There’s no tool that impacts physician practice more than the EHR, according to Tom Yackel, MD, MPH, MS, chief clinical excellence officer for CenterWell Senior Primary Care. Oftentimes, if there’s a problem with the EHR you call the help desk, get a ticket and wait for an analyst to call you in a few weeks.
CenterWell Senior Primary Care, like many healthcare organizations, faced challenges with EHR inefficiencies. Physicians were finding it difficult to access patient data and customize templates, and they were spending too much time on home charting, which can contribute to burnout.
Ideally, you want the ability to personalize the EHR so that it addresses the needs of the practice, Dr. Yackel emphasized.
CenterWell sought improvements through several key initiatives, deploying a validated physician satisfaction survey to identify key areas for improvement as well as existing strengths. It leveraged Abridge’s augmented intelligence (AI)—also known as artificial intelligence—technology to reduce cognitive load and streamline data entry processes.
Committees were also created to oversee evidence-based practices, quality improvement and clinical informatics. This enhanced the physician voice in decision-making that affects clinical care and workflow.
The initiatives improved EHR satisfaction and physician burnout, leading to a 54% reduction in cognitive load in documentation, a 64% reduction in severe burnout and a 41% improvement in "no burnout” responses, indicating better overall mental health among care teams.
CenterWell Senior Primary Care is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Challenges of older patients
Owned by Humana, the group encompasses 335 practices in 15 states and includes more than 1,000 physicians and other health professionals who care for more than 430,000 patients. Physicians typically have a panel size from 350 to 500 patients and see about 10 patients a day. It’s an intensive care model, allowing for more face time with the physician.
The goal is to ensure that older patients get the most out of the health system while avoiding high costs, said Dr. Yackel.
CenterWell’s patients are older adults who often have two or more chronic diseases and may require longer visits. The longer the visit, the more the physician has to document, and the workload piles up, said Dr. Yackel.
Eighteen percent of CenterWell’s patients are dually enrolled in Medicare and Medicaid, and 14% are older than 80. Some patients also take more than 25 medications and see as many as 14 specialists. With many complex patients, efficient EHR and processes become even more imperative for doctors.
There is nothing more intimate than being in the room with a physician and a patient, “and if we put technology in there that they don't trust or they think has alternative motives…we’re going to be in trouble,” said Dr. Yackel.
The goal is to facilitate and figure out how to make the EHR work for them, he said.
In 2024, CenterWell conducted an Arch Collaborative (EHR Improvement) physician satisfaction survey. The survey revealed that CenterWell physician satisfaction with the EHR was average, with scores at the median for its EHR vendor. Training programs were highly rated, placing in the top 10%.
Despite these strengths, “accessing data in the EHR and customizing templates were significant pain points, with satisfaction scores in the lower percentiles. Additionally, our EHR vendor received low ratings, and there was notable variability in satisfaction across different markets,” Dr. Yackel said.
The challenge CenterWell had to tackle: Could it make the EHR a source of engagement and professional satisfaction?
Getting rid of the burden
CenterWell drove improvements by following best practices, including guidelines from the AMA STEPS Forward® toolkit, “Getting Rid of Stupid Stuff,” which is designed to reduce unnecessary administrative burdens—especially those related to EHRs—that contribute to physician burnout.
The AMA STEPS Forward “Reducing Regulatory Burden Playbook” has also been helpful in debunking myths about EHR practices, said Dr. Yackel. For example, the AMA debunks the assumption that federal health and policy rules prohibit physicians from giving a verbal order if the EHR prompts a physician or team member to share something with the patient.
“AMA STEPS Forward has been an amazing tool for us to be able to go and say: ‘Look, this is not true. You can give a verbal order in the outpatient setting,’” he said. “These ideas about what is compliant and is not compliant are fantasies in many cases.”
Another misconception is only physicians or nonphysician providers can participate in medication refills.
“By clarifying these misconceptions, we established a more efficient and compliant workflow,” said Dr. Yackel.
CenterWell also formed a clinical informatics committee to optimize the EHR for its care teams, creating a subcommittee dedicated to improving clinical documentation.
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“These efforts aimed to reduce the time physicians spent reviewing and correcting documentation, aligning guidelines from clinical, coding and compliance teams,” Dr. Yackel summarized.
Integrating AI into its charting workflow to reduce cognitive load and streamline workflows was another key strategy. CenterWell decided to replace its EHR vendor to address the low satisfaction scores. It identified and rapidly deployed tools with a high likelihood of reducing EHR workload, such as piloting clinical staff participating in the refill process and expanding AI ambient transcription solutions.
“These initiatives were designed to streamline processes and improve overall efficiency, ultimately enhancing the EHR experience for our physicians,” said Dr. Yackel.
From AI implementation to EHR adoption and usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors—not a burden.
Changes reduce pajama time, improve notes
Comparing baseline Arch survey results with a post implementation survey in January, CenterWell reported significant reductions in burnout and cognitive load, as well as these improvements:
- 6% reduction in EHR time.
- 16% reduction in pajama time.
- 12% rise in same day closure rate.
- 89% notes retention.
- 50% utilization.
- 30,452 notes created.
Some physicians reduced their pajama time from 2.6 hours to 1.7 hours a day, a 34% reduction.
Comparatively, the lag time for closing notes on new patients rose by 61%. But that’s not necessarily a bad thing, noted Dr. Yackel. It may mean that the notes have improved. They were capturing more diagnoses and getting more of the patient's history.
Patients as a result were getting into the system faster and their subsequent visits were less about finishing things up, so the physician could get to know them better.
“In our model, that's extremely valuable to us,” said Dr. Yackel.
Giving physicians a voice
These experiences have informed CenterWell's provider strategies moving forward, emphasizing the importance of continuous practice workflow optimization, skillful use of AI and robust support systems for physicians.
“It’s critically important that physicians are engaged and lead these efforts and believe that they are truly at the table in making the decisions,” said Dr. Yackel.
