Background: The electronic health record (EHR) is a contributing factor to healthcare worker associated stress and burnout. In f most EHRs, users cannot provide feedback and suggest improvements. To capture potential solutions at the point of care, the University of Chicago Medicine’s (UCM) Clinical Excellence team launched a program to provide physicians and advanced practice providers (APPs) with a centralized mechanism to suggest and identify EHR-related and other solutions with the goal of improving ease of practice and reducing daily frustrations. In this innovation, we describe this novel program, known as #WhatToFix, and evaluate levels of clinician engagement associated with use of this tool.
Purpose: To capture fixes, a tool consisting of six questions was created to disseminate to physicians and APPs at periodic intervals; it included two free-text fields to allow the user to describe the problem and a proposed solution. Submissions were routed to a small team for triage with the goal of selecting one fix per month to operationalize. Fixes were evaluated for 1) feasibility, 2) impact, and 3) alignment with institutional goals. Ideas were categorized into four primary categories, which include EHR/IT related (usability, order entry, results, documentation, mobile, and video visit), Hospital (processes/operations, infrastructure, clinician resources), Physician/Patient (communication, scheduling/accessibility, wellness), and Other. The team committed to one of the following 1) exploring the idea further with an explanation of why it can’t be fixed, 2) triaging to appropriate leadership teams for further consideration, 3) resolving the issue at hand, and, 4) in winning cases, both implementing the fix and later broadcasting the solution to the entire provider community.
Description: Since the program was established in July 2019, 307 submissions have been received. The majority of submissions (n=189, 62%) were EHR (Epic) or IT-related changes. Within the EHR/IT category, the majority related to order entry (n=61, 32%) and usability (n=52, 28%). Hospital- and physician/patient-related submissions consisted of 63 (20.5%) and 50 (16.3%) of total entries, respectively. IT fixes that were selected for operationalization included: adding vital trends in Haiku mobile app, adding e-cigarette and vaping usage to social history, improving EKG results formatting in Epic, and electronic ordering of home health equipment. At times, some physicians reached out with fixes they wanted us to broadcast that they had worked on. An example of an impactful non-IT fix was expanding the flu vaccine to include walk-in onsite pharmacies during the pandemic for employees and their families due to lack of mass vaccination events with social distancing. Early feedback from the submitters of winning fixes demonstrated high satisfaction with the program, would recommend the program to their colleagues, and stated that the platform helped reduce their daily frustrations.
Conclusions: A crowdsourced program for clinicians to suggest IT optimization and other fixes can improve ease of practice, reveal knowledge gaps, and promote engagement with IT in finding impactful fixes for the broader community. While much of the frustrations of daily work are related to the EHR, a surprisingly high proportion of suggestions had to do with non-IT related issues that need attention.