Bill Russell: 00:06 Welcome to this week in health IT where we discuss the news information emerging thought with leaders from across the health care industry. This is episode number 49. Today we do a deep dive episode where we take a look at a decade of EHR implementations probably longer than a decade to examine what correlates to success and what doesn’t. This podcast is brought to you by health lyrics. Health systems are moving to cloud to gain agility efficiency and new capabilities. Work with a trusted of partners has been moving health systems to the cloud since 2010 visit healthlyrics.com To schedule your free consultation. My name is Bill Russell recovering health care CIO writer and adviser with the previously mentioned health lyrics from time to time listeners of the show will recommend that I speak to someone or cover a specific topic a recurring topic of conversation this past year has been the arch collaborative. I sat in on a session at the chime Fall Forum and took in Taylor Davis’s presentation on this topic and knew that I wanted to have him on the show. So today’s guest is Taylor Davis the EVP of strategy and analysis with class research. Good morning Taylor welcome to the show.
Taylor Davis: 01:13 Good morning Bill. Thank you for for having me.
Bill Russell: 01:16 Well so many people have come on this show Amy Menaker discussed it and as have others who have come on the show and it seems like you guys have done the research that we’ve all been waiting for and really wanted which is, What leads to success and what doesn’t lead. Potentially what doesn’t lead to success that we’re spending an awful lot of time on. So I really appreciate the work that you guys have done. So let’s, we’ll jump right in here. So the format of the show is usually we go back and forth on news stories. Today’s a deep dive episode which means we’re just going to focus in on this one topic. So let’s start with the basic question. You know what is the arch collaborative and why does it exist.
Taylor Davis: 02:04 Well Bill you said, Thank you. that We’ve dived in and worked on the research that we’ve all wanted we wanted it too. So class is a research organization for a lot of years.
Speaker 6: 02:14 Let me give you my personal experience so I’ve been with class for 12 years I joined class in 2007 early 2007 and watched the rise of electronic health records with you know in 2009 through 2015. Right. Right. And so I’ve done thousands of interviews with healthcare leaders with CMO CMIOs and CIOs. And it’s common that we get on the phone with them we say hey how are these going for you. And they say we still are really struggling a lot of people are really disliking our EHR and we hear that about every ERH I have interviews with a passionate physician that say well you know Cerners way better than epic and Athena’s way better than Cerner and Epic’s way better than then. You know Athena and I think it’s broken Transitive law right there as I described that but that’s how it felt for us right. We were hearing it from everyone else and everyone’s talking about hey it’s the software class has put out ratings about the software for a long time and there’s no doubt that the software makes a difference. But that we pulled together actually just two years ago it was late November 2016. We emailed out to 10 of our friends and said Hey what if we all we, sorry, a couple months before that we had done a quick poll in about 100 organizations. Hey, have you measure the feedback of your end users about your EHR and only 7 percent had done that. So. And most of those percentage points were organizations that recently come live on epic and epic requires you to do a post go live survey. So there was only like 3 percent of organizations that were doing this themselves out of their own choice. Right. And so almost nobody was doing this and at the same time were spending millions millions dollars on optimizations and a bunch of work. So we said to 10 organizations what if you all send out the same EHR satisfaction survey to all of your users five of those organizations said yeah and they took us up on it and we collected the feedback from the five organizations and as it came back in the feedback was so interesting. So we had two organizations that were using the same EHR they were both using Epic. And the feedback was night and day different. One was incredibly satisfied with it and and one had their physicians just screaming angry about their experience. And it was at that point that we said OK there’s something really interesting here two organizations using the same software very different experiences and So it started out as a benchmarking effort two years ago where we helped organizations benchmark against each other today it is a collaborative and and we’re working I’d say with some of the premiere organizations provider organizations not just in the country but in the world. And this survey that has been developed and continues to evolve. Has now been deployed to 154 organizations in seven countries around the world. And and we’re really starting to learn a science of what drives success and then what’s almost more exciting than anything else is that we’ve got 62 actually 63 this morning ongoing members who have committed to measuring every year or 18 months their experience and we’ve now had six organizations they have remeasured their experiences and were six and there were five of those six organizations are improvements in their satisfaction. And two of them saw huge improvements in their satisfaction. So as we do this we’re trying to really learn what drives success in those remeasurements those are new since our presentation in Chimes. So we weren’t even a place where we could talk about those. Yes. So pretty exciting.
Bill Russell: 06:01 Yeah one of the things you talked about in the presentation was this whole idea of a playbook. So one of the reasons that I think epic has done potentially better than some other EMR or EHR implementations out there is they have a very defined playbook. You will you know you do these things on these things but you know one of the things you talked about is you know just having the right playbook doesn’t necessarily lead to overall success. In fact you talked about a bunch of things that didn’t necessarily correlate that were potentially myths that we had grown to believe over the years.
Taylor Davis: 06:37 Yeah. You know that’s the problem with with doing things but not measuring is that you start getting into ruts and you get those ruts deeper and deeper and you start thinking hey this makes all the difference. So let me give you an example of one of those ruts is that it is there’s just an assumption that if we put at the elbow trainers for people it’s gonna make a big difference for them or if we give them voice recognition it’s going to make a big difference. And what we’ve learned is that you can actually dig yourself deeper into a hole by doing that if you don’t have a great trainer that goes and engages with those clinicians so if you’re not measuring. And if you deploy voice recognition in the wrong way or even scribe’s in the wrong way it gonna end up taking you the exact opposite directions so you’re gonna put a bunch of time energy and money into make your EHR work better or your experience better. And it’s going to be it’s going to be worse. On the epic side I think that this describes that there’s been a number of folks over the years and who have described and Judy Faulkner and her approach and that teams approach to the EHR is you know sometimes people would use the term I’ve heard people use the term benevolently manipulative. So you know they’re kind of pushing us in ways to help us be successful ourselves. And I’d give that a different term change management epic understands a lot of cases that change management is critical and. And how do you incentivize human beings to to make changes. And there’s a whole science behind this but the epic has done a lot of that at the same time as we start to measure you know we didn’t have measurements for epic organizations very much either and we’re starting to really learn that there are some things that make a huge difference. There are some things that don’t make a huge difference so it has been such a fun journey for us over the past few years.
Bill Russell: 08:22 Yeah I could see that when you threw up a handful of charts in the presentation that sort of struck me. And I think it was based on the question of does EHR enable high quality care essentially. And then you have the response across 100. And I think at the time was like 133 organizations and the crazy thing was just the disbursement of that and then you kept breaking it down. You said well maybe maybe correlates on the platform and as you said before you know there’s an epic implementation that has a lower percentile. There’s one that’s at the top percentile so well maybe it’s academic medical centers maybe children’s hospitals and you just kept breaking it down. I mean did that stuff surprise you I mean give us. Oh yeah give us a little feel into into that specific those specific metrics on the EHR enabling quality care.
Taylor Davis: 09:19 Yeah let’s touch about this because we actually just worked with Chris Longhurst UCSD and a number of other leaders in the arch collaborative to submit a paper to the Journal of applied clinical informatics and we got a rejection. And I think we’re going to resubmit. And one of the referees said. Look everybody knows the software and the challenge that I have with that is that if the software was the key driver of success for an EHR implementation and I’m not going to argue the other side that it doesn’t matter. It matters. But if the software were the make or break factor of success for your users then we wouldn’t see high variation within the customer base. We would see most ethnic organizations scoring in about the same place and most Cerner organizations Athena, Allscirpts and Mediatech and down the road. But that’s not what we see. We see this huge dispersement as you say and we see we see some EPIC organizations scoring higher than some Cerner organizations and vice versa. And we see this this huge variation. We do see some EHR platforms that we have not really measured a successful user group yet and so the EHR does make a difference. But the variation is very very telling. So then you look at it from an organization standpoint you say you know maybe maybe it’s the type of organization maybe it’s children’s hospital versus academic versus large versus community hospital. And look we found a successful type of organization of every type and actually the organization type doesn’t make a big difference. We do find the organizations outside the U.S. tend to be a little bit more satisfied but they can also be incredibly unsatisfied. So currently the least satisfied organization that we’ve ever measured using epic software is an organization that outside the United States. So you know there’s just a lot of variation that goes into this and and really what it comes down to is and we believe that we’re building checklists and learning the things that are helping organizations focus on what matters most. But at the very end of the day an EHR is a leadership test. It is a test of leadership and teamwork and joint effort and culture to be able to see if you can work together and make this thing work. And if you don’t have the leadership in place and the team work everything you need to do then it is going to not work and it doesn’t mean that you can’t improve your leadership it doesn’t mean that you can’t improve your teamwork. And in a lot of times the insights from these users identify those opportunities.
Bill Russell: 11:57 Is there a correlation with some of the things as you threw them up there. I was wondering is there a correlation with budget the amount that a system budgets or is there a correlation between size of the organization.
Taylor Davis: 12:11 K so hold on a little bit it’s not a statistically significant correlation but organizations spending more tend to have slightly lower satisfaction. That’s how the regression line lands right now. So it’s slightly negative and although we do see on the tail there’s a few organizations, if you’re spending less than 3 percent of your operating budget on IT You tend to have a little bit lower satisfaction so there is a group that’s really really really low satisfaction that they’re just not putting enough resources into it. But by and large there’s a lot of organizations that are in the very same range in terms of how much they’re putting into their EHR and into I.T. and they’re getting very very different results. We don’t see, your most satisfied type of organization in the United States is a multi-hospital community health system. So a health system of around Five hundred to fifteen hundred beds. That’s going to be your most satisfied organization but that’s not worlds better than other organizations but they tend to have a little bit more skill to be able to support things. but They also tend to be a little bit closer to some of their users they have some of the teamwork. But we’ve seen very large organizations be quite successful and. And we’ve seen very small organizations be quite successful. But when it comes to investment I don’t think we should be very surprised. I shared this when we were presenting at chime I believe, there is a great post from Nate Silver the 538 website and he talks about how you know even in baseball where we have so many statistics and so much data baseball 30 years ago was really bad at Spending more money and getting a higher win rate and there was a very poor correlation and it’s gotten a little bit better in the last 30 years which is kind of bad for the game but we won’t go there. But the bottom line is that this is hard stuff to do to spend money in a way that’s really going to make a difference and which is why look if you go and measure with the Arch Collaborative or you measure with somebody else just measure don’t keep moving forward with what you’re doing. And if they arch collaborative can help with anything we would like it to become absolutely unacceptable because we believe that it is unacceptable to move forward as an IT organization and not measure the feedback of your users because you just don’t know what you’re spending money on. It’s a little bit reckless to not measure in this day and age when any organization even if you don’t do it through US could just build a Survey Monkey survey and send it out to your users and collect their feedback. This is just something that should be standard practice in the industry and we think will dramatically improve the experience of clinicians using their EHR technology.
Bill Russell: 14:49 Yeah. Now with that being said there is a science to collecting that data. We won’t go into that. But you know there are good questions and bad questions there’s leading questions there’s. Yeah I mean but yes it’s easier to create a survey these days.
Taylor Davis: 15:06 So let me share with you. Every organization that’s a great point Bill. But now let’s go to our Web site and steal our survey and put it in Survey Monkey and do it so we don’t care. What we really want to do is have you measure or come to us and have us help do the measurement for almost no cost. At the end of the day go do the measurement. And so you know how I said that there is 3 percent of organizations that are doing their own survey. We’ve run into 1 percent of organizations they have longitudinally resurveyed and every single one of those organizations and there’s three that we’ve run into. When we share with them our findings they they’ve all gone. Yeah that’s exactly what we see also. So they’ve come to some of the very same truths and findings that everybody else has just by measuring their own organization over time because they put in some of that effort. And I’m gonna throw in an extra word on that they put in the effort and the courage. Because it is a really scary thing. I’ve had CIOs and CMIOs say to me Hey do you realize that this is something that could make me lose my job. And by doing this measurement, and we’ve had others who said in not quite as uncertain language hey there’s kind of a scab forming over that the frustration with the EHR our from our clinicians. We’d rather not pull off that scab. And we hear that and that’s just like nails on a chalkboard for us because we know the truth of the matter is is that there’s not a scab forming over the frustration with the EHR, It’s just that people have stopped coming to you, because They don’t see you as problem solver any anymore in your IT or your informatics department and that’s just not acceptable for us to do that. When we’ve got frontline care clinicians caregivers who need to have the best tools possible to be able to be successful.
Bill Russell: 16:51 Yeah it’s it’s interesting because the way health care is one of the few industries where we’ve applied significant technology and resources and data and analytics to it and we get back that is becoming less efficient. It’s becoming more burdensome. It’s not user friendly it’s, I mean we end up telling these stories there are other industries where it’s made all the difference in the world. I mean you can you can do things that you couldn’t do before. Now true there are a lot of those stories within the EHR we can we can now find correlations across multiple populations and we can identify things a lot better and those kind of things. But that’s not what the physicians are experiencing. So do you or the clinician so you do you spend a lot of time on the clinicians feelings and burn out and their use. Does that get covered a lot in the survey.
Taylor Davis: 17:50 Yeah yeah. Bill as you say you know that’s one thing because we haven’t been measuring we’ve taken this universal fact that in health care, there’s a there’s a Russian word for Varosha just generalized across the board. That this is just how it is and it’s not, because there’s organizations that their clinicians report back to us extremely satisfied experiences with their EHR and at those type of organizations you has users who have really mastered how to use the EHR well they have a great governance and communication structure where they’re able to give feedback and they love the EHR because it’s able to adjust to be able to help them out. So when they need it they feel like they have a backstop or something that’s helping them. And then they’ve learned that they’re responsible for part of the success their EHR so they’ve had to personalized experience. But a lot of those organizations are just happily doing what they’re doing. They don’t know. I mean everybody else is kind of whining and I talked to one of the physicians that was from the highest satisfaction organization that she had practiced and then she had recently moved and she was at a conference I was speaking at. But she had been practicing in Oregon at Kaiser Permanente. Highest satisfaction group that we have measured amongst physicians. Ninety two percent of them report that their EHR enables them to deliver high quality care. And just getting 92 percent of physicians to agree on something that means you’re really doing a good job. And I said, this was just happenstance and we talked about the frustration with EHRs. I had a slight up that talked about the general frustration with the EHRs. She raised her hand and said I don’t get what this frustration is about these things are amazing they’ve helped us so much. And I said, can I ask you, and this was this was just dumb luck I said Can I ask you where did you practice at she said. I just came from Kaiser Permanente in Oregon and I said well guess what you’re coming from the highest satisfaction organization. So she’s not relating with her peers. And if they’re talking and kind of nodding their heads and going yeah we, you know we hate EHRs she’s sitting there going no this is amazing. This revolutionized the way that we practice medicine. And anyway so just kind of an anecdote around some of this but when you talk about burnout and some of the experiences that we’re measuring on that we’ve just started measuring burnout. We’re using the single question Burnout Inventory from the American Medical Association. And what’s interesting whereas there’s huge variation in EHR experience variation and burnout by that measurement. And I know that there’s others out there so. So we’ve got to say what measurement we’re using, but by that measurement there is very little variation between different organizations. it’s Pretty steady and in so even just when you know that you know that the EHR success can’t be that big of a driver of burnout because it’s all over the board. We believe that mathematically right now in the stats then we believe that about 10 percent of burnout is driven by the EHR. So organizations that have a better EHR satisfaction do have lower burnout, but It is only a reduction as you go to the lower ones, or an increase of 10 percent burnout where you have greater EHR satisfaction. We’re still getting.
Bill Russell: 21:02 Yes that’s interesting. That’s a lot lower than I would have guessed. Now a lot of physicians are entrepreneurs entrepreneurs have a high burnout rate in and of themselves the EHR typically gets a lot higher. I mean you’re saying 10 percent. That’s that’s fascinating. You know I think there’s a regulatory burden that’s hitting them. There’s documentation burden that’s hitting them. So it would be interesting to get a good feel for why, I mean do you have a good feel for what the factors are for burnout.
Taylor Davis: 21:30 Yeah
Bill Russell: 21:30 Oh, you do.
Taylor Davis: 21:32 And there are several groups. There are several groups that are researching this also. So there’s the Stanford well M.D. group and I just had a call with them last week. Mayo has a group. That’s measuring this. I just was emailing back and forth with them an hour ago and and then the American Medical Association is also measuring this. Most organizations measuring burnout. There are some others too and as I’ve had conversations with all three of those groups. There is an agreement among these groups and I don’t want to speak for them but I think that they’d be ok would be to say, as I’ve had conversations with them that the EHR is a contributor and I think we’d all agree with that. And there is data that says that the EHR is a contributor and in some organizations. It is a more significant contributor. But the greatest contributors to burnout include a chaotic work environment include a lack of teamwork and shared values in the organization and include too many bureaucratic tasks and those tend to be your top three issues with burnout followed by the EHR so we. So right now there is not complete agreement between all of these groups that are measuring burnout. But that tends to be sort of the order that folks are putting it that the burnout challenges in. And I prefer to think about the EHR as sort of a magnifying glass. If you have poor teamwork and you’ve let your bureaucratic processes just go unchecked. Because guess what. They’re not the same for everybody. Now even in the same state some organizations have a compliance department that has gone completely crazy and some organizations have been able to have meaningful real discussions about how to rope this in. And if you know have you know worried about the work environment for your clinicians if you’re worrying about these things you put an EHR over the top of that have environment is going to be fantastic. Probably there’s a few other factors involved. And one example of an organization I’ll say is JPS healthsystem out of Texas they have really really high clinician fulfillment high position wellness and really high EHR experience and it’s because they are some of the best teamwork we’ve ever observed in any of these organizations. And they have an incredible executive leadership team and they do some things are really outside the box in terms of how they approach things. So that’s an example of an organization that you put an EHR over the top of then the EHR, of course incredibly successful because you have really really strong teamwork between different clinicians and the way that they working together.
Bill Russell: 24:06 So you’re building some of these best practices so I’d like to dive into some of this stuff. So gosh we could talk about this for the next three hours. Of course we only have like a 45 minute episode so. You know one of the myths that I sort of propagated was that you’re, I don’t know if this is a myth but the day you’re done your implementation is typically when you want a survey because it’s going to be the lowest satisfaction rate you’re going to have because then you’re gonna start optimization. And every year after that you should have increasing levels of satisfaction. But I think what I hear you saying is that’s only true if you have certain things in place so what are what are the organizations that score high versus the organizations that are scoring low. What do they have in place that leads them as they’re doing their optimization efforts as they’re investing as they’re increasing their focus on this. What what are they doing that that enables them to actually move their satisfaction into an upper percentile.
Taylor Davis: 25:14 No, that’s a great question. You’re exactly right so we see some organizations. So some of the most satisfied organizations that we’ve measured. I’ll give you an example. Metro Health in Cleveland has had Epic for a really long time. I give the example of kaiser permanente they’ve had epic for a long time. Memorial Health System has used Cerner for a lot of years so some some very long term success for organizations that have just built up their success. What they’ve done at these organizations. I’m going to give kind of a high level perspective and then dive down a little bit what they’ve done is they have built real teamwork around the EHR and what does that mean. That means that they’ve helped users realize that they’re responsible for a piece of their success. And that’s that’s tough to do to help and to help them realize that they’ve got to do some things in order to be successful. That takes really good communication and persuasion and that makes sure that when you sit down for a training engagement you don’t say well here’s how you use the EHR. You say look our goal today is to work together as a great team in our care processes our processes are embedded into our EHR. So when we’re talking about today’s training we’re not just talking about the EHR we’re talking about how to work together as a team. We’re also talking about some things that you’re going to have to put into place to be highly successful. And there are things that we can’t do to make you successful you have to do these things. So let’s dig into it right. Just that little tiny beginning of the end at the beginning of training can make a world of difference as organizations are really capturing the hearts and minds of their folks. They also have in place really good communication networks. It shows up in different ways. Some groups are really good at doing Rounding and they are visiting their clinics and visiting their departments and talking to them about where they need to improve. Other organizations have, so memorial Health or Stafford Health in the UK they have these I.T. centers where everybody can come in and get help. And they’re centrally located and they have in the UK they have coffee and sorry tea and cake you know to lure you in. Right. So you can learn from them. Or they come and engage you really well on their departmental meetings. We see that in some organizations. However it is there’s this communication layer and you feel like if you’re a clinician of all these organizations that there’s real caring people on the other side that you know in informatics and IT that are trying to work with you to get the best situation possible.
Bill Russell: 27:41 Yes. So what you gave is three common negative EHR emotions and I love this framework because you said, Generally speaking people using an EMR feel stupid. In other words they don’t know enough to really get their job done they felt more effective before they had the EMR because they were you know they were the master they understood how to get things done so they feel stupid. They feel discomfort using the EMR sometimes then feels like I just give them a hand me down like here’s my brother’s shirt put it on. Yeah it covers you. You’re good it’s one size fits all kind of thing but they feel there’s discomfort such stupidity discomfort and then a third you said was hopelessness which is they just throw up their hands and say. You know there’s nothing we can do. You just gotta grin and bear it. We’re just going to make it so these are the three really deep emotions that you got from the survey. But I love the fact that the findings you know from there you could really build out what you need to do to address stupidity discomfort and hopelessness. Can you talk to the things that successful organisations have done to not have those negative emotions present.
Taylor Davis: 28:49 No, that’s great. Bill, you explained it better then I try to so in order to not feel stupid. I need to be a master around the EHR it’s a core piece. There’s a lot of studies Stanford did a study showing that a majority of the time in my patient engagement is actually spent in the EHR. So the EHR is becoming something that I spend you know half or more of my time in as a clinician or a physician depending on my specialty. And so if you’re now spending half of your time in a tool and you don’t know the tool very well you’re going to hate your life. But the flip side of it is is that organizations that do at least six to 10 hours of training for new positions and three to four hours of training in a year on the newest functionality but even more than that they have great trainers. So DKS health system. Their trainers can’t get hired until they can teach their IT and informatics leadership how something really cool, like how to barbecue you know how or how to cross stitch, they have to be engaging and interesting right and they have to be able to capture your heart so first in order to not feel stupid you have to create mastery. And we all know what a great teacher looks like. We’ve all had those in college and high school. And so you need to have those in place in an organization so that you don’t have a bunch of positions that are unhappy.
Bill Russell: 30:12 Does a clinician want to learn from another clinician or are you more looking for a great trainer and storyteller and communicator.
Taylor Davis: 30:23 We’ve seen six organizations where they say that they have, only six, where they say that they have positions that are doing the teaching and that for those organizations are really really high satisfaction and two of them its pretty mediocre. So I think that actually might be a fairly good split. A teaching a physician can be amazing and sometimes it’s not and sometimes there’s you know I think physicians will say there are some of my colleagues I would rather not be trapped in a room and have to listen to them for a few hours you know and there’s some of them that are going to be way better because they get me and you know they understand me. So at the end of the day we also see other organizations. Mayo Clinic has participated in this and we did a key study, a write up on them. They had incredibly high training scores and we came to them said who does your training. And they said it’s all it’s all non clinicians. But for several months when they’re on boarded they have to go through and learn all the clinical workflows and essentially they have to come up to speed, they Have to become educated about clinical workflows before they’re allowed to be a trainer and they said, for us it works great. So impossible to either way. It’s probably a little bit better to have clinicians teach clinicians excluding the cost side of it but you can be successful either way it just has to be a great trainer, it has to be a great teacher it has to be somebody who doesn’t just tell you what you need to know. First they tell you, they capture your heart and mind and then they help you understand how this is going to be applicable to your life. And then they tell you what you need to know. So anyway so that combats the feeling of I’m stupid when I use this. The second piece is this is kind of one size fits all this isn’t for me and I present a lot out and this is one of my favorite things to do and steal it from, because it works really well and it communicates things really well but I always say, hey, especially if I have a group of physicians in the room I say what technology works the very best for you and so and I always see ten people pull out their cell phones hold them up right. So I walk over to one of the physicians, I’ve done this a bunch of times, I walk over to one of the physicians, I say Can I see your cellphone, they pull it out they hand it to me and I say can you unlock it for me and then they get nervous and it’s great. And so then they unlock it and I say OK this this iPhone right here mine is not an iPhone but it always is an iPhone if it’s a physician. I say this iPhone right here. You say is the most usable piece of technology in your life. Yes. What would you grade this iPhone. I’d give it an 8 minus it’s super usable. OK great. I’m now going to take your phone. I’m gonna wipe out all of your personal preferences. I’m not going to delete anything. So all your pictures your e-mails everything’s going to be here. But Im just going to put your apps in alphabetical order and your lock screen is going to be default and all that sort of stuff it’s just gonna be default.
Bill Russell: 33:01 Does the person jump up tackle you to make sure you don’t do that.
Taylor Davis: 33:05 Yes! But the point, right you want to see those personalizations are like sacred to you. Right. They matter a lot and you hate getting a new phone because you have to go put them back in. And I never of course erase it but then I turn to him and I say ok lets say that I actually did that. What is, how would you grade your phone for usability now. They say a C minus D plus right. And then we say look you moved your phone from a C minus or D plus to A minus because of the effort you put into it to set it up to make it work well for you. The same is true for The EHR. But Bill I don’t know if I said this out at Chime but guess what percentage of physicians have taken the time to set up their EHR, it’s less than 40 percent. And so of course they’re walking around they’re all walking around saying I’ve be stuck with C minus and D plus technology and we go oh my gosh. And over 95 percent of organizations those who taken the time to personalize their environment are dramatically more satisfied than those who haven’t. And there is a group, organizations where that’s not true. They have a really problematic EHR. So you need to look at the technologies itself. And then lastly the hopelessness comes I’m not frustrated that I have clicks it just comes because I walk into you as the I.T. and informatics guy or gal and I say I’m really frustrated with this and rather than find a real solution with me they just say that’s kinda how it is and rather than give me a real answer they just tell me well sorry. Tough. That’s what it is. So your most successful organizations have put a lot of thought and effort into. Brian Tew at greater Hudson Valley health system. Their previous CIO who is now their chief transformation officer that tells you a lot about who he is. Look there’s only me and one other person in my department who can say no. Everybody else either has to fix the problem or escalate. And when your IT handle this and your frontline has to either fix the problem or escalate. Turns out that there’s a lot of things that they can do to fix the problem so they have a better problem solving group and they end up having better clinicians they end up having better teamwork and better communication. So a lot of that rest on the shoulders of your I.T. and your informatics group. How good are you at solving your clinicians problems and helping them make the technology work for them.
Bill Russell: 35:19 So that was great. So we have comfort hope and mastery are three things that you found that really correlate. I found it interesting early on that you said scribe’s doesn’t necessarily correlate, which. That’s interesting because we hear that all the time it takes too much time. Give me a scribe and I’ll be happy. But that’s not necessarily the case.
Taylor Davis: 35:40 Yes scribes dont. You know we’re still waiting for longitudinal data but we don’t see scribe’s in our cross-sectional data correlated with any higher EHR satisfaction or lower burnout and which is interesting because you’re putting a lot of investment into these scribes and then those physicians report the same levels of burnout. And actually they report lower EHR satisfaction on average and so it really makes you scratch your head and you go Oh my gosh this whole class arch collaborative surveyed flunked. Because everybody knows that scribes make a difference. And here’s the problem is that we forget the human element of everything that’s going on. You’ve got somebody who’s a bad user who hasn’t taken the time to really learn it who isn’t engaging and communicating well and hasn’t set things up well for them and all you’re doing is putting bandaid over it. the scribes don’t go in and tell you what are the the most painful parts for clinicians of getting data out of the EHR, scribes do nothing to fix that. And in order to make that work you still have to be a great user you have to understand how to use it. And this is tough technology because health care is really complicated and when God made us he made us a little bit complicated so that the software that runs this most complicated services industry that I think humankind has ever seen is going to end up being fairly complicated it’s going to take some work to be very very confident in an EHR technology plus possesses and hospitals and billing and everything like it’s complicated so it’s going to take some education to really be able to use this well is a scribe is a bandaid, it’s kinda like putting a bandaid over a broken bone. It just is not going to do anything unless you solve the first piece. However we see a few organizations that use it as an accelerator once they’re in a good spot.
Bill Russell: 37:27 Well that’s sort of where I was going is you know you take a look at something like voice notes and those kind of things. And as an I.T. guy so I was former CIO, people would come to me and say hey if you give me transcription I know that’s going to help. But in reality you know all these all these investments in technology and scribe’s and what not these are good but
Taylor Davis: 37:53 they’re not bad
Bill Russell: 37:54 they’re not bad. But essentially what you’re telling me is focus on the people focus on the people side of that focus on change management focus on creating a culture that listens a culture that’s responsive a culture that’s collaborative in terms of making it better educate the, utilize physician builders to customize the system implement training in ways that people can receive it and people can digest it and make it a part of it. So you’re looking for ownership personalization mastery are the three things you talked about in all of those things none of those things where they go do another 3 million dollar technology project on top of the EHR to make it better or even upgraded. We need to stay current with upgrades but at the end of day you can still have you know something that’s three versions behind. But if you have the right things in place people are going to know how to use it feel empowered to make changes and make it work for their workflow and for their patients. I that capturing it?
Taylor Davis: 39:05 no bill that’s exactly right. And you know that your best users when it comes to voice recognition technology have taken time to train their dragon so to speak. I actually steal that phrase because we’ve added a new question on the collaborative survey that says if you report really high satisfaction it pops up and says you report really high satisfaction what are you doing that maybe your peers are not and the most common answer is I’ve taken time to set things up to my needs. And one of the recent responses I saw was I train my dragon. So you know it’s the same principles that end up making voice recognition successful mastery. Right. And then setting it up. Well to use it and then some good support and communication and empowerment from the IT department. And so these are principles bedrock principles. What if we get, And it’s the low hanging fruit at almost every organization. Once we get most organizations up to a place where we’re really starting a fire and people are using the functionality that they have now we’re at a place that you can come in and layer on top artificial intelligence and clinical decision support. And in a lot of these national language processing a lot of these functionalities that are going to really be accelerators to the industry that’s going to be really exciting but we can’t do any of that until we have users that are up to where our current technology is. Most are not even using most of functionality in the latest version let alone these next generation pieces. If you think that it’s frustrating today because you don’t know where to click and where buttons are start adding on artificial intelligence over the top to start giving you predictive algorithms. And if you don’t know why they’re predicting that then you’re similar to a pilot that doesn’t know the limits of his autopilot. Then you don’t know how to use it and you shouldn’t use it at all if you don’t know whether you can use it in rain or snow or fog or when you can use it when you can’t. And there are times when you can’t use autopilot. So similarly we’ve just got to get our users up to a place that we can start to do some of the exciting things that we’re all excited about. And then we could really revolutionize health care. Moving forward
Bill Russell: 41:02 are there. And as we get close to closing this out are there you know a couple of stories you share in terms of just some things you’ve seen out in the industry and you go man they’re just doing it right. That is you know that’s going to lead to a really successful implementation.
Taylor Davis: 41:18 You know there’s there’s a lot of there’s a lot of stories. Let me give you two right now. One is a Viden health we haven’t done a before and after measurement with Viden health but they by their own admission said we were in a really bad spot with our EHR and nobody knew how to use it very well and we had a lot of frustration around it. They did a big upgrade but they used the upgrade as an event and they said they went to all of their hospitals. So they’re on the East Coast they went to all their hospitals in their community hospitals they don’t employ almost any of their physicians and they change the bylaws of each individual hospital. One at a time to say a part of having privileges at this hospital is being an expert on our technology in order to deliver quality care. And then part of changing that bylaw is they set expectations with everyone. And of course they had to have CIO support for doing this right.
Speaker 6: 42:13 They set expectations. Hey, were going to retrain everybody. And then when they did their restraining they had the physicians do the retraining and they said we had amazing training because we knew that if we were going to require this and change these bylaws that now that the pressure was on us to do great. So they has Great training we measured them and their satisfaction was off the charts in terms of what they had done. They had worked with their people incredibly well they had expected a lot out of their clinicians their clinicians Of course rose to the challenge. These are some of the smartest people in the world. They rose to the challenge and now they’re able to have a baseline to go work on improving clinical outcomes in different areas and do some things. There’s one other group that is really exciting had recently come live with their first measurement it was Ortho Virginia a large group of orthopedics practices. By the way orthopedics tends to be the lowest satisfaction specialty that we measure at the collaborative and Ortho Virginia is their CMIO and is really a fantastic leader in my opinion. I as I watched him and they took their feedback and they went from lower satisfaction. They jumped their satisfaction up from being one of the lowest satisfied epic organizations to one of the very highest highest satisfied organizations in their second survey. And as we talked to them about what they’ve done you know we’re still learning from them, but they’ve done a lot of training a lot of working one on one with individuals to get there. They also use scribe’s and but they were using scribes before and they are using scribes now but they have found ways to use their scribe’s not as bandaids but as accelerators so an interesting organization that shouldn’t be successful because it’s a bunch of orthopedic surgeons who typically are pretty unhappy. And now they’re one of the most successful organizations that we’ve measured. And what do they do it was a lot of teamwork. A lot of effort and some really great leadership. So a couple organizations that we think identified and really show with this what this looks like.
Bill Russell: 44:07 That’s fantastic so. So tell people how they can get more information on the arch collaborative, and its a collaborative so people can become a part of it they can join it. It’s on the class research dotcom site. But how can they get more information on this?
Taylor Davis: 44:24 It is super easy. Google arch collaborative it comes up with our kind of our Web site there’s a button on there down the bottom that says I want to know more it e-mails us we get in touch with you. There’s a lot of organizations today that I mean we’ve gone in two years from an idea to 154 organizations doing the measurement so that just tells you that it’s not that hard you know, we’re moving that fast and some come join in. We’re just now instituting a cost you know to date we had been measuring most organizations for free. There is now a nominal cost to come in and measure at least that going into effect early next year. But this is not what this is as high courage. It’s not high costs to come in and participate and then we have a conference this next year in May. We’ve got 62 ongoing members. They’re going to come together in Salt Lake City. Last year we had 50 organizations that came together and. And they teach each other about their best practices. And I’m gonna boast that we have some of the very best organizations in the country. Premier, premier health systems. And when I say Premier I mean that the Premier Community Health systems to a large premier organizations. And that conference is just amazing. So some things that we’re trying to do. But it is a collaborative where folks are working together to solve this problem.
Bill Russell: 45:46 Absolutely. And I think I saw your your survey maybe it’s not the complete survey, but I saw your survey actually out there it’s public domain.
Taylor Davis: 45:55 Oh Yeah it’s out there! look steal it take it the secret is not in the survey. The survey is something that we keep editing the secret is in uncovering these principle and helping organizations learn from each other. Our goal is that in a few years this collaborative is done because we figured this out as an industry and everybody started measuring and maybe there’s an ongoing measurement piece that we help people with I don’t know. I don’t know if that makes sense or not. We want to solve the problem then class and everybody else can go start working on the other problems that we have in health care. We’ve got plenty. But let’s solve this problem so come get engaged right now. Come come get involved with us and lets all solve this together.
Bill Russell: 46:33 Absolutely. Well great work. I know that you know Lee Milligan mentioned to Amy Manacher mentioned you and they were you know really highly excited about the work and both encouraged me strongly to engage with you and I’m glad that I did. Is there a way that people can follow you. Maybe social media or another way.
Speaker 4: 46:56 Yeah. @tayloratclass is my Twitter handle. And I just was tweeting this morning about the ONC report that just came out. And so if you’ve listened to me the last few minutes you’ll notice that we have some strong opinions so class is also on Twitter if you just that. If you just do a search you’ll see class and then class is tweeting all the time about the things that we’re finding on the arch collaborative. So. So join us and come reach out to us with an e-mail. come talk to us.
Bill Russell: 47:23 Absolutely. Are you talking about the HHS ONC announcement to reduce the burden Yeah yeah I remember talking to you about that but we didn’t really want to dive into the news story today. But that’s good. I mean everybody seems to be coming at this challenge differently and it’s great. We’ll need it all to make it work.
Taylor Davis: 47:46 No and we need some of the things that they’re pushing they continue to be kind of the same trap that a lot of organizations are where they think it’s the software which is where we were a couple of years ago too. So it’s understandable but we’re working. Dan Rather is a key to our summit before. So we’re working to try to work with them and to help them see what we’re learning and we’re trying to share with them some more findings
Bill Russell: 48:13 the number one thing I say to people is okay. So if that’s your mindset what you’re saying is if we put every health system on the same EMR across the entire world we would solve these problems and people look at me. Probably not. Exactly. We still have. There’s other challenges we need to solve. And you highlighted a lot of them in the show which is great.
Taylor Davis: 48:38 We’re all just new at this I guess this final closing comment. We’re all just new at this. I mean we only had the EHRs and really rolling these out for just a few years. So of course we have no idea how to do these really well and we’re all going to look back at the challenges that we had. And it’s similar to when we invented the automobile and it took us 50 years to really realize that we needed an interstate highway system to really see the value out of these automobiles. Right. And driving an automobile on bumpy dirt roads was just only a little bit better or maybe the same as a horse. So we’re still kinda figuring out what do we need to really make these works. It is not just exactly what we thought it was. It’s going to be a little bit different and we’re learning all together.
Bill Russell: 49:17 Absolutely. All right well that’s how you can follow you which is great. You can follow me on Twitter @thepatientsCIO. The show @thisweekinHIT our Web site is thisweekinhealthit.com And shortcut to our YouTube channel. Who’s now up over 400 videos. Is thisweekinhealthit.com/video I’m trying to get that vanity URL with YouTube. But quite frankly I’m busy at my day job so I haven’t had time to really pick that up. So thanks again for coming on. Please come back every Friday for more news information and commentary from industry influencers. That’s All for now.
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