June 12: Today on the Conference channel, it’s an Interview in Action live from HIMSS 2023 with Andrew Burchett, MD, Executive Director of Medical Informatics at Meditech, and Doug Kanis, MD, Physician at Pella Regional Health Center. How has Meditech's Expanse platform improved the clinician's experience and productivity, particularly in terms of mobility and accessibility of patient data? What are the main challenges and benefits of integrating external data sources through interoperability tools, such as the Google Search and Summary feature, and how does it impact the clinician's workflow and patient care? How has the clinician experience improved with the introduction of customizable tools and widgets in Meditech's EHR system? How does the integration of voice navigation and voice ordering in the EHR system contribute to enhancing clinician experience and reducing cognitive load?
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Welcome to this week, health my name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health. A set of channels dedicated to keeping health IT staff current and engaged. Today we have an interview in action from the 2023 Spring conferences, ViVE in Nashville and HIMSS in Chicago.
Special thanks to our cDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders.
You can check them out on our website this weekhealth.com, now onto this interview.
All right. Here we are from HIMSS
2023 in Chicago. I'm here with Doug Kanis Dr. Doug Kanis and Andrew Burchette, Dr. Andrew Burchette with MEDITECH and looking forward to the conversation. How's the conference going so far?
It's fantastic. I've been working in the booth and a lot of traffic.
I'm really enjoying showing off the MEDITECH Expanse to all the people that are coming by. It's been quite busy.
Yeah. I would, I would imagine this is we're thinking it's about 30,000 people who are here sort of milling about. By the way, that's me doing this with my thumb and going, I think there's about 30,000 people here.
But having been to a bunch of conferences, that's what it, it feels like. Yeah. Andrew, you're pretty new with. MEDITECH, right? Yeah. Started in November. So a longtime customer. So
longtime customer. Been with Avera 20 years 20 year customer of MEDITECH or I've been using MEDITECH for 20 years.
MEDITECH'S been with them 34, so long standing relationship there.
And Doug, how long have you been with MEDITECH?
I've been doing consulting for MEDITECH probably about 15
Wow. so Expanse represents a pretty significant move forward. How is the physician, the clinician's voice being heard in the development of, the solutions that MEDITECH'S bringing
think what you've seen with Expanse is a large commitment to provider, including nurse productivity, efficiency bringing clinicians into the development process, early development and design. Doug and I work with them closely and many others to make sure that our needs at the clinician level, if you will, including nurses, is brought forward into the product.
And then we can then take that out to, to current and prospective customers.
So what does it look like? I mean, how will the clinician experience some of the, it's not only Expanse, but it's some of the other tools. I, we, we've talked about I'm not sure what to call it, the Google integration, is that
Is that what we're calling it? Google Search and Summary? Yeah. Is probably the, the latest and most exciting development, if you will, so that, you know, we, we sit on a tremendous amount of data in the EMR largely unaccessible, right? So we can, surely we have tools and Expanse is one of them to bring that forward.
I can personalize my experience. I can get to data pretty quickly. But we are inundated with outside data as well. So, Interoperability is probably the, the hot topic here, I guess, at HIMSS this year more so than in the past. That does bring a lot of extra burden to us as providers. All the CCDs coming from outside sources, Commonwealth and Carequality, amazing.
You know, coordination between those two organizations bringing data from across the country, however, we have to ingest it and then process it. So, what does that mean for you as a patient? That's our job to do that it's the EMRs job to make that easy. Google Search and Summary will help us do that.
So I can look for concepts such as CHF or diabetes and see everything associated with that. So it wouldn't matter if it was legacy data, current data consumed data from an outside source, structured, structured, unstructured uh, single pane of glass, right? So that I can see structured, unstructured scanned documents even written documentation if there's some written assessments that are done. So, that just speeds my hour. Time to diagnosis, to treatment for you but also connects us to the outside world. So I think from a patient perspective, it's a big win. Cause you can be assured that we have access to most of the data, right?
Not all, every. Maybe we'll get there at some point, but I think the interoperability tools that are available there are huge. I would take a close look at the MEDITECH Traverse product that allows me to connect to another EHR vendor and another vendor system. And then I think the other thing with interoperability is just the how would you say the improved coordination among.
All vendors. So I think that the Commonwealth Carequality platforms allow us to connect to disparate sources that we don't, wouldn't normally
be able to connect to. So,
so if what, what's driving the interoperability? Is it demand from the health systems? Or is it the the 21st Century cures and the drive around that?
I mean, what's, what's, what's really driving it?
I think there's many drivers. Obviously. I think that patients are pushing for it. I think patients expect it. I think physicians need to have that to take care of patients appropriately. So, There's many different areas that are demanding it at this point.
And I think also when we can have that information brought to us in a timely and efficient manner that makes us better and more efficient, and what I see in my practice every day is that it's tough. Nursing staffing problems are happening. And we need to be able to get as much information as we can get it in an organized way and make really rapid but appropriate decisions with it.
So I think there's many different factors that push into that, but I need to do that in my clinic to make the workflow work.
So you, you are both still practicing ?
Correct. So I background hospice palliative medicine continued 20% of of my time is medical time.
So the EHR now, over the years, we've talked about the importance eye contact, talking to the patient, whatnot.
Have we made significant progress in that area of, of really engaging the patient instead of being a clerk like they talked to you in, medical school?
Yeah, absolutely. I think that with the Expanse platform, particularly going mobile, any browser, any device using a tablet in our work, in our workspaces, versus being tethered to a wall on a pc being able to interact with the patient with the same experience.
So I can discuss a chest x-ray or maybe your lab values with you just flip the tablet and you can have the same experience I'm having on the clinical side. So I think that sort of mobility brings a different interaction with patients and providers. So any device, any device.
So it used to be we have to put a computer in every room, right?
And you go in, then you'd have to, you know, badge in or worse, you'd have to do your password and whatnot. You're, you're essentially doing your rounds or. Potentially going , from room to room with just the tablet and it's tablet. Yep. Just going, going through.
Yep. Yeah, and it's, it's your, it's provider choice.
So I use a, convertible laptop, tablet. Sometimes I need a keyboard, sometimes I don't. It's voice enabled so I can navigate the chart. I can also dictate in any field, I try to order and e-prescribe real time so that I'm not forgetting to do that later or doing something in error. Absolutely mobile all day. 📍
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now, back to the show.
And so give me an idea. So I was a significant MEDITECH customer back in the day 2012, 2013, 2014 timeframe. How has the clinician experience changed with the tools that we've rolled out?
It's vastly different. It's so impressive now to see these tools that we have with the widgets that physicians can design to really suit their workflow individually.
I've been able to sit with so many different doctors and go through these widgets to get them the information that they want, so really they can customize their experience with the EHR. The time that they're spending doing chart review is decreased so much at this point. They're really getting the most pertinent information pushed to them to make them so much more efficient.
It's really a fantastic experience.
It's, it's interesting because the, the KLAS the Arch collaborative, and one of the things they said was training, obviously very important, but they said customization is so important. Yes. Yeah. What level of customization are we looking? And, and by the way, what they essentially said is the physicians who didn't customize their environment, Absolutely just didn't like the experience at all.
And those that did found much more productivity, much more just adaptability to their practice, that the EHR sort of put its arms around them instead of them having to really morph all the things
do. Right. So what does that look like?
So I think legacy platforms are pretty rigid on the devices you use.
User interface, couldn't move things around. I kind of get what you get, right. With, I think the new platform Expanse being one of them, being able to again, move things around, including widgets or clinical tiles. I mean, we can do this everywhere else in our life, right? So you. Pick the apps on your phone.
Your first two or three screens are the ones you use the most. That's what we do with clinical data. Nothing should be more than a click or two or a tap or two away if you're using a tablet. And that's what we optimize for when we, we both work through optimization in our organizations. If you're looking for something more than once or twice a day, it should be on your home screen.
Ours will look different. We, we see different patients. You know, you can have a cardiologist, an ob, an internal medicine, all with a different experience. But in the same EMR, we're doing the same enterprise umbrella, but not in that rigidity. That was in past EMRs and so wanna makes you more efficient.
I think your satisfaction is higher. Obviously you're not pecking around looking for data all day. You're not a data a data scientist. And then the same, I would move it into documentation, the ordering, all those areas where you can customize personalized, maintain connection to your enterprise system, maintain connection to best practices like order sets but allowing me flexibility to do what I need to do day to day, those little things.
Are incremental. So, you know, not having to search for a hemoglobin a1c, having it front and center. If I do that four or five times a day or maybe 20 times a day they add up, right? So each one of those things has these incremental things, but at the end of the day, they're big. So if we're making four or 500 clinical decisions a day, if I have to look for data for each one of those if I can take two or three steps out of that, I mean, it's.
Just a tremendous overall savings
and it saves so much time. You know, at the end of the day, if you want to help prevent physician burnout, we're gonna provide excellent care to patients, prevent physician burnout. And I think one of the things that's been most highly associated with that is being able for physicians to say their charts are closed at the end of the day, so when they go home, they're done.
They don't have to log in from home and do more documentation. And when your chart review process and your documentation process is so customized and so efficient, and you know your partners are closing their notes by the end of the day. I think, you know, you're doing a good thing.
That's fantastic. The Google search to me is an iterative step to the next, which is, and I've talked about this a couple times, people look at me, but it's Star Trek essentially.
Remember in Star Trek they used to just say, Hey, computer, give me this information, and the computer would come back and say, here's the information. Are we getting closer to that, where essentially we're interacting with the EHR not through our fingertips. But essentially a conversation.
So we were an early adopter for the voice navigation. So I could say, Hey, MEDITECH, show me the last CBC, whatever it is I'm looking for. But to your point, the next step of that is voice ordering. So the Expanse platform makes it efficient enough that the navigation isn't as beneficial as it would've been in the past.
But voice ordering, is life changing, I can say, Hey, MEDITECH, order a CBC, or, Hey MEDITECH order, you know, lisinopril 10 milligrams, one PO daily, number 30 with five refills. That couple seconds it takes me to dictate. That would take me much longer to go into the ordering module and, do that.
Manually, right? So that is where I think we see big benefits. You marry that to an efficient user interface, a Google search and summary that gets me data better, faster, bigger. We can chip away at some of these things that cause physician burnout.
So a couple minutes of patient. How many patients a day, all that stuff starts to add up, right?
A lot less pajama time. Also just a cognitive load, right? The amount of, I mean, you were saying the number of medical decisions you're trying to make in the course of a single day, that's a significant cognitive load and it reduces the
burden, so, right. And it's cumulative, right? So I'm tired at the end of the day.
I'm tired at the end of the week. I don't want to see that one more patient, but that often is the patient you need to see. Right. So they're usually the sick patient or the one that will end up in the emergency department, or I could go on and on, but that's what we need to be kind of empowering our providers to take that cognitive workload away where possible so that they can provide better and more empathetic care when they, when they need to.
Fantastic. Andrew? Yeah. Thanks Doug. Thank you. Thank you, bill. Appreciate it.
Another great interview. I wanna thank everybody who spent time with us at the conference. I love hearing from people on the front lines and it's phenomenal that they've taken the time to share their wisdom and experience with the community. It is greatly appreciated.
We wanna thank our partners, CDW, Rubrik, Sectra and Trellix, who invest in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.