When Steven Strongwater, MD, joined Atrius Health as the new CEO, he asked what could be done within an organization to address the practice frustrations physicians and other health professionals experience. He also asked how the information technology (IT) department could partner with clinical and operational leadership to move the needle. The solution involved a team approach between the IT department, physicians and leadership, resulting in a dramatic increase in joy of practice among physicians.
The success of this collaboration was highlighted by Christopher Joseph, associate chief information officer of Atrius Health, to a packed room at the American Conference on Physician Health. Atrius Health is the Northeast’s largest nonprofit independent medical group located in the Boston metro area. The medical group delivers care to more than 740,000 patients and is made up of 1,300 clinicians.
Before implementing a new strategy, Joseph looked at their old way of doing things, which was through isolated efforts. The team would receive requests from across more than 20 different practices. Each request was evaluated and printed out at the end of the day. It wasn’t doing what they wanted.
“The isolated efforts, if you asked our providers was that increasing their joy? The answer was, ‘Thank you for the work, but it’s really not doing what you asked,’” Joseph said.
To overcome this, Atrius Health conducted an intensive pilot study over the course of one year. They threw everything at the pilot site to see if it would have a different outcome than the isolated efforts. This included having a variety of IT teams and working with clinical operational leadership. As a result, they came up with a prototype and path that could be used for going through a practice to achieve different outcomes.
“I had a lot of technical analysts designing for the pilot site,” he said. “What we found was we needed trainers and great people that could interact with physicians at the elbow.”
New technology was also introduced to the pilot site, including the widescreen format of the Epic electronic health records system and electronic prescribing for controlled substances. The first pilot site, as well as two additional sites, told Joseph the approach was “materially different” and could significantly improve their practice satisfaction.
Making practices more efficient isn’t just about making days less packed, but providing a standardized workflow using valuable technology with collaboration between the IT department and physicians. When creating a new workflow plan for the medical practices within Atrius Health, Joseph said it was all about teaming. This meant placing IT with clinical leadership, operations and also within the clinical care team.
“We had a lot of physicians that wanted to do things their way and sometimes you work with the medical assistant to get things done, but the other provider wouldn’t,” said Joseph. “It was a good opportunity to look at options for standard workflows for clinicians.”
The availability of technology provided options that hadn’t moved the needle before, such as the widescreen format from Epic that helped reduce the number of clicks per day per clinician. However, they found that when the hardware was put in offices, it didn’t stick.
“People weren’t using it, so being out there and facilitating the usage of the widescreen made all the difference,” Joseph said.
When offices just had the monitors out there, it didn’t work with physicians. Only about 15 percent were using the widescreen view consistently at first. Now, 73 percent of Atrius Health physicians are consistently using the feature. Joseph estimates this saves about 300,000 clicks per day across the practice.
There were also minimal technical changes made to Epic, which was less than what Joseph had expected and was not solely an IT project or effort. They also took the opportunity to standardize workflow where it was possible, such as with e-prescribing for controlled substances.
“We had a lot of practices doing their checkout information on paper and the medical assistant had to come get the paper to figure out what needed to be done for checkout,” Joseph said. “We started using the electronic tools within Epic for that.”
Since going live, about 94,000 prescriptions were ordered electronically instead of on tamper-proof paper, which led to about $56,000 in savings for the group.
And when surveyed about the changes, more than 80 percent of physicians said they were beneficial to themselves or their department. Another 50 percent of physicians said the IT adjustments had improved their “joy” in practicing medicine at Atrius Health.
It took seven weeks for proof of concept for creating more efficient practices, using three sites as pilots to ensure the first site wasn’t just an anomaly. However, leadership wanted it completed faster, so Joseph and his team got it down to two weeks. This allowed them to get it completed in a year.
“Approaching this as a team really booted uptick of changes,” Joseph said. “The energy this brought to our department was wonderful.”
The AMA offers online CME to improve physician wellness. The AMA’s STEPS Forward collection features 50 practice-improvement modules, including a new module, “Creating the Organizational Foundation for Joy in Medicine™.” Several come thanks to a grant from, and in collaboration with, the Transforming Clinical Practices Initiative.