I think there are three distinct pieces that make up building and optimizing the electronic health record (EHR) for physicians: customization, documentation and easy access, and iteration. Successfully optimizing all three will lead to efficient and pleasant use of the EHR and is a way for health systems to show respect and care for their physicians. I’d like to explore possible solutions to each individually, starting with customization.
Customization
I think it is important to explicitly state that customization exists on a spectrum. Put plainly, are you considering building and optimizing for your entire health system, an entire service line (pediatrics, surgery, internal medicine, etc.), an individual hospital, a team, or an individual? All of these are important, but I would argue that a strong, focused build at the team level is the foundation for excellent EHR implementation. On the opposite end of the spectrum, a poorly implemented on-the-ground build has a large effect on burnout, likely measured well by increased time spent in the EHR, whether engaging with clinical documentation or just feeling lost hunting for things. On top of that, you may have EHR-focused goals (decreasing note bloat, decreasing time in the EHR, improved billing and documentation), with many of those goals being endpoints touching, and likely requiring, this focused build piece at the individual or small team level.
Separately from the build is consideration for how to understand what your frontline physicians need as well as how to communicate down to them what is being built, required, and changed from the health system level.
Narrowing Down
I believe a strong push to identify, and possibly in the future recruit, physicians interested in EHR build and optimization work will pay dividends. These individuals will be your EHR champions. You want to narrow as much as is feasible. Obviously, having a champion for each individual physician is unrealistic, but consider a champion for 1-3 individual teams. The narrower you are able to get, the more specific feedback and solutions you can implement.
Being themselves part of the team, or at least working very closely with them, these EHR champions will understand deeply what is needed and work to build solutions and generally keep the EHR functioning optimally for their teams. They will act as an important central node for the team within the system's network of people who can answer technology questions, help align and iterate on what is already built, and keep things moving forward. The current state without narrow EHR champions generally leaves teams with a poorly optimized EHR experience that makes it feel more like a burden and less like a useful tool. A well-placed individual who is interested in these pieces will remove this burden from the team and unstick them from an EHR perspective.
These on-the-ground champions can also be leaned on to understand and communicate changes coming, needed additions, changing tools, and new solutions. Instead of relying on another email to fill inboxes, there will now be an individual at the team level to implement what is needed and communicate the rest in a way that is best fit for each team. It changes a one-size-fits-none solution to something that feels very individualized, leading to improvement in desired metrics and more goals reached over time, while improving overall satisfaction for the frontline physician. The EHR should feel like a well-oiled machine when it is needed and to otherwise disappear into the background hum of the team’s day-to-day work.
These individual champions can also come together from time to time to share excellent ideas and builds, as well as to work through problems together. This will act as a multiplying force for excellent EHR implementation which simply will not happen on its own. The more organized and intentional the structure, the likelier it is to happen.
A final point to make is that these champions should be given space, trading in clinical responsibilities for EHR work. This work takes a good deal of time and effort to build, coordinate with others, understand processes and updates, and explore and learn from others building elsewhere. I believe strong work here from an individual who is engaged and excited about this work will pay that time back with dividends.