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A Multi-Pronged Approach to Improve Provider SatisfactionSession 149, March 7, 2018 1 - 2 p.m.

Thomas Selva, MD, CMIO, MU Health Care

Bryan Bliven, CIO, MU Health Care

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• Thomas Selva, MD

• Bryan Bliven

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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Ask/Listen

Engage

Plan/Do

Measure

Educate

Communicate

Agenda

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Learning Objectives• Identify key components in a multi-pronged approach to positively

impact provider satisfaction

• Demonstrate the importance of provider EMR surveys

• Recognize the value of physician-funded positions on a EMR council

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University of Missouri Health

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Basic Principles

Basic principles: no matter what,

no matter when, no matter

who…any CMIO / CIO has a

chance to sweep any user off their

feet. They just need the right

broom.

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Ask/Listen

Engage

Plan/Do

Measure

Educate

Communicate

Basic Principles

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Ask/Listen

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EMR Survey Results• Questions are grouped into five categories to facilitate analysis and

to track response trends

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2.5

3

3.5

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4.5

2012 2013 2014 2015 2016 2017

Targeted Impact

Ease of Access

Efficiency

Communication

Patient Safety

Research and Process Improvement

2017 Average Score

% Change from 2016

Ease of Access 4.11 10.5%

Patient Safety 3.45 -2.3%

Communication 2.96 -6.6%

Efficiency 3.07 0.0%

Research & Process Imp. 2.22 -5.1%

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Ask/Listen

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Ask/Listen

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Ask/Listen

Engage

Plan/Do

Measure

Educate

Communicate

Engage withStakeholders

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Shared Governance

EMR Council

PI-LDP/QI Model Experience

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Shared GovernanceCEO/President of Cerner

Tiger Institute Board of Governors5MU/5Cerner

University System President

Tiger Institute Prioritization and Steering Committe (TIPS)

Operations Project Management

Value Creation OfficePopulation Health Workgroup

Docu

menta

tion

Pro

vid

er

Experience

Patient

Engagem

ent

Devic

e O

Vers

ight

Clin

ic I

nfo

rmatics

Multi-D

Info

rmatics

Ord

ers

Managem

ent

Ente

rprise

Media

TIPS Sub-Committee

Pharm

acy

Advis

ory

Clin

ical D

eci

sion

Support

/ E

BM

Registry Management

Value Based Performance / Ops

Data Governance

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EMR Council

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PI-LDP/QI

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Model Experience

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Plan/Do and Measure

Ask/Listen

Engage

Plan/Do

Measure

Educate

Communicate

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Plan/Do

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Plan/Do

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Measure/Measure/Measure• DART Team Engagement Results

0:02:53

0:10:05

0:17:17

0:24:29

0:31:41

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Au

g-1

5

Se

p-1

5

Oc

t-1

5

No

v-1

5

Dec

-15

Jan

-16

Fe

b-1

6

Ma

r-16

Ap

r-16

Ma

y-1

6

Ju

n-1

6

Ju

l-1

6

Au

g-1

6

Se

p-1

6

Oc

t-1

6

No

v-1

6

Dec

-16

Jan

-17

Fe

b-1

7

Ma

r-17

Ap

r-17

Ma

y-1

7

Ju

n-1

7

Ju

l-1

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Dyn Doc Time Compared to Power Note Time

% DynamicDocumentation

DynDoc TimePer Note

PowerNoteTime Per Note

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Measure/Measure/Measure• DART Team Engagement Results

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

0:00:00

0:28:48

0:57:36

1:26:24

1:55:12

2:24:00

2:52:48

3:21:36

3:50:24

4:19:12

4:48:00

Dyn Doc Impact to Outside Hours Documentation

% DynamicDocumentation

DocumentationTime OutsideHours

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Plan/Do

• Case Study:

– PILDP Project – reduce readmissions

• Cone it down: Start with small test of change on quantifiable population

• CHF – leading cause of readmissions

– Problem is not identifying patients with CHF when admitted for other issues

– Build algorithm to look at previous admissions, problem list, subset of labs and medications.

– Fire alert on admission that patient may have CHF

– Add CHF to problem list

» Sets off process / orders to assure daily weights, discharge education

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Measure/Measure/Measure• CHF Algorithm

Results

• Outcome: Readmissions for CHF drop by 50%!!!

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Plan/Do• Case Study:

– PILDP Project: Who is My Doctor…Right Now?

• Solve the problem of who is the resident caring for the patient ”at this moment”.

• Large source of frustration for nursing, consulting, and ancillary services.

• Engage “big-small” test of change on Medicine Service using Cerner I-PASS Handoff tool.

• Challenge: It works! Now spread it to the entire organization.

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Measure/Measure/Measure• Primary Contact Results

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EducateAsk/Listen

Engage

Plan/Do

Measure

Educate

Communicate

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Educate

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Educate

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Educate• DART Team / EMR Training Team Engagement

– Meeting with departments during faculty meetings or residency staff meetings.

– Participation in ”EMR Happy Hour” sessions

– Cover “hot tips” or topics of interest to help assure staff are using the best workflows to achieve optimum efficiency with the EMR and associated tools.

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Ask/Listen

Engage

Plan/Do

Measure

Educate

Communicate

Communicate

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Communicate

• Regular “flash” updates from CMIO via e-mail to all staff

– Distribution list grows each month as staff get interested

• End of the month CMIO Digest of all updates sent during the previous month

– One more “bite at the apple”

• All CMIO updates stored on CMIO blog site for easy retrieval

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Communicate

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Communicate

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Communicate

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EMR Survey Results• Overall satisfaction is evaluated with the question “I am overall

satisfied with the EMR”

– Prior to 2014, overall satisfaction was calculated as an average of all year-over-year comparable questions

3.03

3.15

3.25 3.27

3.30

3.2

2.93

2.98

3.25

3.16

2.9

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3.1

3.2

3.3

2012 2013 2014 2015 2016 2017

Consistent Improvement

Average Score Overall Satisfaction

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Key TakeAways

Ask/Listen

Engage

Plan/Do

Measure

Educate

Communicate

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Questions?

• Thomas Selva, MD

SelvaT@health.missouri.edu

www.linkedin.com/in/

thomas-selva-49207351/

• Please complete the online session evaluation

• Bryan Bliven

• BlivenBr@health.missouri.edu

• @bbliven24

• www.linkedin.com/in/bryanbliven/