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Art Nicholas put a post out on LinkedIN that got the discussion started. This is based on a Becker's article you can find here. Here are my thoughts.


today in health, it most impactful EHR changes that can save physicians time and reduce burnout. My name is bill Russell. I'm a former CIO for a 16 hospital And creator of this week health. Instead of channels dedicated to keeping health it staff current and engaged. We want to thank our show sponsors who are investing in developing the next generation of health leaders, Gordian dynamics, Quill health Taos.

So site nuance, Canon medical. And current health, check them out at this week. All right. So. Did a poll, there was a, an article last week. It was last week. Let's see. October 19th. Yep. Last week. Oh, in Becker's eight EHR changes that can save physicians time and reduce burnout. And there was a good discussion that was going on on a post. And I decided to turn that into.

A poll and see where it was going to go and, and get some background to have this discussion with y'all. So here are the eight year EHR changes that were recommended. Let's see who they talked to. , report from the AMA well, It's probably a pretty good list. Let's see. Number one, minimize alerts. Keep only alerts with favorable cost benefit ratios.

Number two simplify login, streamline log-ins by updating elements, such as single sign-on fingerprint and facial recognition. Number three, extend. Time before on a log-out such security measures based on computer usage, location, et cetera. , number four, decrease password burdens. Number five, reduce clicks in ordering cut down on the excessive clinical data.

Required to order tests number. Six. Eliminate password revalidation do not require repeated physician logins. When sending in prescriptions for non-controlled substances. Number seven reduced note, excess reduced number of That automatically pull in data from other parts of the EHR. And number eight, simplify order entry process, optimized technology to automatically populate data fields.

And I think in the poll people right into that a little further. Then, , Then what I've said. So there are the eight. , items outside of, and I agree some of it, some of these are going to mirror some of the comments I read in the, a post that was out there. , there's a oversimplification of things in terms of really understanding.

, security requirements to extend the time before auto log out. , we set it to four hours, , four hour shifts. You go to lunch, you come back, you. You read log in. That was our. Thought process four hours was the most, we felt comfortable extending it because, , when you extend that auto log out, it.

It it, , It creates a, an opportunity for hackers. Let's just say it that way. , simplify log-ins single sign on and all those kinds of things. , we, we did that in 20. Gosh, 2012. We did that. We went to an Impravada solution, single sign on across the board. Tap in, tap out. , it had challenges early on in the process, mostly because we were, , we were ahead of the curve and really driving some things. We had a sub.

One minute, first log in and then sub ten second. , log-ins after that actually My second logins after that, that you tapped in after that. Cause he didn't have to log in again the second And launch all those machines and because it was a Citrix environment, we were able to just move those sessions from place to place. Some of this stuff is just basic blocking tackling. So four hours was the minimum I'd recommend set with simplify. The logins is technology that's already out there and tested.

, expensive and complicated at the time. I don't know if it's a complicated and expensive today. , my guess is it's only gone up in costs. The complexity of it. , Actually complexity should come down over time. So, , and the amount of resources that really understand the technology should go up. So it shouldn't be as hard to get experts on it.

, as we had back in the day, , let's see. Password burdens changed the intervals between password reset requirements. , that's just a bad idea. Quite frankly, I'm a huge fan of eliminating passwords altogether. In the system because, , the biggest. Security. , risk in every health system is the people.

And the best way for them not to give away their passwords, just to not know their passwords. And there are a bunch of companies working on password lists, systems and mechanisms moving forward. So we don't even know. Our passwords. And, , to me, that's going to be the best place to get to as quickly as we can get there. But until we get there,

, changing your password every 90 days, 60 days, whatever. Your password. Policy is some are 30 days. , 30 days to me was too much of a burden on the clinician. 60 days, I think is what we settled on. , we could have gone out to 90 days, but again, the. With every day, you move that out. You just increase the.

, likelihood that an attacker can get in using those passwords. And again, I still think password Login is the way to, , the way to Eliminate password revalidation for, , prescriptions and non-controlled substances. We should be able to do this. With things like And that kind of stuff. So all this stuff is available. Make sense.

And to be honest with you, I don't think it's one thing. I think it's all Right. You should be doing all of these things. If, if, if the physicians are telling you that all of these things. Potentially can, , reduce the amount of burden on them and increase the time that they Should be looking at and doing every single

I reduce reduce note excess. This is not a technology thing per se. But, , , reduce the number of links that automatically pulling data from other parts of the EHR. This is mostly driven by. Your, , clinicians and requirements, but one of the things you have to do, you have to have a strong CMIO who was going to ask, why, why are we doing this? Is this something that we would do system wide? Is this something that contributes to a patient's safety is, is something that contributes to outcomes.

And we have to ask ourselves why we ended up with a lot of processes and alerts falls into this category. We ended up with a lot of processes and a lot of, a lot of alerts. That just over time. Have no meaning. And by the way, Alerts is one of those things you should go through your alerts annually.

And cut down on the number of alerts, because if you don't cut down on them, The human brain cuts down Automatically. Like we can, we have a cognitive load that we can handle and a cognitive load that we cannot handle. And our brain is really smart this way and it just shuts them off. Right. So if you're getting.

, 10 alerts, every 15 minutes or five alerts, every 15 minutes or whatever. And you just say, ignore, ignore, ignore, ignore, ignore your brain gets really smart. And it just ignores them for you. So, , alerts lose their meaning. If you have too many of them should go through them. , , are they necessary? Are they, , helping to provide better care? Those kinds of things renewed.

Reduced note, excess is probably a process problem. You need a strong leader. Who is going to ask the question? Why, why are we doing this and good governance around changes to the EHR? Shouldn't just do it to make the loudest physician happy. , there should be a process that it goes through so that people understand why we're making the changes we're making. And there should be strong consideration given to the clinician.

, time and burden. And then the last I left this last one for simplify order entry process. And some people commented on. , things like ambient clinical listening and those kinds of things. And that falls into this category. There's a bunch of technologies that In this area. And, , , every time I mentioned a technology there's there's costs, there's training there's time.

Associated with each one of these things. So it depends on your house with some, what your budget is, whether you can do some of these things, but ambient clinical listening has helped the clinicians a lot. , I think there's a lot of work to do in the area of helping the nurses. , with ambient clinical listening. I think they're working on that as we speak.

And making progress in that area. The, , order entry process. A lot of it has to do with. Collecting information that either we don't need or collecting information that is, , Not required to. , for better care or for better outcomes. , or for safety. And. A lot of that's driven by the federal government and some of that's driven by billing.

Right. So those are the two primary things. I think that drive. To a, an excessive amount of data being collected by the EHR. And that burden is put on the clinicians, just put on the doctors, put on the nurses, put on others. , within the system now to the extent that we can automate that within technology.

By all means. Let's do Let's put in things like, , , computer vision type systems that can see things and then put, , notes in there and whatnot. , and take some of the mundane tasks, tasks off of the clinicians. , but at the end of the day, the battle needs to be fought. With the systems that are requiring the data.

And saying, do we need this data? And so there needs to be a strong voice in the government as they're making regulations, which they think are leading to the better outcomes. For patients for the people that they And we need to make sure that our voice at the table is looking at that burden. And at that time commitment to put that information in. And I think the same thing in the other direction.

Looking at the administrative side and the billing side. , with the carriers with CMS and And saying, what do we need this information? Is this information required? Now those are harder, right? Th those, those changes don't happen overnight. , but it is something that makes sure your voice is being heard. Make sure you're participating in the process.

At every turn and then, , look at it. I mean, because there were some changes that were just made, , and sometimes these changes get made the requirements get made. Or changes get made because we're successful in moving that, that ball down the field. And one of the things that happens is we don't make the changes in our system.

So. Got to keep an eye on those things. I, again, I think you're revisiting this, , I would say every year, Would be the wrong way to say this. We're revisiting this process all the time. Is And ask yourself, is that information necessary? Is it necessary for clinical care? Is it necessary for outcomes? Is it necessary?

For quality. , is it necessary for government regulation? And is it necessary for billing? I mean, just go through those things. And if the answer, if you go through that, that gauntlet and the answer is no. Ask yourself why you're collecting that information. Because every click, every. A character that a physician has to put in there.

It takes time. It takes cognitive load and creates stress creates bird. So, , that is on the entire system to put the processes together, put the governance together, put the right teams together to have the conversation. This isn't just a technology conversation. As you know, this is a. , health system.

, initiative that should be going on at all times. Reducing burden reducing waste at all times should be a process that is going on. We had a lean six Sigma at our. Health system. And we had daily huddles with a majority. I in fact, I can't think of a department that didn't have them. , across the board and it was part of our culture and part of the way we operated.

, highly recommended if you're not doing it. And, , , again, I think there's a lot of value there. All right. That's all for today. If you know someone that might benefit from our channel, please forward them a note. They can subscribe. On our website this week, or wherever you listen to podcasts.

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Thanks for listening. That's all for now.  

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