1

Reducing clinician burden with user-centered design

White Paper

2

ContentsThe relationship between usability and clinician burden ....... 3

Allscripts Sunrise™ .................................................................. 7

Paragon®............................................................................... 10

Allscripts TouchWorks® EHR ................................................. 13

Allscripts Professional EHR™ ................................................. 16

Reducing clinician burden: A collaborative goal .................. 19

3

Healthcare organizations today face many challenges, from improving patient outcomes with limited resources to succeeding in a time of changing regulatory requirements. Healthcare organizations are also struggling to improve clinician satisfaction, and one of the largest factors affecting clinician satisfaction is health IT usability. Usability is a challenge across the board, with 86% of acute organizations citing usability as their biggest complaint, and 67% of ambulatory organizations citing usability as their biggest complaint.1 The impact of poor usability is concerning, because it is a major contributor to clinician burnout.

What is clinician burnout? Clinician burnout is a long-term stress reaction characterized by emotional exhaustion, depersonalization (cynicism) and loss of work fulfillment.2 Clinician burnout is a critical concern, because it has been linked to serious consequences which impact clinicians, patients and the entire U.S. healthcare system. Examples include reduced job performance, decreased patient engagement, poor quality and safety of care, increased healthcare costs and inferior health outcomes.

Several alarming statistics illustrate the severity of the problem, and highlight the need for immediate intervention3:

• More than 50% of U.S. physicians report symptoms of burnout.

• The physician depression rate is significantly higher than that of the general population (39% vs. 7%).

• The physician suicide rate is 2x higher than that of the general population.

• Significant numbers of physicians are leaving practice early.

• The cost of replacing a physician is $500,000 to $1,000,000.

Clinician burnout is a system-wide problem with numerous external and individual factors. External factors, or the system attributes over which clinicians have limited control and within which they must work and adapt, include society and culture, rules and regulations, organizational factors, the learning and/or practice environment (which includes health IT usability) and healthcare responsibilities. Individual factors are the factors which are unique to clinicians, and over which they have more control.

Research suggests that external factors carry more weight in contributing to burnout4,5 and that interventions should focus more on the external system factors, to reduce burnout and promote well-being. The conceptual model and specific examples of external and individual factors are listed in the following figures from the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience6:

1 Peer 60 (now Reaction Data) (2006). “Physicians’ Take on EMRs.”

2 Agency for Healthcare Research and Quality (July 2017). “Physician Burnout.” https://www.ahrq.gov/professionals/clinicians-providers/ahrq-works/burnout/index.html

3 Noseworthy, Madera, Cosgrove, et al.(March 28, 2017). “Physician Burnout Is A Public Health Crisis: A Message to Our Fellow Health Care CEOs.” Health Affairs Blog. DOI: 10.1377/hblog20170328.059397

4 Institute of Medicine (2000). To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press.

5 Manzano-García, G., and J. C. Ayala-Calvo 2013. “New perspectives: Towards an integration of the concept “burnout” and its explanatory models.” Annals of Psychology, 29(3):800-809.

6 Brigham, T., C. Barden, A. L. Dopp, A. Hengerer, J. Kaplan, B. Malone, C. Martin, M. McHugh, and L. M. Nora. 2018. A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201801b

The relationship between usability and clinician burden

3

400physicians die by suicide each year,

a rate

2xthat of the general

population

Andrew & Brenner, 2015

24%

of ICU nurses tested positive for symptoms of post-traumatic stress

disorder

Mealer et al., 2007

23-31%

Prevalence of emotional exhaustion among primary care nurses

Gomez-Urquiza et al., 2016

39%

Physician rates of depression remain alarmingly high at

Shanafelt, 2015

4

External factors

SOCIETY & CULTURE

• Alignment of societal expectations and clinician’s role

• Culture of safety and transparency• Discrimination and overt

and unconscious bias• Media portrayal• Patient behaviors and expectations• Political and economic climates• Social determinants of health• Stigmatization of mental illness

RULES & REGULATIONS

• Accreditation, high-stakes assessments and publicized quality ratings

• Documentation and reporting requirements

• HR policies and compensation issues• Initial licensure and certification• Insurance company policies• Litigation risk• Maintenance of licensure

and certification• National and state policies

and practices• Reimbursement structure• Shifting systems of care and

administrative requirements

ORGANIZATIONAL FACTORS

• Bureaucracy• Congruent organizational

mission and values• Culture, leadership, and

staff engagement• Data collection requirements• Diversity and Inclusion• Harassment and discrimination• Level of support for all

healthcare team members• Power dynamics• Professional development

opportunities• Scope of practice• Workload, performance,

compensation, and value attributed to work elements

Individual factors

PERSONAL FACTORS

• Access to a personal mentor• Inclusion and connectivity• Family dynamics• Financial stressors/economic vitality• Flexibility and ability to

respond to change• Level of engagement/connection

to meaning and purpose in work• Personality traits• Personal values, ethics and morals• Physical, mental, and

spiritual well-being• Relationships and social support• Sense of meaning• Work-life integration

SKILLS & ABILITIES

• Clinical Competency level/experience• Communication skills• Coping skills• Delegation• Empathy• Management and leadership• Mastering new technologies or

proficient use of technology• Optimizing work flow• Organizational skills• Resilience skills/practices• Teamwork skills

Learn more at nam.edu/ClinicianWellBeing

SOCIETY &CULTURE

PERSONAL

FACTORS

SKILLS &

ABILITIES

HEALTH CARE

RESPONSIBILITIES

LEARNING/PRACTICE

ENVIRONMENT

OR

GA

NIZ

ATION

AL

RULES &

REGULATIONS

FAC

TOR

S

CLINICIAN WELL-BEING

CLI

NIC

IAN-P

ATIENT RELATION

SH

IP

PATIENT WELL-BEING

This conceptual model depicts the factors associated with clinician well-being and resilience; applies these factors across all health care professions, specialties, settings, and career stages; and emphasizes the link between clinician well-being and outcomes for clinicians, patients, and the health system. The model should be used to understand well-being, rather than as a diagnostic or assessment tool. The model will be revised as the field develops and more information becomes available. Subsequent layers of the model, and an interactive version of the model, are in development in conjunction with the Action Collaborative’s other working groups and will be made available shortly.

Copyright 2018 National Academy of Sciences

FACTORS AFFECTING CLINICIAN WELL-BEING AND RESILIENCE

Factors affecting clinician well-being and resilience

LEARNING/PRACTICE ENVIRONMENT

• Autonomy• Collaborative vs. competitive

environment• Curriculum• Health IT interoperability and

usability/Electronic health records• Learning and practice setting• Mentorship program• Physical learning and

practice conditions• Professional relationships• Student affairs policies• Student-centered and

patient-centered focus• Team structures and functionality• Workplace safety and violence

HEALTH CARE RESPONSIBILITIES

• Administrative responsibilities• Alignment of responsibility

and authority• Clinical responsibilities• Learning/career stage• Patient population• Specialty related issues• Student/trainee responsibilities• Teaching and research

responsibilities

Figure 1: Factors Affecting Clinician Well-Being and Resilience – Conceptual Model, National Academy of Medicine Action Collaborative on Clinician Well-Being

5

Clinician burnout caused by burden has impact beyond clinicians. While reducing impact on clinicians is a valid reason to improve usability, burden also has a profound impact on other stakeholders and factors across the healthcare continuum—staff, patients, costs and much more. To address this growing concern of clinician burden, the healthcare industry has relied on clinicians to adapt, but we have now reached a point where clinicians can no longer continue to adapt while maintaining desired outcomes.

Allscripts is dedicated to adapting, so clinicians no longer need to. Health IT—especially the electronic health record (EHR)—is often seen as the face of the healthcare system and presents a tremendous opportunity for improvement. Therefore, Allscripts is focusing on improving usability across our solutions with purposeful, user-centered design.

The importance of user-centered design

Why does user-centered design matter?Usability is considered the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use.

• With improved efficiency, clinicians can complete tasks more intuitively, with speed, fewer steps and no wasted effort.

• With improved effectiveness, clinicians can improve outcomes, safety and learning, and provide goal-centered care.

• With improved satisfaction, those clinicians are less burdened, and they feel respected, with peace of mind and trust.

A user-centered design process is critical to improving usability. The usability and safety achieved through a proven user-centered design process helps deliver the right product to meet user needs. Allscripts follows the user-centered design process, shown in Figure 2, which enables us to understand the key concerns clinician users have, create innovative solutions and measure the results.

UserProfiles

UsabilityMetrics

Patterns &Standards

UsabilityTesting

Understand Create Measure

Clinician input in designInvolving end users early and often is an important part of a successful user-centered design process. Allscripts leverages our internal team of clinical leaders, as well as client users, throughout the design and development of our solutions. Our teams of clinicians, developers, designers and solution owners research, and work to understand, user needs, tasks, environments and goals, through a variety of research methods. Once design and development are underway, collecting feedback from end users is important, to make sure that we are on track to meet our measurable usability goals (e.g., efficiency, satisfaction, intuitiveness, and confidence). We do this through conducting formative usability testing using real-world, rigorous risk assessment-based scenarios. Our data has shown us that formative usability testing is where we catch the most potential patient safety issues. This involvement of clinical users throughout solution design and development allows us to deliver solutions that meet user needs for reduced burden, and increased safety, efficiency and outcomes.

Figure 2: The user-centered design process enables us to understand the key concerns clinician users have, create innovative solutions and measure the results.

6

Tracking usability improvementsAllscripts has measurable goals for improving usability. These goals include objective measures (e.g., time on task, errors, accuracy and efficiency) and subjective measures (e.g., subjective usability, confidence and satisfaction). For example, we may aim for objective 100% use with no errors as a usability measure, but a subjective user confidence measure would be “confidence in result averages a 6 on a 1—7 scale.”

Another useful subjective measure of usability is the System Usability Scale (SUS), a validated, industry standard for evaluating user reaction to product usability (Figure 3). We use this scale with clients, to baseline our products in their environment, enabling us to track performance and focus on areas of priority. We also use this scale during our formative usability testing that we do during design and development. We engage with our clients early, and often, to evaluate our designs, to make sure that we are on track to achieve their goals.

Figure 3: The System Usability Scale (SUS) provides an industry standard for evaluating user reaction to product usability.

The most important question in user-centered designWhile following a rigorous user-centered process is necessary for reducing clinician burden, and improving the experience of using health IT, it is not enough by itself. Allscripts has found that approaching the design of products with a philosophy of helpfulness is also required. Simply put, we ask ourselves the question, “What would make this the most helpful for the user?” Answering that question provides the fuel for innovation, and delivers a product that goes beyond just being usable, and becomes one that actively helps the user. This is another area where Allscripts engages with our clients to understand what would be most valuable to them.

We have recognized that our clients do not evaluate us on the features that we deliver in our products, but on how well the features we deliver help our clients achieve their goals. This can take many forms, but successful outcomes include the following:

• Spending more face-to-face time with patients

• Delivering safe care

• Getting home for dinner with family

• Working at the top of their license

• Having peace of mind that they’ve seen everything necessary for this patient

• Spending less time on non-clinical tasks.

As a result, Allscripts is focused on creating products that guide, warn, suggest, orient and assist users in a variety of ways—all helping them meet their goals.

The System Usability Scale - Standard Version 1 2 3 4 5

I think that I would like to use this system.

I found the system unnecessarily complex.

I thought the system was easy to use.

I think that I would need the support of a technical person to be able to use this system.

I found the various functions in the system were well integrated.

I thought there was too much inconsistency in the system.

I would imagine that most people would learn to use this system very quickly.

I found the system cumbersome to use.

I felt very confident using the system.

I needed to learn a lot of things before I could get going with this system.

Strongly disagree

Strongly agree

7

Allscripts Sunrise™

Major steps in intuitive design

Allscripts solution improvements come about through the intersection of user-centered design process/science and our focus on helpfulness. A perfect example is Allscripts Sunrise,™ the Allscripts EHR for large hospitals and health systems. Sunrise modules have recently been reworked with user-centered design principles in mind.

In the example in Figure 4, a feature in Sunrise called Compass has been visually redesigned to improve readability and intuitiveness, which, in turn, reduces the cognitive burden on the user. However, what makes this Sunrise design so valuable is that it provides assistance to the user, by understanding what they are doing during tasking, and bringing the information necessary to complete the tasks directly to the person—rather than them having to go and find that information themselves.

Figure 4: Sunrise Compass gathers tasks from all areas of the Sunrise solution, so users can see and take appropriate action on their tasks from one place. With the improvements made to Compass, users found the new version 49% more enjoyable, 40% more intuitive and 36% better at giving the right information at the right time. Users found it 70% “newer” and “fresher,” with a 97% task completion rate with no previous training. The subjective usability score improved 180%.

Figure 5: Patient Timeline provides a visual representation of gaps in care, with the ability to see upcoming patient events or historical trends.

Another feature of Sunrise that helps reduce clinician burden is Patient Timeline (Figure 5). Timeline provides a visual representation of gaps in care, with the ability to move forward to see upcoming patient events, or back in time to see historical trends. Timeline also provides single-click access to relevant clinical information that combines all documentation in a clear concise patient record. With the updates made to Timeline, users found it 24% more enjoyable to use and 31% more intuitive, and had a 97% task completion rate with no previous training on the solution. Timeline achieved a subjective usability score of 75, improving from a score of 49.

8

Compass and Timeline tools benefit clinicians in all areas of the hospital, but Allscripts is also focused on improving usability in specific departments. An example is Sunrise™ Smart Pump (Figure 6). With Smart Pump, users can send infusion-order information to pre-populate the pump, and in turn, receive confirmation of actions taken on the pump. The user-centered, visual design of Smart Pump enhances readability and understanding, and the system points out differences to the user, rather than the user having to look for discrepancies.

Figure 6: Sunrise™ Smart Pump enables users to send infusion-order information to pre-populate the pump and receive confirmation of actions taken on the pump.

Figure 7: This shows Prescription Writer before edits through our design process and input from our client users.

Another solution that’s in process now, Sunrise™ Prescription Writer, will help generate electronic prescriptions to improve patients’ pharmacy needs, ultimately improving accuracy, reducing errors, and saving clinicians valuable time. The design of the current product (Figure 7) meets functional and regulatory requirements, but the product was not easy to use, due to a high cognitive load on users. In addition, writing prescriptions is not as satisfying or efficient for users as our clients would like.

9

We consulted with our clients to determine what they’d like changed, and what would be most helpful for them in achieving their goals, be that pre-filling information or preventing mistakes. We then built that helpfulness into the solution. Together with our clients, we crafted the following measurable usability goals:

• The user can complete a new prescription (100% by the second attempt).

• The user can add a prescription for a compounded medication (100% by the second attempt),

• The user believes that they can prescribe quickly.

• The interface is “new” and “fresh.”

• The application gives the user a sense of satisfaction.

In our user testing, the new version of Prescription Writer (Figure 8) has been a tremendous success. One hundred percent of our usability goals were met, and the SUS score went from the original 49 to 78 on the first test, then all the way up to 88 by the second test. There was a 29% improvement in perception of safety. One user called the new version “beautiful,” and another said it was “the best solution for rounding options with calculations I’ve seen among EHRs.”

Figure 8: The new, improved Prescription Writer provides a more streamlined interface, with information that is easily and readily digestible by the user.

Together with the help of our clients, Allscripts has improved the usability in Sunrise, and reduced burden on our clinician users.

10

Paragon®

Constantly improving for community hospitals

Paragon,® Allscripts fully integrated acute and ambulatory solution for community hospitals, helps organizations improve user satisfaction through more efficient workflows and faster application performance, with the same clinical decision support and a single registration system across all settings. Allscripts is focused on improving user-centered design in Paragon, and has made great improvements in recent months.

One example of such improvements based on user-centered design is Paragon® Clinician Hub (Figure 9), which puts the key information your care teams need all in one place in one newly streamlined interface. Clinician Hub provides one profile application across all care settings, with visual indicators for incomplete modules, user-customizable sort order and display of modules, and barcode scanning of implants for procedures performed outside the operating room.

Figure 9: Paragon Clinician Hub puts the key information your care teams need all in one place.

Figure 10: The new full-screen Workqueue in Clinician Hub that enables the ability to view, share, reassign and address results directly.

Allscripts also added a new full-screen Workqueue (Figure 10) to Clinician Hub, enabling clinicians to have easy access to tasks and alerts, including the ability to reassign, as appropriate, to another clinician.

11

Among other changes in the Clinician Hub, clinicians get a clearer patient picture with new Overview Modules that include information on immunizations, problems and procedures, advanced directives and home medications. Clinicians can also save time with patient search and the new “Recent Patient” functionality (Figure 11), enabling them to more easily and quickly access and review recently viewed patient charts.

Paragon® Ambulatory Care EHR Clinician Documentation streamlines care with a next-generation clinical documentation system that makes it easy to deploy and customize documentation templates. Users can enjoy templates tailored to their workflows, while structured data is captured for clinical care, quality measures and analytics. As shown in Figure 12, the doctor can do a live review of the notes (right, inset) based on the patient intake information. Clinician Documentation also has scribe functionality, in which providers can sign off in a scribe, and the results automatically filter into Workqueue.

Figure 11: The new Patient Search and Recent Patient Selector functionality in Clinician Hub enables clinicians to find the information they’re looking for more quickly and easily.

Figure 12: Ambulatory Care EHR Clinician Documentation enables ambulatory clinicians to document in a way that works best for them.

Some of the changes Allscripts has made to the Paragon solution design are simple, but powerful. Paragon now prompts with a “recently given warning” during medication administration for improved patient safety. Allscripts has also added a “save all” button to Paragon, enabling clinicians to enter data on multiple profile modules, and not worry about losing data or needing to save before moving to the next module.

12

Figure 13: New flowsheet filters in Paragon provide the ability to save by user.

Paragon now has more viewing options, with enhanced flowsheet filters, including the ability to save custom flowsheets by user, and view clinical documentation on flowsheets (Figure 13).

Allscripts continues Paragon’s solution design improvements, frequently utilizing feedback from our clients to better our solutions.

13

Allscripts TouchWorks® EHRA refreshed, responsive user interface

Allscripts has recently redesigned the interface of Allscripts TouchWorks® EHR with a focus on usability. The new TouchWorks EHR has been designed using standards-based web conventions and user-centered design process, focusing on:

• Creating efficiencies• Streamlining workflows• Enhancing the user experience.

This redesign has resulted in a responsive web-based user interface (UI) with a responsive web design. In this redesign, Allscripts has increased font sizes and icon click targets, making it easier for clinicians to work within the system.

One of the recent improvements made in the TouchWorks EHR interface is filtering functionality. As shown in Figure 14, the drop-down menu enables end users to quickly filter results, reducing the time required to find pertinent tasks.

Figure 14: Filtering is a key task improvement added during the TouchWorks EHR redesign, enabling clinicians to access the information they need more quickly.

Figure 15: TouchWorks EHR now has larger fonts and click targets, more contrast for improved readability, filtering functionality and organization column definitions.

Another recent change is readability and design improvements in the patient search feature. As seen in Figure 15, with this redesign, TouchWorks EHR has larger fonts and click targets, more contrast for improved readability, filtering functionality and organization column definitions.

14

On the Add Clinical Item (ACI) screen in Figure 16, TouchWorks EHR added a Clinical Assistant flyout during the ordering process. This flyout helps to provide quick access to patient information the clinician might not see otherwise—for more informed decision making.

Figure 16: TouchWorks EHR added a Clinical Assistant flyout for quick access to patient information during ordering.

Figure 17: Banner cards in TouchWorks EHR bring useful information to hand on-screen for clinicians.

With the improvements in TouchWorks EHR, users can update site and organization information without signing out of the application, adjust font sizes for Note Output panel and viewers, and utilize Banner Cards to make useful information easier to find, as shown in Figure 17.

Another major change in the TouchWorks EHR solution is in the Charge workflow.

Based on physician feedback, Allscripts streamlined the Charge workflow by unifying Diagnoses and Procedure/Visit Charges into a unified workspace (Figure 18). During usability sessions with providers and clinical staff, the new Charge workspace achieved the following usability results:

• A 47% increase in perceived usability as measured by the SUS, when compared with the pre-18.1 workflow, was found.

• Via a task-oriented usability test, 100% of users completed Charge workflow tasks (e.g., add/edit charge documents, understand navigation paradigm or add favorites).

15

As one user says, “Condensing it is win-win for everyone, so this is much more efficient in minimizing clicks and navigation and any of those sorts of hold ups. I like how you can see it all on one screen.”

One last update to highlight in this TouchWorks EHR redesign is schedule consolidation (Figure 19). With this update, interactive “status indicators” alert to new arrivals on provider schedules, and update schedule views, saving users clicks by eliminating inefficient navigation to separate workspaces. The consolidated schedule provides a larger text size, icons and contrast, allowing for easier scanning and selecting on this crucial provider workspace—validated by provider and clinical staff usability sessions. The consolidated schedule also provides easier access to inline item editing (e.g., fields like Location or Status). The streamlined access to the Charge workspace directly from the Schedule screen saves users clicks.

Figure 18: The new Single Page Charge reduces clicks, consolidates workflow and is easier to read for clinician users.

Figure 19: The updated schedule screen consolidates what used to be two separate screens into one, improving user-friendliness, consolidating the workflow and making the information easier to read and digest.

Allscripts is focused on design improvements for TouchWorks EHR, moving forward with the help of our clients and clinician team.

16

Allscripts Professional EHR™

Improving usability through mobility

Mobile technology is driving today’s healthcare industry. For Allscripts Professional EHR,™ Allscripts looked to move to a service-oriented architecture, and supplement the desktop with feature functionality through mobile capabilities, with applications that are task-oriented and easy for clinicians to use. This desire to move to a mobile platform is based on four key reasons:

• Task-based: Mobile applications tend to be task-based rather than monolithic, making users more agile.

• Simple: Task-based applications are easy to learn, thanks to their simplicity.

• Stable: Smaller, simpler applications tend to be more stable for mobile devices.

• Familiar: Most users are familiar with the concepts of mobile applications.

Professional EHR will now be composed of the desktop application and three mobile applications: Professional EHR Mobile, Clinical Imaging and a new Rooming application, all enabling clinicians to be productive on the go. The Rooming application is tablet-based, and will include everything that needs to be done from when the patient gets in the exam room until the provider sees the patient, to meet Meaningful Use. With this application, practices can optimize data entry for rooming patients, and get intelligent reminders to improve their workflows.

The new streamlined applications are easy to use, and visually easy to understand. For example, a clinician might start their day by viewing their schedule in Professional EHR Mobile (Figure 20). The interface is simple, with nothing unnecessary in the view.

Figure 20: The schedule feature in Professional EHR Mobile enables clinicians to see their upcoming patients at a glance, with no unnecessary information.

17

If a newborn was born last night at the hospital, the doctor can easily add that new patient with the new Add Patient feature in Professional EHR Mobile (Figure 21). The patient appears in the system moments later (Figure 21).

Figure 21: The new Add Patient feature in Professional EHR Mobile enables clinicians to quickly and easily add new patients as needed.

The doctor could use the Quick Encounter feature in Professional EHR Mobile to document the newborn exam. If the newborn has a birthmark, the doctor can use Clinical Images to document it.

Figure 22: The Quick Encounter feature enables clinicians to quickly and easily document exams, and the Professional EHR Mobile application enables the clinician to quickly get to the Clinical Images application to document the newborn’s birthmark.

18

The doctor uses the Clinical Images app to take several photos of the birthmark (Figure 23). She then indexes the photos with the appropriate document type and tags. The Edit Image feature enables the doctor to annotate the size of the birthmark on the image. With Clinical Images, clinicians can capture images directly at the point of care, link those images to the patient and eliminate the need to transfer from a device and import into the chart, increasing security. Wound progressions can be captured, and compared from visit to visit.

Figure 23: With the Clinical Images application, the doctor can quickly and easily document the size of the newborn’s birthmark.

In addition to Professional EHR’s mobile improvements, we have added the ability to link family members in the EHR. With our new Family Charts feature (Figure 24), we can link families, and share pertinent history items, saving time and increasing accuracy.

Figure 24: With our new Family Charts feature (Figure 24), we can link families, and share pertinent history items, saving time and increasing accuracy.

Allscripts is dedicated to continued solution improvements within Professional EHR. With Professional EHR’s new mobile strategy, we can help clinicians be more productive, and get the information they need more quickly and easily—no matter where they are.

19

Clinician burden is a system-wide problem, affecting organizations worldwide. While Allscripts has the most control over the design of our products, we recognize that we have a part to play in the broader system approach to burden—and that role does not stop at design. As part of the system approach to reducing clinician burden, our optimization efforts configure products to the organization. We also improve efficiency, and reduce burden, through training and skills development.

Studies have shown that how a health IT product is implemented and configured has a significant impact on the usability, safety and overall experience using the product.1 Michael Hodgkins, MD, chief medical information officer of the American Medical Association (AMA), says: “While design can be an important factor, so too can implementation choices made onsite. Increased collaboration between vendors, information technology purchasers and physicians is needed to optimize experiences and address current needs.”

Allscripts firmly believes (and available data strongly suggests) that obtaining the full value from clinical systems begins with acceptance and deep adoption on the part of end users, and that deep adoption begins with deep collaboration between the client and the vendor. Rather than an endpoint, achieving deep adoption constitutes a process of continuous improvement, not only to address end user satisfaction and confidence but also to drive important clinical and operational outcomes.

1 MedStar Health, “Study Points to Need for Performance Standards for EHR Usability and Safety,” 18 July 2018.

Reducing clinician burden: A collaborative goal

"One thing that has to happen is…actually finding a vendor willing to look at how you work. To look at your workflows, to do the things that a good informatics department does in terms of examining how an individual system functions, and actually partnering with them to design cloud-based solutions."

Chief Quality and Transformation Officer, Allscripts client

20

© 2019 Allscripts Healthcare, LLC and/or its affiliates. All rights reserved.WhitePaper_ClinicianBurden_06-25-19

www.allscripts.com