to go. We've been able to create a prototype that can absolutely do what I mentioned before and just within, within five or six seconds be able to deliver the progress note.
But again, this is, you know, early on we're still, I, would say a few years away on that. So that's exciting that that's a big project. But what I really try to emphasize to people is this concept. Getting rid of stupid stuff. So I didn't come up with that. Although it is clever it came up a number of physicians at Hawaii Pacific came up with that program, and it was really simple actually.
They just went out to their, unit nurses and said, tell us what you think is silly or superfluous or stupid in the system right now, and we'll do our best to get rid of it. And they made huge gains just by reducing. Flow sheets that were in the system, questions that were being asked. What we find with the nursing documentation a lot of times is we have a tool called neat.
We love acronyms if you haven't figured that out yet. Nursing efficiency and assessment tool where we can show you if you have outliers, and there are always outliers in terms of the nurses that are out there on the floors who's documenting in flow sheets that no one else is documenting it, who's spending more time in flow sheets than other people are.
Maybe they just need some help. A few other examples on the physician side that we've been working on are these, best practice advisories, these popups. We have data now where we can show each organization, okay, here are the ones that are really hurting people because it's interrupting 'em this many times per day.
They take action on it. We have numbers here. We can say in action has taken on this less than 1% of the. And it's a fact. We see really common things like chronic care alerts in the emergency room and well-intentioned alerts, but they don't need to be there in emergency care. You don't need that to take care of your patient.
In fact, it's a detriment. So those are two. I. We also have tools where we can uh, show here are the orders that are set up in these little quick lists for you to pick. We can run data that says, here's what's on the pick lists. But here's what the physicians are actually ordering. And a lot of times there's a delta there.
And so we have a tool where we can say, if you just make these changes, what they order will be on their list. And then the last thing, and then I'll, I, I swear I'll, hand it over. We have a tool called Signal, which is for apps and physicians. We have a wealth of data on how they use Epic, and most importantly, when they use Epic.
So we can know just at a glance. Down at the individual physician level or at the organization level. How much time are these folks spending writing their notes? How much time are they spending with messaging? How much time are they spending trying to find information? And then also when are they using it?
That's really important because if you have someone doing it at 11 o'clock or midnight, they're probably not terribly satisfied with their job, with their work. With ehr, certainly. I try to emphasize all these things that you can do right now to make the, experience better for your clinicians. And sure, , let's get excited about upcoming big tech projects, but let's not sit around and wait for them.
And when they do arrive, let's not just deploy this technology, sort of uh, drop it from, I said today, just kind of drop it from a plane and just let it land and say, oh, here's the tech that'll fix your problems. Cuz historically that hasn't. What's really moved nurses and physicians and helped them do their jobs better.
They
Janae Sharp: don't like technology dropping from the sky, so I can hit you on the head.
Josh Holzbauer: I like that. I like, but it's, it's more about once it drops, you have to figure out as an organization how to create processes around it and how to tailor it to best meet the needs of the
Janae Sharp: clinician. Yes, and I like that Tom focused on like eliminating time to take vitals and a lot of the solutions you've mentioned.
It's about reducing the amount of time they're spending in their ehr. Tina, I would love if you could talk to that, but also you have this perspective on the national level. Like when you're, you've worked with policy makers what did they see? What trends have you noticed in technology tools and how they're gonna impact
Tina Shah: clinician burnout?
Sure. And I think I'll just reinforce, there's a lot that can be done today, but the one thing that I feel like most health. , our little weak on is a lack of appropriate governance. I, as a doctor, shouldn't need to be on the phone for a long ass time. Sorry, excuse my language, , but you know , when you're in the ICU and you have 15 patients and you, don't know when the next one's gonna crash.
I shouldn't need to be on the phone to put in a ticket for a problem with my ehr. We need to make it simple, right? So we need governance in a way that this is not just a priority, but it's urgent that we take out those extraneous extra in-basket messages that just clutter our brain space.
And so I think if we really focus on a better marriage between the clinical side of the house and the IT side of the house, and actually we probably need a few others, I think your compliance, your head of compliance really needs to be part of that. We could really move quickly and get rid of stupid stuff.
And as far as thinking about what's happening on the policy level, what love and what I'm, what makes me very optimistic is that we're seeing, folks from both the executive branch and the legislative branch starting to look at clinician burnout. So if we take a look with what's happening legislatively and we go further back, there actually was a bit of legislation that passed that then asked the Centers for Medicare and Medicaid to simplify.
The administration of, like the practice of medicine. And so actually further, I think if we go further back in the Trump administration, there was a whole amount of effort to cut regulations. There was a, initiative called Patience Over Paperwork. Now as a, physician, I can't feel that I'm in , but I, it's a sign.
There's also a new Office of Clinician Engagement that's actually in Health and Human Services and sits in. C m s and the Surgeon General released a report last year, and that's a large part of some of the work I was leading that literally says, health worker burnout is a problem. It's a national priority and we need to work on it.
And in that lists a bunch of stakeholders that are important, including the tech industry. So we're starting to put the building blocks in to say, some piece of accountability. We need more from our tech vendors. It's not enough to fulfill what originally the legislation said we needed to fulfill, which was to really automate the financial part of healthcare.
And that's why we all implemented EHRs. Now we need to have all the technology really fit the usability for the doc, the nurse, and everyone else. And so I think this is really exciting, but we really need more things and fast. And this is where I think. this is about who we elect to Congress. This is, are we gonna elect a person that doesn't understand healthcare again, or are we gonna start to boost up people that are in science and medicine to then be able to make these better decisions?
I don't think people quite understand that, at least for doctors, before the pandemic, it was two hours on paperwork for every one hour with patient. So we have a shortage, right? I mean, have you heard that we have a shortage? I guess I would make that controversial point to say that what, what if we flip the script, if we actually have technology that works better and we have how we implement it in a different way.
What if doctors spend two hours on patient care and one hour on paperwork for nursing? On the inpatient side, 50% of a nurse's time. On the, computer, nursing the computer instead of really being at the bedside and taking care of the patient. This is absurd,
Janae Sharp: right? Yeah. And, and I like that you've brought that up.
Oh,
Tom Cushing: Go ahead. I just wanted to inject a point there. So I, I love that you said that because you reminded me of something that was really critical. So during the pandemic, one of the things and where I think we could start getting to a middle ground, we were given, I think, by the office, you know, federal, state, local offices.
We were told during the peak of the pandemic that was described not to be dramatic by some of my friends that have been in critical care for 30 years, who said to me, you know, I've wrapped more bodies in one year than I have in my previous 29. But one of the things that happened was, that was interesting, that was driven by legislation and the legislature was they cut our documentation standards and requirements by almost 50 or 60%
and we still did really good care. There's still a lot of people that survived, and so it's like if we can drop what we write down by 60% and still care for these people really well, there's gotta be some middle ground where if what you're talking about is a hundred percent, and this was like 40% somewhere, maybe do we land at like 60?
So maybe we can get to that one-to-one. Maybe we won't get to the two patient care. Charting. But I would love, and you too, would love to get to a one-on-one. If I spend an hour with the patient, only takes me an hour to document, doesn't take me two hours. And I think that's really where we could either work on legislation, work on the tech, and automating things, you know, like automated vital signs, like a lot of that stuff.
I know one of the things you also talked about was, you know, we've pushed our help desk guys. You talk about ticketing, that is the biggest thing that people complain to me about. I don't have time to sit on the phone with help desk. , we've been kind of working with a lot of the bot companies out there where it's basically like you can get on your computer and you can do everything from your wow, from your phone, from your computer on wheels and stuff like that.
It's still a little labor intensive, but at least you can still be charting while you're kind of watching The bubbles go up and down. And it's really kind of streamlined and automated. Sum of our ticket stuff is a great no, but at least it's going kind of in that direction. And I think also one of the things that I would love to.
That comes out of a lot of this burnout where the great resignation is, you know, they talked about it. They hinted about it making clinical degrees much cheaper and free. Like I remember there was a lot of stuff going around. Nursing school's gonna be free, respiratory therapy, school's gonna be free.
Flood the market with a ton of people, right? Same thing. Why don't we have more residency spots? My daughter's in medical school, she's like, dad, do you understand there's gonna be 10,000 people that are gonna graduate this year and there's only 8,000? . Hmm. There should be 12,000 spots. That's all controlled by the federal government.
If we have doctor shortages, why aren't we opening more spots for more people to do it and get more people in there? It's a staffing thing,
Tina Shah: right? It certainly is. It requires a multifactorial solution.
Tom Cushing: Sorry, and that's not tech. It's just, you know, kind of some of the things I think about when you talk about solutions for that.
Yeah, of course.
Tina Shah: I like
Janae Sharp: that, that you're thinking about that and also that your organization has involved you as a clinician, cuz this is something that people talk about a lot. Like, are people delivering the care, being involved in developing those solutions. So I thought we should take a moment to talk more about that, both as people who are, are involved in that.
And maybe you could give us a little bit about the perspective from from Epic, from a technology perspective. Yeah. What is
Josh Holzbauer: that like? Sure. Yeah, from, from our perspective, We, for all the projects that we're working on at any given time, we are always gonna do usability testing ahead of time with clinicians, nurses, and doctors typically.
And we also, I have sort of, informal role at Epic of keeping The community of, of CMOs and CMIOs they're in that use epic in the loop with here's upcoming technology, here's our screenshots of it. Give us feedback. You know, as sometimes it's A, B, or C. Which one do you like best? Give us feedback and if you want to talk more, let's schedule an hour phone call and go through it.
And we do have brain trusts, which are represented. Physicians and nurses across the whole world, not just epic that use the software where they're able to steer our development. And that's been in the last five or 10 years. A big impetus of change for us is letting the clinicians who use Epic every day steer what the solutions are and also how we deploy them.
And then something else that I, I'm very excited about. Recent so it's on the top of my head is we now have a physician wellness steering committee that's comprised of leaders in the wellness space across the industry that are within the Epic community, so that, that actually use Epic. So we have our first meeting next week and.
So we have folks from 11 different organizations across the country. There's some familiar names there in the, wellness community like Tate Shal for instance. So we have Chief wellness officers as well as Chief medical Informatics Officers. So clinicians almost every single one of them I believe.
And what they're gonna advise us on is the big thorny stuff. It's, easy enough to talk about technology and how this might solve problems, but with wellness there's a number of areas where we can collaborate. One of 'em is, is research. So we have something called Signal, as I mentioned before, that captures data on how folks use Epic.
Well, we want to pair that with wellness data at given organizations and see what. Trends emerge. Is there something in, the signal data where we can start to predict? Just imagine if you could predict who, whether the likelihood of someone burning out or the likelihood of them staying. So that's exciting.
But we also want to talk about things like we want to, I mean, we're very excited to do interventions in the ehr. So a good example is, National Suicide Awareness, physician Suicide Awareness Day is in September. So we've started to talk about is there's something that we could do. Could we put something in the interface that says, do you feel like you need help?
Do you. Is there someone you need to reach out to? Something like that. But who know, like that could also be a very bad idea. It could be triggered. We don't exactly know. So that's why they might be
Tina Shah: confused. They're like, why is my
Josh Holzbauer: employer asking you this E? Exactly. So there, did you want me to go home? ? So there, there have been a number of ideas sort of thrown up against the wall here.
And then we want the steering committee to, to tell us here that's a bad idea. Or actually that might be a good idea if we take these things into account.
Janae Sharp: Yeah. There are no bad ideas in brainstorming unless there are.
Sure. Tina, what's even your experience with that, with involving clinicians?
Tina Shah: So what I love is that everyone generally has. good intentions, right? But the problem, and the issue is that we're just siloed. So I think just thinking about the first six to 12 months of the pandemic, that was a great exercise in which we saw what would happen when you break the silos.
And I can give a really good example. So, you know, to, give you the bottom line up fronts, we need more cross pollination between those that really understand the technology and implement it. So on the IT side of the house and those that are using the technology. And the thing is, we both talk with different languages, so we need someone to also be the connector, which we often don't have.
But I will share a really, really positive story in that if you dial yourself back to March, 2020, And I don't know if you remember March 18th? Raise your hand if you remember that day. . Okay. All right. Well, I remember that day because that was the day the federal government said, Hey, you could use any video chat that you want.
You can use Facebook, you could use FaceTime, you could use you know, WhatsApp and all of a sudden, We were allowed to do this, which by the way, we couldn't use any of these before because of HIPAA and privacy and security concerns. But they said, we understand what the climate is. We just need to, we want you to be able to touch your patients.
And here's what happened at WellStar in my institution. I called up my friends, I called up the head of IT revenue cycle. I called up my dyad, who we work as a partner, a physician, and a person that used to live in the IT side of the house, but now is, is now in the medical group. We pulled up revenue cycle and we all came together and compliance and we said, what can we do in a day?
What what like one piece of paper can we. And maybe there's one for, and it ended up being this way. There was one for Microsoft teams, there was one for how to do FaceTime and like how can we put it at a doctor reading level, which means you can only have 15 seconds of stuff you need to read, but what do we need to put on that page?
And then what do we need to do on the back end to make sure that we can bill for it and that we're not out of compliance? And within, I think it was 36 hours, we had these sheets out and everyone started doing virtual. The only way that happened was because we had all these different disciplines together, and somehow we started learning each other's languages.
So you only get that when you spend a lot of time together. We started to call ourselves a virtual health brain trust. I wanted to make t-shirts. We never had time, but our results were that we went from zero to 50,000 build visits. We dropped our claims denial rate by 81% for these types of ambulatory visits, and we did this all without giving doctors or their clinics any new technology.
I think that's pretty amazing. Yeah,
Janae Sharp: that is amazing. What do you. as an opportunity that electronic health records have to build back trust. Would you like to start, Tom?
Tom Cushing: Sure. You're gonna go last.
Tina Shah: Josh
Tom Cushing: Fair enough. , I, think it has, you know, a lot to do with what I kind of mentioned before. I think you build back trust by making usability. . So I think it's a lot of that automation, it's a lot of data flowing in, in an automated fashion so that you really just need to approve it instead of input it.
It's putting in a set of problems as you're interviewing the patient and it kind of serving up order sets and certain things that will basically help you streamline, you know, how you take care of the patient. It's having documentation, you know, I know everybody hates popups. But having the kind of popups that not only say, Hey, you forgot to put in, you know, all 10 systems when you did a review of systems, but bringing you to, Hey, based on your acute mi, you forgot to do this.
And serving it up, I think to say, let me just go there instead of getting to the end, hitting submit. And you get that kind of error message and you gotta go back automating that, using the technology and the algorithms. I'm an ICU guy like you, so everything is based on algorithms about how you resuscitate patients.
Done that for 30 plus years now. So you can apply that same kind of knowledge and technology to how you chart. So if you're somebody who's really great at doing documentation on the physician side, you won't get a lot of the popups and you learn by kind of reducing your pain. But I think a lot of that stuff will kind of get served up a lot.
So this way it just kind of makes things easier and faster. I think that's where you'll get trust and.
Janae Sharp: I like that. Serving up the right data for the people who need it and reducing pain. All right. What do you think?
Tina Shah: So I would reinforce that I trust will be built when the EHR helps me, not hurts me, and
Janae Sharp: it's a pretty bold assertion.
How far away are you?
Tina Shah: I think it depends how much energy we're willing to put in in the next 12 months as a nation. So if we stay in the course we are now, I don't see this changing in the next five years. Mm-hmm. great. But I wanna take your question a different way and talk about trust. Could, the EHR be a vehicle of trust between us and our patients?
And that could be kind of interesting. And I think the answer is yes. I'm really curious to see what, what you think as well. But imagine if I actually was given this information. That was more than demographics because A, as a doctor, we're still used to writing 59 year old female history of X, Y, and Z.
But what I really need to know is, this woman really faith-based or not? Because I'm about to go in there and ask her a question that's sort of a life or death question about whether she wants us to do cpr, if it comes to it or not. Where does she really come from? What does she view healthcare as? Is she already sort of barriers up or has she had good experiences?
Is there a way that the EHR can give me a little bit more of this context? And I don't mean that we ask a nurse to put this in before, so then the doctor can see it later, but is there a way that E H R can serve this up maybe in a more automated way? If I actually knew my patients a little bit before, that would be.
We, because everything is in the ehr sometimes look, and there's the patient door and then there's the computer, and we sometimes go to the computer first, but if the EHR gave us this kind of data where we could build trust, maybe we would go, then go to the patient first.
Janae Sharp: Right. I love that. Like that you could actually see insights into what people might need and what they want.
Has it been, I mean, do you guys have a plan for.
Josh Holzbauer: Of course, of course. Yeah, we do. So I, I did want to ask, in those cases, have, have you tried to use chart search to find things? Do you, do you know how to search the
Tina Shah: chart? Do you think It's my job to know how to search a chart? ,
Janae Sharp: this is one of my favorite. No, I did
Josh Holzbauer: wanna say, so I hear that commonly, and I, I promise there is a way, there's a search box where you can type in faith or you can type in religion and what chart search.
Is it will look at every progress note that's on file. Even there's, even if there's 10,000 of them, it'll look through every single one of them and surface, these are the times that either face was mentioned or spirituality, et cetera. So I could talk to you a, little bit after about that, but that, that's something that I show people where I do see the joy when someone says, oh my gosh, I've been sort of browsing, going through hundreds of notes, looking for information, and I didn't realize.
Like Google, I can just search and find it faster. That is, I've seen that joy but I have seen a lot of joy in showing people how if, if you just do things a little bit differently.
it can really be helpful and it can help you do spend more time with your patients. So that's one example. I think another thing that we're working on when it comes to, you had mentioned the patients is we have, again, partnering with Nuance and 3M and Modal. We, we have a tool that's available today on not just the phone, but also in, on your desktop as well.
That's a voice assistant, and you can just say, you know, Hey, epic. , what, what was the patient's weight the last time I saw them? What's the history? Is there a history of hypertension? Is there a family history of, of lymphoma? And also what that allows you to do is turn that screen to the patient, have your conversation with the patient, and when you have, when you want to find information from the e ehr, don't go over and, put your hands on it and turn your face away from the patient.
Just verbally ask it and whatever that case might be. What was the last he? Hemoglobin a1c. So we, we have dozens of groups that are live with that right now. The, the we have gotten pretty darn good feedback. We're in a number of different specialties, but that's also been, it's been helpful for engaging the patient in that experience as well.
So doesn't feel like as, as you mentioned before, you're treating the, computer and, not the patient. And then in, to get back to the original question about trust this is something that. It's very important to me. It's something that I work on every day. I think that people do have issues with health systems and just trying to get excuse me, help.
Systems and trust trying to get basic answers to the questions. And so sometimes it's just sort of this communication barrier. So what we're doing back at Epic is we're just providing basic training and basic tips and q and a for anyone any clinician out there that uses Epic, for instance.
No matter where you are in the world, if you use Epic as a clinician. You can send an email to tips epic.com and Wendy's got that email address now. And you will get us the Physician Wellbeing Team at Epic and we will do our best to help you. And in some cases we found probably. I would say two-thirds of the time, it's just a question, like I need to be able to write my note faster.
Like, come on, there's gotta be a better way. We can answer that from, from back at Epic. And then one thirds of the time it's about something that's local and that's okay too, cuz we can channel that to the local Epic team and help them answer it. So, between that email address, we also offer somebody called Efficiency Hours, which we're actually doing this week.
Again, any clinician. Excuse me. Any a p p or physician anywhere in the world that uses Epic? It's free. It's virtual it's CME accredited and we offer. A pretty flexible schedule early in the morning, midday, late at night. Cuz we want to reach out directly to the clinicians who use Epic. And I'm someone who, I'm on Twitter.
I'm reading the negative comments about Epic. I'm aware of them. I also get a lot of them sent to tips at Epic and. People have found my email address as well. And so I'm very sensitive to this. Sorry about that. I, I'm aware , it's ultimately a good thing. Someone needs to be there listening. That's what we're doing on the physician wellbeing team.
So that's one way that we are trying to build more trust with the clinicians that use that pay. Now, I don't
Janae Sharp: know how much more time we have. I get a really unique perspective. I've been able to see some of those technology. And then hear feedback from CMIOs and there is still a gap. Like we still have that big gap.
We're like, well, great, we had the great conversation, but they don't care about me. And I would like, we don't have much time, but I would like if each of you could kind of speak to that. Like what do we need to bridge that gap and do you think it exist. and you mean you only have like one minute though, so it should be easy.
Tina Shah: Do you mean between the tech community and tech vendors and users,
Janae Sharp: or what do you mean? Yes, I mean like I've been on a call with the Epic physician burnout team and with the C M I O it went great, but then afterwards the C M I is like, okay, well great, I'm glad we did that. And it's almost like you throw it in the trash, you know?
And there's a disconnect there. Cause I think you're
Josh Holzbauer: throwing me in the trash in that
Janae Sharp: situation. I. . I, I hope not. Was that a, is that a yes or no question? Because I'm not
Tina Shah: answering that.
Josh Holzbauer: Fair,
Janae Sharp: but there's a lot of discouragement. Yeah. So tell me, why is that, like, why do we still have such a broad gap?
Tom Cushing: I think it's because we lack the proper amount of customer. . We're a service organization. You know it. I've always thought of myself, you know, I cared for patients. Everybody's like, oh, don't you miss being a nurse? I said, no. I have just different kinds of patients now. They're the clinicians, they're the people who I serve.
Instead of being in a critical care bed, they're in the hospitals and health system. So I think as an IT side, customer service is really important. I know I actually went to a surgeon recently because he had a whole concierge. . Every single thing I get, it's a special number I call, I pick up the phone and I get an answer right away.
It's follow through. It's customer service, it's engagement. It's a lot of those things that you can't do with tech. You actually need people. Right.
Janae Sharp: Ooh, that's a great answer. All right, Tina, do you wanna go last or
Tina Shah: first? Next? I can go last. All right, Josh,
Josh Holzbauer: you're next. Yeah, in order to bridge that gap, we have some of those solutions that I mentioned earlier about picking up easy things that will make that just save a click here and there, and also dropping stupid things as well.
And for us, what we encounter is. The organization that use Epic, just like every healthcare organization right now, is incredibly, they're strapped, they're resource strapped, they're cash strapped, they're people strapped. And they say, this is cool. I just wish we had more time, more people to do these types of things.
So for us, I mean, a focus, a, a big focus is automation. So some of those things that I. about, you know, finding things that, that are done that you should drop or or taking some things that'll save clicks. Right now we have to use the tool. They, they run a report. It shows what needs to be changed and then a human needs to change it.
So, you know, what we need to do, we know this going forward, is make this a more automated process so that you don't need a person in there or at least use it. , we tell someone who's an analyst at the healthcare site, this is a change we're making. Here's why we're making it cuz we know it's gonna save physicians time.
You know? Are you okay with that? Is it okay to move that to production? , that's where we need to move in the next five years. And I, I also think there's potential not to just use the the buzzword of the day, but the artificial intelligence and cognitive. Where we're already seeing that. On the, on the inpatient side, I would say with deterioration models and things like that where we can calculate from a large amount of, of data, you know, who has the highest acuity at a given time or who's the most likely to be readmitted once they're discharged from the hospital.
So that's, that's live that's out there today. I think it's just sort of the tip of the iceberg of what we can do. So, yeah, that's what I would say overall. I like
Janae Sharp: that and I like that it's like, give them feedback,
Tina Shah: right. So I think we need a way to empower everyone from tho those that work at Epic to those that work in health systems, frontline clinicians to actually move faster.
And I think the way we can do this, and I think the goal is high usability, because right now there are rules for usability, but they're not pertaining to me as a doctor. For example, epic is tested for usability, but there's still a discrepancy. It's not tested in my local environment to where I get all of my needs served.
So if we keep going back, what's the best way we can empower people? And I think this is the time where we need a stick. I'm just gonna say it. I think we. Legislation because we've only gone so far on the regulatory side, so we actually need Congress to empower us to move faster because you have a phenomenal group.
I didn't know there was a physician wellbeing group, but how is it that for me, having worked in four systems in the last year, three of which use Epic that I didn't even know this week of helping me with all my epic gripes is about to. That has not come in any email from any one of my four in three institutions.
So I think this is a stick that really is a secret empowerment for everyone. We need to enforce and to set accountability standards that it has to be something where tech works for the humans in healthcare, not the other way around. .
Janae Sharp: Right. Well, thank you.