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 Welcome to this week at Health It, where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 49. Today we do a deep dive episode where we take a look at a decade of E H R implementations, probably longer than a decade to examine, uh, what correlates to success and what doesn't.

This podcast is brought to you by Health Lyrics. Health systems are moving to the cloud to gain agility, efficiency, and new capabilities. Work with a trusted partner that has been moving health systems to the cloud since 2010. Visit health lyrics.com to schedule your free consultation. My name is Bill Russell, recovering Healthcare, c I o, writer and advisor 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 of the Chime fall forum and uh, 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 e v p of Strategy and Analysis with class Research. Uh, good morning Taylor. Welcome to the show. Hi. Good morning, bill. Thank you for, thank you for having me. Well, I, uh, you know, so many people have, have come on the show. Uh, Amy man, uh, discussed. As, 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, and really, uh, wanted, which is what, what leads to success and what doesn't lead, uh, potentially what doesn't lead to success that we're spending an awful lot of time on. So, uh, I really appreciate the, the work that you guys have done.

Um, So the, 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 gonna focus in on this one topic. So let's start with, uh, the basic question. Um, you know, what is the arch collaborative and, and why does it, it exist?

Well, Billy, you said, uh, thank you that, that we've dived in and worked on the research that, uh, that we've all wanted. We wanted it too. So Class is a research organization for a lot of years. Let, let me give you actually my personal experience. So I've been with class for 12 years. Um, I joined class in 2007, early 2007, and, uh, Watch the rise of Electronic health records with, uh, you know, in 2009 through 2015, right?

Right. And, uh, so, so I've done thousands of interviews with healthcare leaders, with CMOs and CMIOs and, and uh, uh, CIOs. And it's common that we get on the phone with 'em and we say, Hey, how are these going for you? And they say, well, we still are really struggling. A lot of people are really disliking our E H R.

And we'd hear that about every E H R and I'd have interviews with a passionate physician that say, well, you know, Cerner's way better than Epic and Athenas way better than Cerner and Epics way better, you know, Athena. I think I just broke a transitive law right there as I, as I described it. But, but that, that's how it felt for us, right?

Is we were hearing it from everyone else and everybody was talking about, Hey, it's, the software class has put out ratings about the software for a long time and, uh, and there's no doubt that the software makes a difference. Um, but, uh, but we pulled together, uh, actually just two years ago. It was late November.

Um, uh, We emailed out to 10 of our friends and said, Hey, what if we, uh, all, you know, sorry. A couple months before that, we had done a, a quick poll and asked about a hundred organizations, Hey, have you measured the feedback of your end users about your E H R? And only 7% had done that. Oh, wow. So, so, and, and most of those of those organizations recently come live on Epic and.

There was only like 3% of organizations, uh, that were doing this themselves out of their own choice. Right. And, uh, so almost nobody was, was doing this. And, and, and at the same time, we're spending millions and millions of dollars on optimizations and a bunch of work. And so we said to 10 organizations, what if you all send out the same e h r 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 those five organizations. And, and as it came back in, the feedback was so interesting. So we had two organizations that were using the same e h R. They were both using Epic and the feedback was night and day difference.

One was incredibly satisfied with it, and, uh, and one had their, their physicians just screaming angry about, uh, about their experience. And it was at that point that we said, okay, there's something really interesting here. Two organizations using the same software, very different experiences. And, uh, um, so.

It started out as a benchmarking effort two years ago where we helped organizations kind of benchmark against each other. Today it's, it's a collaborative and, uh, and we're working, I'd say with, with some of the premier organizations, provider organizations, not just in the country, but in the world. And this, this.

Uh, survey that has been developed and continues to evolve has now been deployed at 154 organizations, um, at seven countries around the world. And, uh, and we're really starting to learn a science of what drives success. And then what's almost more exciting than anything else is, is that we've got, uh, 62, actually 60.

Have committed to measuring every year and, uh, or 18 months their experience. And we've now had, uh, six organizations that have remeasured their experiences. And, and for six of those, or five of those six organizations saw improvements in their satisfaction. And two of 'em saw huge improvements in their satisfaction.

So as we do this, we're starting to really learn what drives success and, and those re measurements, those are actually new since you saw our presentation at Chime. So, uh, we, we weren't even a place where we could talk about those yet. So pretty exciting. One of the things you talked about in, in the presentation was this whole idea of a playbook.

So one, one of the reasons that, um, I think Epic has done potentially better than some other EMRs, our E H r uh, implementations out there, is they have a very, um, uh, defined playbook. You will, you know, you do these things on these things, but, um, 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. Yeah. You know, that's the problem with, um, with doing things but not measuring is that you start kind of getting into ruts and you get those ruts deeper and deeper and you start thinking, Hey, this makes all the difference.

So let give you an example of one of those ruts, um, is that, uh, is there's just an assumption that if we put at the elbow trainers with people, it's gonna make a big difference for them. Or if we give them voice recognition, it's gonna make a big difference. And what we've learned is, is that you could 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 scribes in the wrong way, it's gonna end up taking you the exact opposite direction. So you're gonna put a bunch of time, energy, and money into making your E H R work better or your experience better, and it's gonna be.

On the Epic side, I think that this, this describes, uh, that there's been a number of folks over the years and, and, um, who have described, uh, Judy Faulkner and her approach and, and that team's approach, uh, to the E H R is, is. Sometimes people would use a term. I, I've heard people use the term benevolently manipulative.

So, you know, they're, they're kind of pushing us in ways to, to help us be successful with ourselves. And, uh, I give that a different term, change management. Epic understands in a lot of cases that, uh, that change management is critical and, uh, um, and how do.

To make changes and uh, and there's a whole science behind this, but Epic has done a of that at. Know, we didn't have measurements for epic organizations very much. And we're starting to really learn that there's some things that make a difference, some things don't difference. It has been such fun journey for us over the past two years.

Yeah, I, I can see that. Well, you, you threw up a handful of charts, um, in the presentation that. Sort of struck me. Um, and I think it was based on the question of does the E H R enable high, high quality care, essentially? And then you had the response across. I think at the time it was like 133 organizations.

And the crazy thing, the crazy thing was just the disbursement of that. And then you kept breaking it down. You said, well, maybe, maybe it correlates on, on the e you know, the, the, the platform. And, and as you said before, you know there's an epic implementation that has a lower percentile and there's one that's at the top percentile.

He said, well, maybe it's academic medical centers, maybe it's children's hospitals. Breaking it down. Um, 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 E H R enabling quality care. Yeah, let's, let's, so, let's, let's touch about this.

'cause we actually just, uh, uh, worked with Chris Longhurst at U C S D and a number of other leaders in the arch collaborative, uh, to submit a paper to the Journal of Applied Clinical Informatics. And we got a rejection, and I think we're gonna resubmit. And one of the, the referees said, Look, everybody knows it's the software

And uh, and the challenge that I have with that is, is that if, if the software was the key driver of success for an E H R implementation, and I'm not gonna argue the other side, that it doesn't matter, it matters. But if the software made or break, uh, were the make or break factor of, of success for your users.

Then we wouldn't see high variation within the customer base. We would see most epic organizations scoring at about the same place and most Cerner organizations, Athena, Allscripts, and Meditech and down the road. But that's not what we see. We see this huge disbursement, as you say, and we see, we see some, uh, epic organizations scoring higher than some Cerner organizations and vice versa.

And, and, uh, and we see this, this huge variation. We do see some e h r platforms that, that we have not really measured a successful user, uh, group yet. And uh, so e r does make a difference. But, 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 hospitals versus academic versus large versus community hospitals.

And, and look, we found a successful type of organization of every type. Um, and actually the organization type doesn't make a big difference. Um, we do find organizations.

Um, 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's outside the United States. So, you know, it, it, a lot of, there's just a lot of variation that goes into this and, and really what it comes down to is, and we're, we believe that we're building checklists and learnings and things that.

Helping organizations focus on what matters most. But at the very end of the day, an e h R is a leadership test. It is a test of leadership and teamwork and, and joint effort and culture to be able to see if you can work together and make this thing work. And, and if you don't have the leadership in place and the teamwork and everything that you need to.

That you can't, your leadership and it doesn't mean that you can't, I improve your teamwork. And, uh, and a lot of times the insights from these users, uh, identify those opportunities. Is there, is there a correlation with, um, you know, some of the things as you threw 'em up there, I, I was wondering is there a correlation with budget, the amount that a, a system budgets or is there a correlation between size of the organization?

Okay, so, uh, 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. Um, and, uh, uh, , although we do see on the tail, there's a few organizations, if you're spending less than 3% of your operating budget on it, you tend to have a little bit lower satisfaction.

So there is a group that's really, really

organizations. That are in the very same range in terms of how much they're putting into, uh, to their E H R and and into it, 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 a health system of around 500 to 1500 beds, that's, that's gonna be your most satisfied organization.

But that's not worlds better than other organizations, but they tend to have a little bit more scale to be able to support things, but they also tend to be a little bit closer to some of their users to have some of the teamwork. But we've seen very large organizations be quite successful and uh, um, and we've seen very small organizations be quite successful.

Um, but when it comes to investment, I don't think we should be very surprised. Uh, um, I shared this at, uh, uh, I shared this when, when we were presenting at a time, I believe, but, uh, there's a great post from Nate Silver, uh, the 5 38 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, uh, um, 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, but the bottom line is, is that this is hard stuff to do, to spend money in a way that's really gonna 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.

And if the 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, uh, because you just don't know what you're spending money on. It's, it's a, it's a, it's, uh, it's a little bit reckless to, to not measure this at this day and age when any organization, even if you don't do it through us, Build a Survey Monkey survey and send it out to your users and and collect their feedback.

This is just something that should be standard practice in industry and dramatically improve.

Yeah. Now with that being said, and, and the, um, there, there is a science to collecting that data, and we won't go into that, but, but essentially, you know, there are good questions and bad questions. There's leading questions. There's, yeah. I mean, but yes, you're, it's easy to create a survey survey these days.

Well, let me, let me share with you every organization. That's a great point, bill. But now look, go go to our website and steal our survey and put it in SurveyMonkey and do it . We don't care. Uh, what what we really wanna do is, is have you measure or come to us and, and, and, and have us help do the measurement for, for almost no cost.

Um, uh, at the end of the day, go do the measurement. And, and so you know how I said that there's 3% of organizations that are doing their own survey. We run into 1% of organizations that have longitudinally, ur, and every single one, those organizations, and there's three we run. They all, when we share with our, with them our findings, they all, they've all gone.

Yeah, that's exactly what we see also, so, They've come to some of the very same truths and, and findings that everybody else has just by measuring their, their own organization over time. Because they put in some of that effort, and I'm gonna, I'm gonna throw in an extra word on that. They put in the effort and the courage, um, because it is a really scary thing.

And I've had CIOs and CMIOs. Say to me, Hey, do you realize that this is something that could, uh, make me lose my job? And, uh, by, by doing this measurement, and we've had others who've said in not quite as uncertain language, Hey, there's kind of a scab forming over the, the frustration with the E H R from our clinicians.

We'd rather not pull out that scab. And, and, and we hear that, and that's just like nails on a chalkboard for us. Um, because we know the truth of the matter is, is that there's not a scab going, forming over the, uh, the frustration with the ehr. It's, it's just that people have stopped coming to you because they don't see you as a problem solving solver anymore in your IT or informatics department.

And that's just not acceptable for us to, uh, to do that when we've got frontline care, uh, uh, clinicians, caregivers who need to have the best tools possible to be able to be successful. Yeah, it's, it's interesting because the, what healthcare is one of the few industries where we've applied significant technology, uh, and resources and data and analytics, um, to it, and we, we get back that it's becoming less efficient.

It's becoming more burdensome. It's not friendly. It's, um, but there . 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 E H R.

We can, we, we can now find, uh, correlations across, um, multiple populations and we can identify things a lot better in those kind of things. But that's not what the physicians are experiencing. Do. Do you spend a lot of time on, uh, the clinician's, um, feelings and burnout and, uh, and their use? Do, does that get covered a lot in the survey?

Yeah, yeah, yeah. Bill, and, and as you say, you know, that that's one thing that, because we haven't been measuring, we've taken as universal fact that, that in healthcare, uh, there's a, there's a Russian word for it. Bob Sha just, just, uh, generalize across the board, uh, that, that, that, that this is just how it is.

And it is not because there's organizations that, that their clinicians report back to us extremely experiences with. Those type of organizations, you have users who have really mastered how to use the E H R? Well, um, they, they have a great governance and communication structure where they're able to give feedback and, and they love the E H R because it's able to, to adjust to be able to help them out.

So when they need that, they, they feel like they have a backstop and something that's, And then they've learned that, that they're responsible for, for part of the success of their E H R. So they've had to personalize their experience, but a lot of those organizations are just happily doing what they're doing, , and they, they don't know, I mean, everybody else was kind of whining and, and I talked to one of the physicians that was from the highest satisfaction organizations, so she had practiced.

And then she had recently moved and she was at a conference that I was speaking at, but she had been, uh, practicing in Oregon at, uh, Kaiser Permanente highest satisfaction group that we measured among physicians. 92% of them report that their e H R enables them to deliver high quality care. And, uh, just getting 92% of physicians agree on something that means you're really doing a good job.

And I, and I, I said, uh, this was just happenstance and I, and we talked about the frustration with EHRs. I had slide up that talked frustration, said. I don't get what this frustration is about. These things are amazing. They've helped us so much. I said, can I ask you, and this was, this was just dumb. I ask.

Where did you, where, where have you practiced that? 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, and, and, and as 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 is, this is revolutionized the way that we practice medicine. And, uh, 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.

Uh, we're using a single, uh, question, burnout inventory from the American Medical Association and what's interesting, whereas. Uh, uh, there's huge variation in E H r experience, variation in burnout by that measurement. And I know that there's others out there. So, uh, um, so we've gotta say what measurement we're using, but by that measurement there's very little variation between different organizations.

It's pretty steady. And, uh, and so even just when you know that, you know that there, that, that the E H R success can't be that big of a driver of burnout because it's all over the board. We believe mathematically right now, I'm a statistician. We believe that about 10% of burnout is driven by the E H R.

Um, so organizations, uh, that, that have a better e h r satisfaction do have lower burnout, but it's only a reduction as you go to those lower ones or, or a increase of 10% burnout, um, where you have, uh, a greater e h r satisfaction. We're still getting. Yeah, that's, that's interesting. That's a lot lower than I would've guessed.

Now, a lot of physicians are, uh, entrepreneurs. Entrepreneurs have a high burnout rate in and of themselves. The E H R typically gets a lot higher. I mean, you're saying 10%. That's, that's fascinating. I, you know, I think there's a regulatory burden that's hitting them. There's a documentation burden that's hitting them.

Be interesting to get a, a good feel for, I mean, do you have a good feel for what the, the factors are for burnout?

There's several groups. There's several groups that are, uh, that are researching this also. Uh, so there's the Stanford, well MD group, and I just had a call with them last week. Uh, Mayo has a group this, this that's measuring this. I just was emailing back and forth with them an hour ago. And, uh, um, and then the American Medical Association is also measuring this.

So there's multiple organizations measuring burnout. There's some others too. And uh, and as I've had conversations with all three of those groups, Um, there, there is an agreement among these groups and, and I don't wanna speak for them, but I, I think that they'd be okay. with me just saying this, I've had conversations with them that, that E H R is a contributor.

I think we all agree with that. And there is data that says that e r is a contributor, and in some organizations it is a more significant contributor. But, but, but the, the greatest contributors to, uh, to burnout include a chaotic work environment, include a lack of teamwork and shared values in the organization.

Um, and, uh, and, and, and include, uh, too many bureaucratic tasks, and those tend to be your top three issues with, with burnout, um, followed by the E H R. So we, so right now, I mean, there, there's not complete agreement between all of these groups that are measuring burnout, but, but that tends to be sort of the, the order that, that folks are putting, uh, the, the burnout challenges in.

And, and, and I, I prefer to think about the E H R as sort of a, uh, a magnifying glass. If you have poor teamwork. And you've let your, your bureaucratic processes just go unchecked because guess what? They're not the same for everybody, not even in the same state. Some organizations have a compliance department that has gone completely crazy and, and some organizations have been able to, to have meaningful, real discussions about how to, how to rope this in.

And, uh, and, and, If you, uh, have, you know, have worried about the work environment for your clinicians, if you are worrying about these things, you put an e h R over the top of that type of environment, it's gonna be fantastic. Probably. Um, there's a few other factors involved and, and one example of an organization I'll, I'll say is, uh, j p s Health System out of Texas.

Really, really high clinician fulfillment, high physician wellness, and really high e h r experience. And it's because they have some of the best teamwork we've ever observed in any of these organizations. And, and, uh, um, we, we, they have an incredible executive leadership team and, uh, they're, they do some things that are really outside of the box in.

Um, that's an example of an organization that you put in e r over the top of. Then the e r is just, of course, incredibly success between, uh, uh, between different clinicians. So you're building some of these, um, best practices. So I, I'd like to dive into, into some of this stuff. So, gosh, we could, we could talk about this for the next three hours.

Of course. We only have like a 45 minute episode. So, um, you know, one of the, one of the myths that I sort of propagated was that, um, You know, the, you're, I don't know if this is a myth, but the day you're done, your implementation is typically when you want to survey because it's gonna be the lowest satisfaction rate you're gonna have.

Um, because then you're gonna start optimization. And every year after that, you should have increasing levels of, uh, satisfaction. But I think what, 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, uh, their focus on this, what, what are they doing that, that, uh, enables them to actually move their satisfaction into an upper percentile? No, that's a, 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, um, I'll give you an example. Metro Health in, in Cleveland, uh, uh, has had Epic for a really long time. I, I gave the example of, uh, Kaiser Permanente. They've had Epic for a long time. Um, uh, Memorial Health System has used Cerner for a lot of years.

So some, uh, some very long-term successful organizations that have just built up their, set, their, their success. What they've done at these organizations. I'm gonna give kinda a high level perspective and then dive down a little bit. What they've done is they have built real teamwork around the E H R and, and, and what does that mean?

That means that they've helped users realize that they're responsible for a piece of, of their success. Um, and, and that's, that's tough to do, to help and to help them realize that they've gotta do some things in order to be successful. That takes really good communication and persuasion and, and, uh, um, that, that makes, that makes sure that when you sit down for a training engagement, you don't just say, well, here's how you use the a h r.

You say, look, our goal today is to work together as a great team in our care processes. Our processes are embedded into our e r. So when we're talking about today's training, we're not just talking about the e r, we're talking about. How to work together as a team. We're also talking about, uh, some things that you're gonna have to put into place to be highly successful.

And, and there's things that we can't do to make you successful. You have to do these things, so let's, so let's dig into it, right? Just that little tiny beginning at the end, at the beginning of training can make a world of difference as, uh, as organizations are really capturing the hearts. Um, they also have in place really good communication networks.

It shows up in different ways. Some groups are really good at doing rounding and, and, and they, they are visiting their clinics and, and visiting their departments and, and talking to them about where they need to improve. Other organizations have, uh, have, uh, so Memorial Health or Southward Royal in the uk.

These IT centers where everybody can come in and get help and they're centrally located and they, they have, uh, in, in the uk they, they have coffee and, and, uh, uh, sorry, tea and tea and, uh, cake, uh, you know, to, to lure you in, right? So you can learn, learn from them, uh, or, or they come and engage you really well in their departmental meetings.

We see that at some organizations, but however it is, there's this communication layer, and you feel like if you're a clinician of one of these organizations, that there's real caring people on the other side. Uh, that, uh, you know, in informatics and it that are trying to work with you to get to the best situation possible.

Yeah. So you gave, so what, you gave us three common negative E M R emotions and I love this framework 'cause you said, you know, generally speaking, people using the E M R feel stupid. In other words, they, they don't know enough to really get their job done. They felt more effective before they had the E M R 'cause they were.

They were the master, they understood how to get things done so they feel stupid. They feel discomfort using the E M R. Sometimes them feels like I just gave 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, yep, there's discomfort.

So it's stupidity, discomfort. And then the 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 gonna make it. So these are the three really, uh, 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, to the things that successful organizations have done to not have those, those negative emotions present? No, that's great. Bill. Uh, you, you explained it better than, than I've tried to. Um, so in order to not feel stupid, I need to be a master around the E H R. It is a core piece. There's, there's a lot of studies.

Stanford did a study, uh, showing that, that a majority of the time in my patient engagement is actually spent in the E H R. So the E H R is becoming something that I spend. Uh, you know, half or more of my time in as a clinician or a physician depending on my specialty. And, uh, 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 gonna hate your life.

But the, the flip side of it is, is that organizations that do at least six to 10 hours of training for new physicians and three to four hours of year of training a year on the newest functionality. But even more than that, they have great trainers. So dea. Uh, they, their trainers can't get hired until they can teach their IT and informatics leadership, how something really cool, like how to barbecues, you know, and, and or how to cross stitch or they, they have to be engaging and interesting, right?

And, uh, they have to be able to capture your heart. So, 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, and, uh, um, and so you need to have those in place in an organization so that, so you don't have a bunch of physicians who are unhappy.

Does a clinician wanna learn from another clinician, or are you more looking for a great trainer and storyteller and communicator? Uh, what, what do you want? We've seen six organizations where they say that they have, uh, and only six , where they say that they have physicians that are doing the teaching.

And at four of those organizations they have really, really high satisfaction, and two of them is pretty mediocre. So I, I think that that actually might be a fairly good split. Um, a, a physician teaching a physician can be amazing. Sometimes it's not. Um, and sometimes there's, you know, I think physicians would say, there's 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 gonna be way better 'cause they get me and they understand me.

So at the end of the day, uh, we also see other organizations, uh, Mayo Clinic has participated in this. And we did a, a case study, a writeup on them. They had incredibly high training scores and we came to them and said, who does your training? And they said, uh, it's all, it's all non-clinician. For several months when they're onboarded, they have to go through and learn all of the clinical workflows and, 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, so for us it works great. So it's possible 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 that they, they, they capture your heart and mind, and then they help you understand how this is gonna be applicable to your life. And then they tell you what you need to know.

So anyway, so, so that combats the feeling of, of, I'm stupid when I use this. Um, the second piece is, is this is kind of one size fits all. This isn't for me. And, and, and I, I present a lot out and, and this is one of my favorite things to do and, and, and steal it from me 'cause it works really well and it communicates things really well.

But, but I always say, hey, especially if I have a group of physicians in the room, I say, what is the what, uh, technology works the very best for you. And so, and, and, and I always see 10 people pull out their cell phones and hold them up, right Bunch.

And I say, can you unlock it for me? Then they get nervous and it's great and uh, um, and, and so then they unlock it and I say, okay, this, this iPhone right here. Mine is not an iPhone, but, but it always is an iPhone if it's a position. Um, I say this iPhone right here, uh, you say is the most usable piece of technology in your life.

Yes. What would you grade this iPhone? Oh, I'd give it an A minus. It's super usable. Okay, great. I'm now gonna take your phone. I'm gonna wipe out all of your personal preferences. I am not gonna delete anything. So all of your pictures, your emails, everything's gonna be here, but I'm just gonna put your apps and alphabetical order and your lock screen's gonna be default and all that sort of stuff.

It's just gonna all be default. Does, does the person jump up and tackle you to make sure you don't do it? Yeah, but that's the point, right? Is you wanna see those personalizations are like sacred to you, right? Yeah. And, and, and they matter a lot and you hate getting a new phone 'cause you have to go put 'em back in and I never, I never of course erase it.

Then I turn to him and I say, okay, let's say that I actually did that. What is, how would you grade your phone for usability? Now they say C minus, D plus, right? And then I, and then we say, look, you moved your phone from a C minus or a D plus to an A minus because of the effort that you put into it to to set it up, to make it work well for you.

The same is true for the E H R, but, but Bill, I don't know if I said this out of Chime, but guess what? Percentage of physicians have taken the time to set up their, their E H R. It's less than 40%. And, uh, and so of course they're walking around, they're all walking around saying, I'm being stuck with C minus and d plus technology.

And, and we go, oh my gosh. And it, over 95% of organizations, those who have taken the time to personalize their environment, are dramatically more satisfied than those who haven't. And, and the group, the organizations where that's not true, they have a really problematic E H R and, uh, so that they, you need to look at the technology 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 IT and informatics, uh, guy or gal, and I say, Hey, I'm, I'm really frustrated with this. And rather than find a real solution with me, they just say, eh, I think that's kinda how it's, 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. A lot of thought and effort into, uh, Brian Greater their, who's now their chief.

Said, 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 analyst 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 rests on the shoulders of your IT and your informatics group. How good are you at solving your clinician's problems? And helping them make the technology work for them. So, so, um, so that was great. So we have, uh, comfort, hope, and mastery are, are three things that you have found that really correlate.

I found it interesting early on that you said, uh, scribes doesn't necessarily correlate that, which, that's interesting 'cause we hear that all the time. Hey, it takes too much time. Give me a scribe and I'll be happy. But that's not necessarily the, the case. Scribes don't, um, you know, we're still waiting for longitudinal data, but, uh, um, but we don't see scribes, uh, in our cross-sectional data correlated with any higher e H r satisfaction or lower burnout.

And, uh, which is interesting 'cause you're putting a lot of investment into these scribes. And then, and then those physicians report the same levels of burnout and actually they report lower e H R satisfaction on an average. And so it really makes you scratch your head and you go, oh my gosh, this whole, this whole class arch collaborative survey, it bunk because everybody knows that scribes make a difference.

And, and, and here's the problem is, is that, that we forget the human element of everything that's going on. You've got somebody who's, who's a bad user, um, who hasn't taken the time to really learn it, who isn't engaging and communicating well, and, and, uh, um, hasn't set things up well for them. And all you're doing is put a, putting a bandaid over it.

The scribes don't go in and tell you one of the, the most painful parts for clinicians is getting data out of the E H r scribes. Do nothing to fix that. And, uh, 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 healthcare is really complicated.

And, and when God made us, he made us a little bit complicated software. Services industry that that I think humankind seen.

Processes in the hospitals and billing and everything like that. It's complicated. So it's gonna take some education to really be able to use this well. And, and as scribe is, is, is, is a bandaid. It's kinda like putting a bandaid over a broken bone. It just, it's not gonna 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. Well, and that's sort of where I was going is, you know, you take a look at something like, um, uh, like voice, uh, voice notes and, and those kind of things. And, you know, as an IT guy, so I was former c I o people would come to me and say, Hey, if you gimme transcription, I, you know, that's going to help.

But in reality, you know, all these, all these investments in technology and scribes and whatnot, these, they're, they're good. Yeah, they're not bad. They're not bad, but, but essentially what you're telling me is focus on the people, focus on the people side of it, focus on change management, focus on, um, creating a culture that listens, a culture that's responsive, a culture that's collaborative in terms of, of making it better, um, educate the, utilize, uh, you know, physician builders to, to customize the system.

Um, implement training in. That people can receive it and people can digest it and, and make it a part of it. So you're looking for, you know, ownership, personalization, mastery are the three things you talked about and all of those things. None of those things were. Hey, go do a, another, you know, $3 million technology project on top of the e H R to make it better or, or, or even upgrade it.

I, we, we need to stay current with upgrades, but at the end of the day, you could still have, you know, something that's three versions behind. But if you have the right things in place, people are gonna know how to use it. Feel empowered to make changes and make it work for, for their workflow and for their patients.

No Bill. That's exactly right. And you know that your best users when it comes to voice recognition technology have taken times to, to train their dragons, so to speak. I I actually, I actually steal that phrase 'cause we've added a new question on the collaborative survey that says, um, uh, if, 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?

The most common answer is I've taken time to set things up to my needs. And, and one recent response that I saw was, I trained my dragon. So, uh, you know, it's the same principles that end up making voice recognition, successful mastery, right? And then in setting it up well to, to use it and then some good support and communication and empowerment from the, the IT department.

And, uh, so these are principles, bedrock principles. Once we get, and it is the low hanging fruit at almost every organization, once we get most organizations up to a place where we're really starting to fire and, and, 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, and a lot of these and natural language processing, a lot of these functionalities that are gonna really be accelerators for the industry, that's gonna 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 the functionality in their latest version, let alone these next generation pieces.

And 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 and start giving you predictive algorithms. And if you don't know why they're predicting that, then then you're similar to a, to a, 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 fog.

There's times when you can't use autopilot. So similarly, we, we've just gotta 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, and then we can really revolutionize healthcare moving forward. Are there, um, you know, as we get close to closing this out, are there, you know, a couple stories you would share in terms of just some things you've seen out in the industry and you go, man, they're, they're just doing it.

Right. That is, you know, that's gonna lead to a, a really successful implementation. You know, there's, there's a lot of, uh, there's a lot of stories. Let me give you two right now. Um, one is, is, uh, uh, Biden Health. We haven't done it before and after measurement with by Biden Health, but they, by their own emissions, said, Hey, we were in a really bad spot with our E H R, and, and nobody knew, knew how to use it very well, and, and we had a lot of frustration around it.

They did a big upgrade, but they used the upgrade as an event. They said, um, they, they went to all of their hospitals, uh, so they're on the east coast. They went to all of their hospitals and their community hospitals. They don't employ almost any of their physicians. And they changed 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, uh, Part of changing that bylaws.

They set expectations with everyone, and they, and then of course, they had to have c e o support doing this, right? They set expectations, Hey, we're gonna retrain everybody. And then when they did their retraining, they had physicians do the retraining and, and they said, we had amazing training because we knew that if we were gonna require this and, and change these bylaws, and now the, the pressure was on us.

We measured them and, 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, and 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, to, to have a baseline to go work on improving clinical outcomes in different areas and do some things. There's one other group that that's 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, uh, that we measure in the collaborative. And, uh, ortho Virginia h c s and Rotor is their, is their, uh, C M I O and, and is really a fantastic leader in my opinion, as I, as I watched him and they took their feedback. They went from lower satisfaction.

Uh, they jumped their satisfaction up from being one of the lowest satisfied epic organizations to one of the very highest satisfied epic organizations in their second survey. And, and as we talked to them about what they've done, you know, we're still learning from them, but, but they've done a lot of training, a lot of working one-on-one with their, with, with individuals to get there.

They also use scribes and, uh, um, but, but they were using scribes before, and they're using scribes now, but they, they have found ways to use their scribes not as band-aids, but as accelerators. So an 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, and what do they do? Uh, it was a lot of teamwork, a lot of effort, and some really great leadership. So, A couple organizations that we think identify and, and really show what this, uh, what this looks like. That's fantastic. So, um, so tell people how they can get more information on the Arch Collaborative, and, and this is, it's a collaborative so people can, uh, become a part of it.

They can join. It's, it's on the, uh, the class research.com site. But how, how can they get more information on this? It, it is, it is super easy. Google Arch Collaborative. It comes up with our, kind of our website. Uh, there's a button on there down at the bottom that says, I want to know more. It emails us. We get in touch with you.

Um, there's a lot of organizations today that, I mean, we've gone in two years from an idea to 154 organizations doing the measurements, so that just tells you that it's not that hard, uh, you know, to, to be, if were moving that fast. Um, and, uh, so come join in the, the, uh, we're just now instituting a cost, you know, to date we had been measuring most organizations for free.

There's now a nominal cost to come and, and, uh, and measure at least that's going into effect early next year. And, uh, but, but, but. This is not, what this is, is high courage. It's not high cost, uh, to come in and participate. And, and then we have a conference this next year in May. Uh, we've got 62 ongoing members that are gonna come together in Salt Lake City.

Last year we had, uh, 50 organizations that came together and, uh, um, and, and they teach each other about their best practices. And I, and I'm gonna boast. That we have some of the very best organizations in the country, uh, premier, premier Health Systems. And when I say Premier, I mean that down to premier community health systems to to large premier organizations.

And, uh, and, and, and, and that conference is just amazing. So, um, some things that we're trying to do, but it is a collaborative where folks are working together to solve this problem. Absolutely. And I, I, 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 just public domain. People can, oh yeah, it's out there. Look, steal it. Take it. The, the, the secret is not in the survey. The survey is something that we keep editing. The secret is in uncovering these principles and helping organizations, uh, learn from each other, our goal is, is that in a few years, this collaborative is done.

Because we figured this out as a, as a, as an industry and everybody started measuring, and I don't know, 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, but we wanna solve the problem and then class and everybody else can go start working on the other problems that we have in healthcare because we've got plenty.

But, uh, but let's solve this problem. So come get engaged right now. Come, come get involved with us and, and, and let's all solve this together. Absolutely. Well, great work. I know that, uh, you know, Lee Milligan mentioned you, Amy Maner mentioned you, and, and they were, um, uh, you know, really highly, uh, excited about the work and both encouraged me strongly to, uh, to engage with you and I, I'm glad that I did.

Is there a way that people, uh, can follow you, uh, maybe social media or another way. Uh, Taylor at class is my, uh, Twitter handle. And, uh, uh, I just was tweeting this morning about the o c report that just came out and, uh, so if you've listened to me for the last few minutes, you'll notice that, uh, that we have some strong opinions.

So, uh, class is also on Twitter. If you just, uh, um, if you just, uh, do a search, you'll see the class, uh, and all the time about, uh, about things we're. Um, so join us and come reach out to us with an email. Come talk to us. Absolutely. Are you talking about the, the, uh, HHS o c announcement to reduce the burden?

Yeah. I thought talking to you about that, but we, we didn't really want to dive into a new story, but, uh, but, but that's, that's, that's good. I mean, what they're, I mean, everybody seems to be coming at this challenge differently and it's, it's great. We'll, we'll need it all. Make it work. No, and we need some of the things that they're pushing.

They, they, they continue to be kind of in the same trap that a lot of organizations are, where they think it's the software, which is where we were a couple years ago too. So, so it's understandable. But, but, uh, but we're working, uh, Don, uh, Ru is, is, uh, It, it came to our summit before, so we're working to try to work with them and, uh, uh, to, to, to help them see what we're learning and we're, we're trying to, to share with them some of our findings.

So, but Taylor, I mean the, the, the number one thing I'd say to people is, okay, so if, if that's your mindset, what you're saying is if we put every health system on the same e M R across the entire world, we would solve these problems. And people look at me and go, Probably not. I'm like, exactly. We, we still have, we still have, there's other challenges we need to solve and, and you highlighted a lot of them in the show, which is great.

We're, we're all just new at this. I guess this final, final closing comments, we're all just new at this. I mean, we've only had 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 gonna look back at at at, 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. See the value out these automobiles, right. And driving an automobile on, on bumpy dirt roads was just only a little bit better, or maybe the same as a horse. So we're still kind of figuring out what do we need to really make these work?

And it's not just exactly what we thought it was. Um, it, it's gonna be a little bit different and we're, we're learning all together. Absolutely. Alright, well that's how you can follow, uh, you, uh, which is great. You can follow me on Twitter at the patient cio, uh, the show at this week in h it, our website is this week in health it.com.

And, uh, shortcut to our YouTube channel, which is now up over 400, uh, videos is this week in health it.com/video. I'm trying to get that vanity, u r l with, uh, with, uh, YouTube, but quite frankly, I'm busy with my day job, so I haven't had time to pick that up. Thanks 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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