The Epic electronic health record at UC Davis Health has been a source of great frustration for Dr. Molly Davis.
A primary-care physician at the health system’s clinic in Rancho Cordova, Calif., Davis spends too much time writing patient notes, answering emails and gathering lab results in the EHR.
“It always seemed like the work was redundant and there was a faster way to do things,” she said.
Her frustrations aren’t unique. Dr. Scott MacDonald, EHR medical director at UC Davis, heard regularly from colleagues that they had a hard time navigating the EHR. Nationally, physicians point to EHRs as a major contributor to workplace stress. A recent survey of 250 physicians cited EHRs as the leading cause of burnout.
But MacDonald said physicians could drastically improve their experience if they had better training.
“I know first-hand if they know how to use the system well and leverage the efficiencies and the tools, they are going to be a lot happier and they finish faster,” MacDonald said.
So with support from leadership, MacDonald in February launched the Physician Efficiency Program, which provides one-on-one training to doctors to improve their experience with the technology. The results so far have been promising. Since the program launched, physicians have reported a 24% improvement in self-rated efficiency with the EHR and a 12% increase in satisfaction. Additionally, the time doctors spend working on records after hours has declined.
For the program, UC Davis hired a team of four EHR trainers and two Epic-certified builders who can add functions to the system to improve usability.
The program initially rolled out to physicians at UC Davis’ 208 ambulatory clinics because they haven’t had robust EHR training since 2004, which is longer than the hospital physicians. UC Davis plans to complete the training across the whole system by 2020.
The EHR training team spends about three to eight weeks at a clinic, depending on its staff size. Each physician spends four hours with a trainer. The training is interspersed throughout the day so the physician can get the hands-on practice right away and follow up with the trainer on any issues or questions.
“We teach it, and then we help them implement it and do it,” MacDonald said.
To ensure the training addresses every physician’s unique concerns, UC Davis deployed several data gathering platforms. The team uses Epic’s provider efficiency profile tool, which tracks how much time a user is spending on the EHR and what functions they use the most and the least. UC Davis then surveys all the physicians before their training to gauge their satisfaction with the system, what they need most help with and how often they spend on the EHR after hours, also called pajama time. UC Davis created its own tool to measure the time physicians spend in the system from 5 p.m. to 8 a.m. as well as on weekends.
During her training last month, Davis was taught several shortcuts to better navigate the various interfaces. Additionally, a template was made for her patient notes so she doesn’t have to spend so much time typing. “It’s been super helpful. I have used a lot of the preferences that have been made,” she said.
The Epic builders are also ready to create interfaces or tools that will improve a physician’s efficiency. For instance, the builders have made several charts that display all the relevant data on a given condition including recommended tests, drugs and management protocols.
“It decreases the number of clicks and the time it takes to gather that information by putting it all in one place,” MacDonald said. The screen can also be shared with patients to help them better understand their disease, he added.
The program is targeted for physicians because they spend the most time with the EHR, but advanced practitioners are also involved in the training if they are the main users at their clinic.
While the EHR trainers are at clinics, weekly meetings are held to share lessons learned so far.
“They tend to be very enriching sessions,” MacDonald said. “Physicians can share their own efficiencies and they are engaging with one another.”