When C. Becket Mahnke, MD, steps into the physician lounge at North Central Washington-based Confluence Health, the atmosphere feels warmer than it did just a few years ago.
“We're entering an era—at least at Confluence Health—where the EHR, which has been the one of the biggest pain points for over a decade, is no longer the biggest pain point,” said Dr. Mahnke, a pediatric cardiologist and chief medical information officer at Confluence Health. “I can go into the doctor's lounge and not get yelled at now.”
Confluence Health 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.
That cultural shift happened through a deliberate, structured and team-driven effort to transform how physicians interact with EHRs and, more recently, how they harness augmented intelligence (AI)—also known as artificial intelligence—to automate documentation. Confluence Health went from lessening “pajama time” charting after hours to setting a national benchmark for EHR satisfaction.
The results have been striking. In its most recent Arch Collaborative EHR Satisfaction and Wellness survey, Confluence Health landed in the 100th percentile compared to community hospital organizations nationwide, setting the standard for EHR satisfaction.
Feedback from 563 clinical team members, including 166 physicians, showed strong improvement across the board compared to 2023, with double-digit raises in scores among three of the four surveyed groups. Physicians’ EHR Satisfaction scores rose by eight points, nurses by 18 points, nonphysician providers by 12 points, and medical assistants by a sizable 24 points.
Confluence Health’s surveys kick off a two-year process starting with data collection from feedback, followed by analysis, and ultimately culminating in concrete action plans across teams.
The surveying focus switches year to year between burnout and well-being. In 2024, Confluence Health’s burnout rate among family physicians fell from 41% to 26% in that year’s survey. The work after work hours spawned by electronic patient messages and the EHR was both substantial and a driver of the overwork that often contributes to physician burnout. Addressing this need continues to be a priority for Confluence Health.
From burden to bright spots
Confluence Health’s approach isn’t just about raising averages—it’s about addressing variation. Some physicians still find EHR use frustrating, so leadership has introduced coaching resources that run alongside formal training.
“We have a menu of options,” Dr. Mahnke said. “Do you want a trainer to come to you? Do you want to use the Epic online courses—which, by the way, have CME, and Confluence Health will pay you for your time to sit in those?”
Another strategy has been what he calls “bright spotting.”
“We show the folks who are struggling that it is possible in our organization, in your department often, that there’s somebody doing really well. And we pair them up,” Dr. Mahnke said.
That spirit of teamwork also guided how leadership prioritized improvements. In 2023, physicians scored relatively high on EHR satisfaction, but nurses and medical assistants (MA) lagged.
“I said, for the next two years, we're going to stay the course on the physicians with the stuff that we're doing, but we're going to really focus on our teammates in the nursing and MA space,” Dr. Mahnke recalled. “They fully supported that move. And sure enough, the MA and nurse scores rose, and so did the physician scores. You have to lift all the boats. We’re a team, and if we don’t all support each other, eventually no one’s going to be happy.”
AI for meaningful support
Detailed feedback from the surveys laid the groundwork for Confluence Health to help alleviate pain points. The introduction of AI tools has been a boon toward that goal.
“We’re moving quickly into AI. We added four new AI tools this year,” Dr. Mahnke said. “We saw our happiest physicians were those who were using ambient documentation.”
For some, the impact was instant and transformative.
“The AI tools, especially ambient, have an impact on day one of people using them,” he said. “I’ve gotten so many grateful messages from providers who are using ambient documentation.”
For example, one family medicine physician shared his delight at the end of the first week.
“It was five minutes to five on a Friday,” Dr. Mahnke recalled. “He called me and said, ‘I just have to let you know I’m done with all my charting. I’ve finished my in-basket. It’s five minutes to five on a Friday. I feel great.’ He then said, ‘I’ve already told my staff to open up more appointments for next week.’ I read that as we increased access for our patients in the community that he serves.”
Dr. Mahnke acknowledges that adding more appointments may seem like an accelerator right back into burnout, especially for strained offices keeping up with rising medical needs without adequate staffing. But with enough support, it can be possible, he said.
Patients are also noticing the impact of ambient scribes too. Two months into implementation, a survey of 8,000 patients earlier this year found significantly higher satisfaction among those whose physicians were using ambient documentation tools.
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.
Culture, collaboration and the long view
For Confluence Health, technology has never been the whole story. Surveys themselves often reveal cultural insights unrelated to EHRs.
“When we're asking for survey feedback, we learn so much about culture and how the system works,” Dr. Mahnke said. “That is not solely EHR-related. We ask what’s contributing to burnout, and now thankfully EHR is at the bottom. But we’ll find out what else we should tackle to improve work satisfaction.”
That holistic lens has led to deliberate coordination between informatics, IT, training and well-being teams. Many staff members work in a hybrid format, but on certain days they prioritize being physically together.
“On Tuesdays and Thursdays, people tend to be in the building more,” Dr. Mahnke said. “I spend as much of Tuesday there as I can. And that allows those groups to get together and function better.”
But Dr. Mahnke emphasizes that working to optimize the EHR will never truly end.
“A former boss asked me years ago ‘when does this EHR stuff end?’ I had to break the news to him that it doesn’t. Ever,” he said. “Medications change, devices change, procedures change. The EHR is another part of health care delivery.”
That’s why Confluence Health surveys every two years—not every year.
“Surveying every year is too fast,” Dr. Mahnke said. “First, we prepare for the survey, then carry it out over a quarter, then interpret the survey and actually implement adjustments and changes. That takes longer than a year to do it meaningfully, and that’s why we do it every two years.”
The cycle, alternating focus on burnout one year and well-being the next, has proven sustainable with the purpose being to see variations with the vendor, health system or user.
“We’ve found so far that it’s about 25% vendor, 25% system, and 50% user. People don't like to hear that, but I remind them that how would that be any different than the variation in surgical outcomes based on skill set? It starts some really important conversations that then point us toward the changes we need to make.”
A future focused on people
From Dr. Mahnke’s perspective, the technology is always in service of people—both patients and physicians.
“Our informatics role is, are we meeting the needs of the people who are taking care of the patients?” he said. “We make sure we meet the needs of patients, so we need to do the same for our staff.”
That philosophy, coupled with deliberate investment in AI tools, training and collaboration, has reshaped daily life for physicians. It has also positioned Confluence Health as a national leader in EHR satisfaction.
“Every comment and data point was reviewed, giving us clear insight into where we can still improve and where we can learn from other top-performing organizations,” Dr. Mahnke wrote to colleagues. “Our priorities will focus on the areas of greatest opportunity identified through this benchmarking process. Your commitment and partnership are the foundation of our ongoing success.”
For EHR transformation tactics, check out the AMA STEPS Forward® toolkit “A Systematic Approach to Reducing EHR Inbox Burden.”
