This Week in Health IT
September 25, 2020

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September 25, 2020: Some topics are worth coming back to over and over again because they are front and center for anyone in health IT. And one of those is EHR user satisfaction. Dr. Amy Maneker, an experienced CMIO, who among other roles, serves as Physician Executive Advisor to the Arch Collaborative at KLAS, addresses the topics of EHR user satisfaction, clinical informatics, governance as well as user ownership and engagement, with physician burnout as the backdrop. What are the key components associated with user satisfaction as revealed by the Arch Collaborative data? What are some of the best practices around personalization? What about training? Is the CMIO role distinct or different at each organization? What critical areas should they be focusing on? Discover where we have seen significant progress in the areas of experience and satisfaction among clinicians.

Key Points:

  • The wild lack of transparency during COVID [00:07:40] 
  • The huge topic of physician burnout [00:10:15] 
  • Ownership and engagement [00:10:45] 
  • Arch Collaborative [00:12:55] 
  • Some CMIOs are focused on the EMR, others have a heavy focus on analytics and informatics [00:26:15] 
  • Information blocking related to the 21st Century Cures Act [00:36:55]

Building EHR User Satisfaction

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Building EHR User Satisfaction with Amy Maneker

Episode 308: Transcript – September 25, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] This is going to be a wild episode. I’m having work done at my house. You’re going to hear a lot of construction in the background. I apologize for that ahead of time. Amy Maneker does a phenomenal job working through it, but, but it’s still there, especially at the end. You’ll just, you’ll hear flat out the jackhammers going and those kinds of things, but a great episode, enjoy the conversation.

[00:00:20]Remember two things, clip notes is live. If you want to stay current, keep your team current best way to do that. Send an email to clip [email protected] [00:00:30] fastest growing list. We’ve had a it’s up over 400 people already who have signed up for clip notes. Don’t miss out. Get signed up. and also we want your feedback.

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[00:01:02] [00:01:00] Welcome to this week in health. IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creator of this week in health IT. I said a podcast videos and collaboration events dedicated to developing the next generation of health leaders this episode.

[00:01:16] And every episode, since we started the COVID-19 series, that’s been sponsored by Sirius Healthcare. Now we’re exiting  that series. And Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts during the crisis [00:01:30] and beyond.

[00:01:31]Some topics are worth coming back to over and over again because they are front and center for anyone and health it. And one of those is EHR satisfaction. And what I did is I reached out to Amy Manaeker, who was a guest on our show in the first year. And she’s been doing a lot of work around this topic for various health systems.

[00:01:48] She also partners with the arch collaborative around this work as well. and we have a great discussion again. A bunch of background noise. I apologize for that. But, again, Amy is [00:02:00] phenomenal. Appreciate her content and her wisdom. I hope you enjoy the show.

[00:02:05] This morning. We’re joined by Amy. Maneker the experienced DMIO product of Penn medicine, university hospitals in Ohio, Akron children’s a physician executive advisor to the arts collaborative board certified in clinical informatics. And I’m sure a lot more, past guests to the show. Welcome back to the show, Amy. It’s great to have you back. 

[00:02:24] Amy Maneker: [00:02:24] Thanks Bill. It’s great to be back. 

[00:02:26] Bill Russell: [00:02:26] it’s been awhile. So September of 2018, you were actually one of the guests [00:02:30] on our first year of doing the show.

[00:02:32]what have you been up to? This seems like a huge question. what have you been up to since the last time we visited, but, I’m sure you’ve been up to a ton since the last six months 

[00:02:41] Amy Maneker: [00:02:41] I’ve had more go on in the past two years than I had probably in the in the five years previous to that, which is, Been exciting, a little bit overwhelming, but has added a lot of wisdom.

[00:02:51] Like I feel like I’m much wiser. I don’t want to add the older parts. That comment though, what I’ve been doing in the past two years. So I did an engagement with a consulting [00:03:00] firm internally to help them come up, help develop their offerings, to address user satisfaction and developing, physician informatics teams and governance and ownership.

[00:03:13] Then I went on from there to be a CMIO adviser and New York health and hospitals during wave six of their go lives, largest public health system in the U S phenomenal, impressive new CEO there, who is really there [00:03:30] is just so impressive. And it was a real joy to be a part of that in my hometown.

[00:03:35] And from there, I went to the, to be a CMIO, Oh, at the largest health system in New Jersey while they implemented there. one of their districts regions, they call it and I was there. So each of these are, long engagements. And then after that, it was fortunately, it was before the pandemic. I took some time off to deal with an ailing parents and then the pandemic hit.

[00:03:57] And so now I am, [00:04:00] since the pandemic I’m based in Cleveland, sorry about that. Sorry, little technical hiccup and doing a variety of things still. Spending some time with the arch collaborative. In fact, that’s my next meeting today, also working with, a startup healthcare technology startup that has a new AI, artificial intelligence directed towards healthcare with based on quantum mechanics. So it takes into account [00:04:30] probabilistic reasoning. So that’s been exciting and fun. 

[00:04:33] Bill Russell: [00:04:33] Wow. one of the things I find interesting people are when I became a CIO for a health system and I was there for about six years, I used to make the comment and I don’t want anyone going to take offense at this.

[00:04:44]there’s a certain aspect of this as true. I felt like everyday I was the CIO. I got dumber. And part of that was, I was so in, there was so much work to do, and I was so engrossed. I didn’t have as much time to read. I didn’t have as much time to network and to talk to people. And they said, what’s the [00:05:00] alternative?

[00:05:00] I said, when I was a consultant, one of the crazy things about that was I would visit. 50 different organizations and I’d see all the different ways that these really smart people were doing things. And I get to engage with them. And I just felt like I became smarter by interacting with 50 different organizations than being within one.

[00:05:19] Not saying that it’s better. I’m just saying it was, that was one of the benefits of being in the consulting realm was just talking to a lot of different people. Is that what you’re finding? 

[00:05:28] Amy Maneker: [00:05:28] Yeah, that’s what I think I meant [00:05:30] by wisdom. That I, working in the larger public health system and then working in the largest health system in New Jersey internally for months and months, really wow.

[00:05:41] Wildly different ends of the spectrum, but really gave me a lot of wisdom and knowledge. And now that, I have a little more time you write your time to read, tend to catch up one of my hobbies. Yeah. I’m using air quotes and I’m an, I’m a nerd from way back and most people know that. Is I’m fascinated by living through an [00:06:00] epidemic pandemic.

[00:06:01] That’s evolving for us. So I become like the expert on COVID, I tend all these grand rounds. And even though I have a family of doctors here, they all call me like, okay, what’s the COVID update. So I’ve spent a lot of time keeping up to date and doing stuff with informatics, learning a lot about AI, but also COVID yes, you’re right.

[00:06:20] Sometimes when you’re. Head down, focusing on keeping an organization afloat. It’s hard to keep up on what’s going on nationally or internationally. [00:06:30] And that’s been a gift for me recently. To keep up nationally and internationally. 

[00:06:35] Bill Russell: [00:06:35] I’m going to, I’m going to push it on that topic a little bit. we’re gonna eventually, we’re going to get to talking about, really the experience.

[00:06:42]I’m going to use physician burnout as a backdrop. We’re going to talk about the Arch Collaborative. We’re going to talk about, the, just other elements of physician burnout, we’re gonna talk about clinical informatics. So those are just some of the top of skips people, but I want to push in a little bit, you’re the COVID expert.

[00:06:55] One of the things I’ve wanted to talk to somebody about, and I realize it’s an air quotes. You’re not [00:07:00] the COVID expert, 

[00:07:01] Amy Maneker: [00:07:01] but okay. Just for my family that I’m in for my, 

[00:07:05] Bill Russell: [00:07:05] but you’re also a physician. So I have you looked at previous pandemics. And the things that are the same or different, like when we look at the Spanish flu and this, what corollaries can be made between 

[00:07:16] Amy Maneker: [00:07:16] them, one of the most fascinating things was, so there’s a gentleman who wrote a book called a forgotten it, a well known book came out 10 years ago and I’ve just forgotten the title.

[00:07:27] And when he was asked, [00:07:30] this will make he’s someone said, what’s what was the most notable thing learned? Or, should have been learned. I guess we should say about that. the influence of epidemic was transparency. A lack of is of wild lack of transparency. And when I read about the 1918 pandemic, I felt like I was going to learn all the things that they did better.

[00:07:52] And in reality, they made the same mistakes. In fact, the same gentlemen, the author, when someone said, Oh, you don’t, you think we [00:08:00] should learn from history? You said. No, I believe that the only thing you learned from history is that we don’t learn from history and forgot. It’s a quote of someone. And so isn’t that fascinating. And apparently Wilson, the president never mentioned publicly the pandemic. 

[00:08:16] Bill Russell: [00:08:16] Oh really? 

[00:08:17] Amy Maneker: [00:08:17] Yeah. And he was so focused, although you have to give him credit, it was right at the end of World War I. And so he was so focused on getting the nation recovered from world war II. That he didn’t want to derail it by [00:08:30] this pandemic.

[00:08:30] So according now, according to this author, who’s the expert on that 1918 Spanish, what they call it, the Spanish influenza pandemic, that there was a lack of transparency. That was one of the greatest like faults of that pandemic. 

[00:08:48] Bill Russell: [00:08:48] That’s interesting. It’s fascinating because we, one of the things I try to stay away from these, first of all, I’ve tried to stay away from clinical topics.

[00:08:56] Cause I’m not a clinician, but second of all, I try to stay away from these [00:09:00] potentially controversial topics. But transparency is an interestingtopic. We have a problem with transparency just within the four walls of the United States, that’s just the boundaries of the United States, but a pandemic doesn’t exist within the boundaries of the United States.

[00:09:16] It exists around the world. So we’re not just talking transparency within the US we’re talking about transparency across, many nations, many types of ways of delivering care and those kinds of things. that’s [00:09:30] a huge, we’re talking about public health globally. That’s actually a huge lift. Yeah. 

[00:09:35] Amy Maneker: [00:09:35] Although I believe that when he talked about transparency, he was talking about it in the US because of, I don’t know that there’s that much known about the 1918 pandemic around the world, like to that level of granularity. Yes. Anyway, I found that absolutely fascinating. And that some of that, a lot of the things that we’re living through were the same things that went on in 1918. And, For better or worse. Isn’t that an interesting comment? 

[00:09:59] Bill Russell: [00:09:59] we’ll [00:10:00] have to, we are going to learn so much and or where are you going to delve into some of this topic in terms of physician burnout, but as we were talking earlier, some of this, the story hasn’t been written, we don’t. But all right, let’s go to physician burnout, huge topic.

[00:10:16] The last time you and I got together, we talked about the Arch Collaborative. In fact, you introduced me to the Arch Collaborative. The last time we talked, I went on to have Taylor Davis on the show, and several other people have come on to talk about their results. Around there as [00:10:30] collaborative, cause it has done so much good work within the industry.

[00:10:33]and you talked about, IT spend, voice recognition, scribes didn’t correlate to user satisfaction. And we talked about that a little bit. Then you shared how personalization training and ongoing ownership and engagement were the keys to satisfaction. That was 2018. What have we learned since then? 

[00:10:52] Amy Maneker: [00:10:52] So the three tenants that come out of the data. So there’ve been the Arch Collaborative. let me back up one. I’m not going to call [00:11:00] burnout. I’m going to call this user satisfaction. Cause I think physician burnout is a much bigger topic. And for the bigger topic, I look to the experts like, Stanford and HFML and all the components.

[00:11:12] But I think the EHR plays a role in burnout. Sometimes, it’s because it’s part of the cost, but sometimes there’s also, it’s where it’s and some of the disease. So if there’s more regulatory requirements put on the physician, you’ll see it in the EHR. So they’ll blame the EHR. [00:11:30] Or if the physician is asked to be doing all these mundane tasks, that really could be offloaded, if we did team based care, they’ll feel it in the EHR. 

[00:11:39] So I don’t think all of you have to separate it out. And so then I try to talk about user satisfaction in the EHR. Cause I think that’s more, we can focus on. The Arch Collaborative is just one tool. There are many organizations who are addressing user satisfaction and may or may not be using arch collaborative.

[00:11:58] What I like about it [00:12:00] is it’s a survey tool and it basically says. Hey, does your EHR allow you to provide quality care? And if so, why or why not? what are the components and the three components despite more data than two years ago, much more data still hold true: training /education, personalization, and what I call shared ownership.

[00:12:24] They have different terms for it. I think it’s mastery and sale. [00:12:30] I’ll get you the exact terms they use. That might help. It’s strong user mastery, shared ownership, and it EHR meets you unique user needs. So strong user mastery is education and training. Shared ownership is ownershipand engagement, and EHR means unique user needs is personalization.

[00:12:54] and I think those it’s whether you do the Arch Collaborative or not, or get this data, I think. [00:13:00] That is becoming more standard understanding. So Judy Faulkner recently spoke at a forum at the Cleveland clinic called ideas for tomorrow, and somehow it’s been all over. I actually saw it because I’m connected to the Cleveland clinic, but her tent, what she’s mentioned there has been seen everywhere in Twitter.

[00:13:20] And she even talked about, Hey, you have to have ongoing education. And, and she talks about personalization. She didn’t. She talks about shared [00:13:30] ownership by they’re very specific. They have one flavor of it at Epic, or they have one term physician builder. I think there’s many more ways to do physician ownership and engagement beyond the builder.

[00:13:41] And that can be vary between organizations and it can even vary within an organization. So the orthopods may have a physician who’s involved in a certain way, and the primary care providers may have a different. In fact, one of my compatriots says we don’t use the title, physician [00:14:00] builder. We call it EMR director. One of the tools they can use as being a builder. 

[00:14:07] Bill Russell: [00:14:07] Interesting. So 

[00:14:10] Amy Maneker: [00:14:10] Arch collaborative, they’ve more data, but it’s still holding to it’s those three tenants. 

[00:14:16] Bill Russell: [00:14:16] Yeah. So I want to break, I want to break those tenants down a little bit. and this isn’t just the Epic, this is any EHR. the arch collaborative covers and it’s interesting. So when we talk about personalization, here’s my quick story [00:14:30] on this, we do an EMR implementation. We have a bunch of physicians that love it. A bunch of physicians that hate it. And one of the stories is we sent a. Person to go elbow to elbow with a clinician who hated it.

[00:14:45] And it turned out. He didn’t, he hadn’t done any personalization. And when the, physician champion came back to me, he essentially said if I ran that same build that he was running off of, I would hate my job just as much as he does. And, [00:15:00] so talk to us about personalization. what is available to us?

[00:15:02] What can we actually do in the areas of personalization? 

[00:15:05] Amy Maneker: [00:15:05] what you can do varies on what EMR you’re on. But I think you’re true. So you may, Taylor Davis will say, if I handed you your iPhone and they took away all your things you added to it or did to it, you wanted anymore. So I think some organizations have heard that the value of personalization surrounding implementation, what I think we’re missing is that it’s never ending.

[00:15:28] So one year [00:15:30] there’s a new med or there’s a new workflow, or you see a new type of patients or the software gets upgraded, or you change what you’re doing. The personalization is ongoing. And so I think many organizations realize the importance of doing personalization of go live, but then they never touched it again, so that’s a loss. 

[00:15:50] And then I agree that some people don’t do it. And then some people don’t even understand what the value of it is. and so they need help for someone to tell [00:16:00] them: a compatriot. And so it’s particularly with ABAC. You’re not everyone has to do the personalization so I can create all kinds of cool things and share them.

[00:16:10] So I’ll give you a goofy, I’m a PTR doc, and I’ll give you a goofy example that resonates with physicians is, during a time when we’re a season where we give a lot of eyedrops, I would create a favorite where it was right. Eye left eye, both eyes. And so that it was one click. And when some people just couldn’t wrap their head around the value of [00:16:30] that.

[00:16:30] But if I told it to them and say, Hey, I built out the most common eye drops, right? Eye left eye, both eyes. Or I built out, the steroids top common topical steroids, and I write what strength they are and insurance. Oh, I need this one for this insurance. Plan, and I need that one for it. Cause once you look it up, once you don’t want to ever look it up again.

[00:16:53] And one, if it’s someone in a different specialty, they’ll look at me and say, Oh, I just thought of the things that would help me. [00:17:00] Two, if it’s someone in your specialty, you don’t all have to personalize it. One person can do it for you and share. So I think personalization, the take home messages, I would say it’s not one and done.

[00:17:13] It’s ongoing. Two, not everyone can wrap their head around of what they need to personalize and where and nor should they have to. So they need someone to help coach them to where it would help them. And three, in certain specialties, you don’t [00:17:30] need to do it. One person can do it and share with everyone.

[00:17:34] So a million years ago when I was an ed PTD attending and we were implementing eclipses. So think how long ago that one, one of the ways that you personalize there is by building specific patient lists. And so I basically, when any was on at night, get a little quiet with anyone, I would say, Oh, don’t sign off.

[00:17:53] I’ll go in and I’ll build your list. So I built them Friday when this is long before you could share it. I would build them for [00:18:00] everyone. Now, some people would then go on yeah. And say, Oh, now that she taught me a, B and C, I’m going to build through Q. Others would never touch it again. But yeah. As I said, not everyone would wrap their head around it.

[00:18:11] So personalization. Is a little bit more complex than it may seem at first lush. Did that help? 

[00:18:18] Bill Russell: [00:18:18] Yeah. So it’s a little loud behind me. I’m going to try to get the questions and what are some best practices you’ve seen around getting people together to share, share those builds, share what they’re working on and those kinds of [00:18:30] things have systems put together a better frameworks.

[00:18:32] Amy Maneker: [00:18:32] I think that goes back to ownership and engagement. I think if you have a physician who part of their job. Is the EMR. No, it doesn’t. Once again, it’s like team based care. Everyone should be operating the highest level of their license. I’m not saying that they should provide the, at the elbow support, but.

[00:18:50] If they have someone, they couldn’t direct to provide the FMO support, but they’re the person who’s responsible for the upkeep of the specialty specific like [00:19:00] preference list. They understand it. They like it. Their job becomes, they often all the person who will also create the personalization or help people. understand what, where the value of personalization is. So I think the best practice ties into ownership and engagement of having someone at the specialty level or the practice level. It’s very dependent on how you’re organized, have that role. So at one organization, we call the DMR medical lead. [00:19:30] Now, remember Epic has this thing of physician builder, and I say, no, there’s all kinds of flavors. And that organization is the medical lead. 

[00:19:40] Bill Russell: [00:19:40] So it might get a little louder behind me at this point. give me an idea of around training. So a lot of different health systems have done training in different ways. what are some best practices in regard to, initial training and then sustained ongoing training?

[00:19:57] Amy Maneker: [00:19:57] So to be clear, I don’t think we [00:20:00] know that much. As much as we should need, should know or want to know someday the arch collaborative is perception and asks you how good your training was. So in the arch collaborative data is clearly someone who cares note knows their workflow. And I’ve learned the hard way that physicians do not tolerate poetic license.

[00:20:20] So if you come up with, you’re doing the training and you use something that doesn’t make medical sense, they get totally derailed by that. They will not allow [00:20:30] poetic license. So the training content, my belief, cause you really need a physician champion or expert to say what’s gonna be important. Not that with collaborating with the trainers.

[00:20:40] Now some of the vendors believe in having the physicians train. And I think that’s great when you find that valuable and find someone who can do it and you can justify the docs time. I think you can also have a physician just be responsible for the content. And have the trainers train and be equally successful.

[00:21:00] [00:20:59] Cause you know, some physicians aren’t meant to be trainers or teachers let alone the cost of that. So that’s training. And when I say training, I’m really talking about initial implementation. Education ongoing comes in all kinds of flavors. And I think it’s probably varies by organization and how they’re organized configured, are they independent docs, employed docs? Are they all one site? Are they 25 sites?

[00:21:28] But I think there’s many ways to [00:21:30] do that. And I personally think, once again, you need some physician owner who says, Hey, this is what my people need to know. This is where they’re struggling the most, my people in GI.

[00:21:43] And then have someone go out who can go out and do that. So I have some at the elbow support and do that. There’s been a lot of success with having training and ongoing training in the classroom. And you may have heard of, there’s been a lot of success with what they call sprints. It [00:22:00] started or got the term from university of Colorado, where they do very focused.

[00:22:04] They come in and do very focused at the, at a group specific group of people. The group of. Physicians, I think it’s at the practice level. So specialty level and they do some build cleanup and they come up with some specialty specific tools, but they do some very focused training. I think there’s also been shown from the arch collaborative that ongoing sometimes just having someone meet [00:22:30] the physicians when they’re already needing. So their division meeting, their department meetings and one, field some questions like what are your pain points? And they’ll come back and also show them some things. So I think there’s a lot of ways to do it, but I think the thing we’ve learned.

[00:22:45] I’ve been doing this a long time. And I think we all thought, Oh, we did training and we never come back. I think what we’ve all learned is no. So in other industries, like if you’re an engineer and you use CAD computer system design, you get trained or [00:23:00] ongoing. My understanding is accountants get trained ongoing.

[00:23:03] I think we didn’t realize that. And I think we also didn’t, I’m going to use air quotes budget for it. So that’s resource intensive. And I don’t. And so I think a lot of organizations, we all, didn’t. Now a lot of organizations have started, there’s these, programs, a few people call them home for dinner.

[00:23:22] Kaiser started a years ago, Kaiser, Northwest, where I forgot what they call it, where they take them off site to a [00:23:30] resort kind of thing. And they have a physician teaching it and it’s a number of days. So it’s very resource intensive, but they’ve got a huge value from that. So I think none of us are planned for it initially, and we’re all wrapping our heads around how the best way to do that.

[00:23:45] And now, some of the CEOs of the vendors now specifically say, Hey, you need ongoing education. 

[00:23:52] Bill Russell: [00:23:52] Yeah, there’s the home for dinner programs. We’ve heard it from a bunch of different health systems. We did a thing called 60 back and we [00:24:00] were measuring, can we give 60 minutes back to every clinician in their day?

[00:24:04] And at first, when somebody said 60 minutes back, I thought, Oh man, that’s pretty daunting. But then you realize, making this change, the order set, making this change, each one of those ads, just, they start to add up very quickly and before long you’re looking way past 60 minutes back. because that’s how much time has been taken away with the regulatory burden and time 

[00:24:26] Amy Maneker: [00:24:26] Physicians hate, and I hate clicking around looking, [00:24:30] and so it’s the frustration. And so we have found that when physicians know how the system works and doesn’t do some personalization, then they actually spend more time in the system because now they’re not clicking around now. They’re, they’re actually delving into the patient’s record and looking for trends and looking for what’s going on in the past, because they feel comfortable in it.

[00:24:53] So it’s not always time, but that clicking around not knowing what to do is just a horrible feeling and the time waste. 

[00:25:00] [00:25:00] Bill Russell: [00:25:00] Yeah. I’ve been at a bunch of different organizations. Is the CMIO role distinct or different at each organization or have you found they’re pretty commonly. Really? Yeah.

[00:25:18] Amy Maneker: [00:25:18] I’ve been a CMIO or in a CMI role for years. And like six, eight years ago, I thought it would start to normalize, you look at organizations and you’ve even asked what is the CFO doing responsible [00:25:30] for, it varies. But I feel like the CMIO was all over the map from organizations that literally expect the CMIO to do at the elbow support, which I’m not above. I like that, but you’re at a big organization, that’s not very cost effective. That’s not scalable. Like what, how many people are you really going to help? 

[00:25:49] And then there are others where I’ve been where, the CMIO is on the CEO’s executive cabinet and is really doing the strategy and vision [00:26:00] of how we’re going to leverage technology to improve quality and value of healthcare. And everything in between.

[00:26:07] Bill Russell: [00:26:07] Yeah. And that’s been my experience as well, is that, when I talk to people, there’s a, some CMIOs are just focused on the EMR. That’s what they do. They come in every day and it’s, and that’s a big job. It’s a significant job and it’s constantly changing. There’s constant needs for education as you discussed.

[00:26:28]and then others, really have [00:26:30] a heavy focus on analytics. And informatics and those kinds of things. So they’re spending a lot of time on the, on the, the report side and on the dashboard side and, and even somewhat on the research side. are we going to see a normalize or is it just going to be specific to each organization?

[00:26:48] Amy Maneker: [00:26:48] I don’t know. I would have thought it would have normalized. And I’m beginning to see in some of the more mature organizations we’re beginning to see. When we go back to this whole idea of ownership and engagement, more [00:27:00] physicians with roles. So I see more and more. I’m the lead for GI. Yeah, I remember I talked to a one organization called it Epic medical lead, or, another one calls it, I think the medical director. 

[00:27:14] And then they have more associates CMOs and they’ll say, Oh, my associate’s CMR handles analytics. Or my associates CMIO handles ongoing education and training because not one person can do that all. So that’s what I’m seeing in the more mature organizations. The [00:27:30] younger or not even younger, just ones who just aren’t getting there.

[00:27:34] They still have the CIO owning these clinical things. And I’m always like, is that really the right role? The CIO has so many other important things to do. And the CMIO is really, as I said, I’ve seen, I couldn’t believe it, but I’ve seen large organizations where the CMIO basically was there to do elbow support.

[00:27:56] Bill Russell: [00:27:56] Yeah. So we’re now. So with the arch collaborative, we’re now entering a [00:28:00] couple of years into it. So we’re probably doing second and third surveys of some health systems. How have we seen significant progress in the area of experience and satisfaction amongst the clinicians? 

[00:28:13] Amy Maneker: [00:28:13] So there they are re-surveying  and not. So I do want to caution is we also hear a lot about. Over-surveying. So there are many organizations who are very interested in all these prem, but aren’t participating in the arch, collaborative army surveying, and many of them will site. [00:28:30] they feel that their users are just not, survey is not where they want them to focus their time and energy, or maybe they survey them too much.

[00:28:39] They don’t want to throw that out there. Yes, we are seeing those, we surveys and with Arch Collaborative data, we do see some wild success stories when people do some really interesting things to intervene, which we can talk about. Then we see some who they don’t move much. Some of those have been. [00:29:00] That even though they did a lot about the EHR, there were other detractors.

[00:29:04] So when people are unhappy, so people were being asked to work more hours or have less control of their schedule. And when they delved into it, those are things that contribute to burnout. And so when you ask people how they feel about their EHR, if you’re miserable. So there are some that I can see an improvement that they felt were due to competing factors.

[00:29:26] There were very few. I think there may have only been one to date that got worse. [00:29:30] And also there was like an explained reason. Explain a reason. I could explain that. How’s that? So 

[00:29:36] Bill Russell: [00:29:36] give us an idea of some of the interventions you said, some interventions came in and really moved the needle. 

[00:29:40] so one of my favorites is, and I’m going to say, who did is ortho, Virginia.

[00:29:44] Amy Maneker: [00:29:44] And the reason is it’s orthopods and private practice. So not an easy group to move. And one, they have a phenomenal leader who has always impressed me, and he has this. I show it to you. You can use the slide. He shows them this is [00:30:00] climbing Denali and he says, climbers of Denali, “survival is your personal responsibility, high risk activities like nuclear technology require awareness, skill and commitment and gratitude and contribution.”

[00:30:14] So one, I think he’s trying to tell the, these orthopods, like you have some responsibility and ownership here. This was just done to you, but then they also created a role. That’s the acronym is PSS. It’s like provider support something. [00:30:30] And I think it who rounds and job is to help.

[00:30:34] The orthopods you found was that early on, they wouldn’t necessarily welcome the assistance. I think that’s why their CMIO said, Hey, you need to have some gratitude and contribution when people understood the role, the value of this world embraced it based on significant increase. So with that, it was changing the attitude, Hey, it’s your responsibility, but we’re going to [00:31:00] provide you with the tools so that, 

[00:31:03] Bill Russell: [00:31:03] yeah. are you finding that budgets change after an organization does, goes through the first survey process? 

[00:31:09] Amy Maneker: [00:31:09] I can’t comment on that. I don’t know that. I know, I do know that people have talked about that. I know I’m the sprints and university of Colorado as a significant budget. So I think what often, what I’ve seen anecdotally, but I, a day is people doing like the CMIO at university of Colorado place where [00:31:30] I worked, we did it significant intervention because we had some other leverage.

[00:31:34] Oh. And a friend of compatriot of mine. In the Midwest there’s was burnout. Ours was, access and ambulatory. I don’t know what Colorado’s was. So they do something to intervene because they’re riding, they put their caboose on a freight train of that, the organizations, big endeavor or big goal, which I am a huge fan of.

[00:31:55] They prove the value. And then they say, Hey, this is great, but this is what it [00:32:00] costs to do. And then I’ve seen those get funded. But yeah, it doesn’t happen. None of these things happen for free, unfortunately. And I think it’s going to be tough in this day and age when budgets are tight and healthcare. Did that make sense?

[00:32:16] Bill Russell: [00:32:16] Yeah, no, it makes sense. I might end up doing a whole show on budgeting if I can find enough people to talk about it. Cause it’s interesting. Cause off the air and email wise is probably the area I get the most questions. Like how did you [00:32:30] get enough money to do training? And how did you get enough money to do whatever correctly?

[00:32:35] Cause. Everything requires a certain amount of money to do it well. And then there’s so many requirements in all these health systems in terms of where they need to invest their money. So it is a challenging area. I’m going to ask you a couple questions, 

[00:32:50] Amy Maneker: [00:32:50] Can I speak to the budget thing before you do that?

[00:32:53] I’m a huge fan. When you’re in a CMR role who often either don’t have a budget or minimal line of tying [00:33:00] your caboose or your car on the freight train to an organizations larger goal. And so then you can at least do the pilot under that budget, or you’re riding that forward wave and that’s where I’ve had success and I’ve seen success.

[00:33:16] Does that make sense? Saying, Hey, I need more money for training. Let’s say the organization is addressing physician on happiness and you say, look, it’s been shown. You need better training while you have that huge endeavor [00:33:30] about physician dissatisfaction. Can we do some training interventions?

[00:33:35] And when you show that value, then you can circle back and say, okay, that’s really valuable. This is what it would cost to continue to do that. 

[00:33:43] Bill Russell: [00:33:43] Can we tell, so what other, what are some other system wide initiatives? Can we tie it to a quality initiative? Do you think? 

[00:33:51] Amy Maneker: [00:33:51] Yeah, I think you could. Yeah, you probably could. I’ve seen it most likely, [00:34:00] most commonly tied to. user satisfaction, physician dissatisfaction, burnout, more particularly in ambulatory. So an ambulatory, if the physician isn’t efficient and can’t move through them, the whole office stops. Okay. So while I’m an inpatient, if I’m not a fit and I’m just there later, but so I’ve seen an ambulatory, then they want to help improve it, access or efficiency.

[00:34:23] Then you can intervene with the EMR and user satisfaction. You’ve done a lot of bang for your buck. I think you [00:34:30] probably could do it for quality endeavors. if you say, we’re not doing great with VTE prophylaxis and the tools are in the EMR, but people don’t know how to use them. We need to do some training.

[00:34:43] And then somehow make it bigger. You could probably do that. Hey, we’re not hitting our quality marks. Cause people aren’t doing them in the EMR. We need to teach it the EMR and spread that. I don’t have an example of that, but I’m not saying it couldn’t be done. 

[00:34:57] Bill Russell: [00:34:57] Do you find that clinicians [00:35:00] generally understand all the things the EMR can do? I mean that, it’s one of the things. So cause the EMR can do a jillion things literally. And what I find a lot is IT organizations struggling because a physician wants to bring something in and they’re like, you realize that our EHR has that module or has that capability or those kinds of things.

[00:35:22] Amy Maneker: [00:35:22] It’s not uncommon that when people ask for an “optimization,” I’m using air quotes. let me speak to things, but it’s [00:35:30] actually there. But the other common thing in informatics is we need to focus on what they’re trying to achieve, not what the user says they want, because what they says they want is not necessarily A, the best way to achieve it, or if the software isn’t going to do it, or that’s not really what they want. So someone recently said on a podcast, Let the experts do their job. 

[00:35:53] So get the CMIO, get the physician informaticist in there in the conversation. So you can say, [00:36:00] this guy says, I want, and I can give a great example of this. I want something. And they’re like, what are you trying to achieve? we can do it this way. So yes, we commonly see, but what someone wants in an optimization, it may even be there. But then if you say to them, what are you trying to achieve? Is that the way to achieve it is there. 

[00:36:23] Bill Russell: [00:36:23] So Amy, we had a discussion earlier about, what are some of the priorities? What are some of the things that CMIOs are focusing on right now? [00:36:30] And what are some of those things that you think are critical that CMIOS should be focused on? 

[00:36:35] Amy Maneker: [00:36:35] I think there are some big regulatory changes coming down the pike that I think are going to inside many CMIOs because of through no fault of their own, they were dealing with COVID for six months.

[00:36:46] And now all of a sudden we’re looking right in here. I have some big regulatory changes in top of mind. Top of mind for me, is information blocking related to the 21st century cures act. That’s one component, which [00:37:00] theoretically goes into effect November 2nd. And in some ways that is no big deal. It’s just some changes on your release rules, but it really, I think it’s a really big deal, I suspect, cause when it’s how you interpret the laws and the exceptions. So there’s seven, I think exceptions, and it’d be interesting to see, people, organizations interpret it and so you probably need to get legal and compliance and Get involved.

[00:37:26] And then there’s going to be a change management component. So if [00:37:30] our patients are now getting our notes, our labs, radiology pathology, the way to handle that is to have the, what I used to say when we first did, release is having a different conversation in the exam room. So not only does everyone need to be familiar with it. So even if the nurse needs to know the patient’s going to get these results and then say, Hey, your results are going to come back.

[00:37:53] As soon as they’re finalized, if you don’t want to see them, before talking to the doctor, wait for the doctor to call like, [00:38:00] that’s a reasonable plan. So one was I think, a significant education and change management. So it’s interpretation is configuration, which I think is the least of it. And then there’s probably a lot of education and change management.

[00:38:15] Bill Russell: [00:38:15] Yeah. the other area?

[00:38:17] Amy Maneker: [00:38:17] The other thing that’s top of mind is that as of January 2021, B and M codes change and. They have a significant impact. you can make them have them. I think they should have a much bigger impact [00:38:30] than you can get by with just teaching people. But in reality, now all of a sudden the ENM codes are not based on history and fiscal they’re either based on time or they’re based on the number of problems, addressed amount of data reviewed and risks and complications.

[00:38:48] Bill Russell: [00:38:48] So that’s a huge benefit to the physician. Isn’t it? 

[00:38:51] Amy Maneker: [00:38:51] Oh, it’s a huge benefit but all those notes, you created the blow, all the information in, do you really [00:39:00] want to still use them? So this is really an opportunity to rethink all the templates and to put the right information. And, Oh, by the way, this is related to what we talked about. Information blocking, because notes are going to the patient. So do you really want a note bloat, horribly bloated note to go to a patient. It really doesn’t communicate, it’s hard to figure out. So this is really an opportunity to reconfigure notes, which is a heavy lift. And then the other part goes back to, we were talking about education.

[00:39:30] [00:39:29] So many people use all the things that blow into the note as their way of reviewing it. So I look at the patient’s meds. I look at their medical problems, cause it’s all blown into the note. they don’t need to be blown into the note, but now the doc needs to know how to efficiently and effectively review that information. So it could be ambulatory. So my understanding is for now it’s ambulatory. 

[00:39:58] Bill Russell: [00:39:58] Yeah, [00:40:00] it has gotten extremely loud at my house directly. Breaking concrete right now. So I can barely hear me self-talk at this point, Amy, this is a fantastic conversation I did want to go into COVID a little bit more and those kinds of things, but, as we were talking earlier, I realized as you pointed out, this story has been written of the impact that COVID has had on physicians and on providers at this point. And, that’s probably a conversation that we’re going to be having, but [00:40:30] we’ll have more data as we go into, into next year I would think. 

[00:40:35] Amy Maneker: [00:40:35] I agree. One, we don’t have the data. And as I mentioned in many organizations, the normal congregation isn’t happening.

[00:40:43]the normal resident work room where everyone hung out on the attending drop by and they traded stories, let alone. They also said, Hey, what do you think of this patient? What should I do in many organizations? They aren’t doing that as like the Harvard hospitals aren’t meeting, everything’s by zoom.

[00:40:59] So all that [00:41:00] trading what they’re experiencing isn’t happening. So I don’t even think in my experience, in not in the hospital that people have even necessarily congregated to see what’s going on. And I think that they really do feel the social isolation is, a lot of my friend compatriots report, I think I chose that anecdote, a friend of mine’s a bench researcher at the med school and she goes in, you don’t see any, if you were going to talk to someone down the hall, you’ll do it by phone or by [00:41:30] video platform.

[00:41:31] She says, someone I, for 20 years, I always either saw it at the coffee place or stopped and we had coffee together. I haven’t seen since March. So I think we don’t know, even with our own organizations what’s going on with everyone and how everyone’s feeling. 

[00:41:45] Bill Russell: [00:41:45] Absolutely. So Amy, and thanks again for, for stopping it on the show. I really appreciate your, as you say, you’re growing wisdom as you get out there. And, I hope to visit with you again next year as you, as you get out there, you’re a [00:42:00] CMIO essentially for hire at this point. 

[00:42:03] Amy Maneker: [00:42:03] Yeah, I’d be happy to be a CMIO for hire. I’m also doing consulting and then my finger or my eye, lots of irons in the fire. I’m working on stuff related to informatics and my areas of expertise, which is really fun. 

[00:42:20] Bill Russell: [00:42:20] And I apologize to my listeners and I apologize to you for the background. I went and talked to them and they just looked at me like, We’ve got to keep working [00:42:30] so they’re breaking concrete behind me. It’s probably not the best studio right now.

[00:42:35] Amy Maneker: [00:42:35] We have to redo it and you’ll let me know. 

[00:42:37] Bill Russell: [00:42:37] Alright. Hey, thanks. Thanks Amy. Take care. That’s all for this week. Don’t forget to sign up for a clip notes. Send an email, hit the website we want to make you and your system more productive. Special. Thanks for our sponsors. Our channel sponsors, VMware, StarBridge Advisors, Galen, Healthcare, Health Lyrics, Sirius Healthcare, Pro Talent Advisors, HealthNXT and our newest channel sponsor [00:43:00] mcAfee Solutions for choosing to invest in developing the next generation of health leaders. This show is a production of this week in health IT. For more great content check out our website this or the YouTube channel. If you want to support the show, the best way to do that, share it with a peer.

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