This fall, athenahealth launched a campaign called “Let Doctors Be Doctors.” The target of the campaign’s ire, the thing standing in doctors’ way, was the electronic health record, or EHR. It really struck a nerve: The associated video has been viewed 25,000 times, a corresponding hashtag has logged over 4 million impressions, and more than 600 physicians have posted impassioned comments to an online sounding board.

How the EHR, which was in part meant to liberate physicians from the drudgery of paperwork, instead became their chief oppressor is a long and complicated story. What we know is that after $28 billion spent in federal incentives to spur adoption and with 8 out of 10 physicians now using an EHR, physician frustration with their technology platforms is at an all-time high. In fact, the 2015 Medscape Physician Lifestyle Report listed the increased computerization of the practice and the burden of administrative tasks among the top four drivers of physician burnout.

Going back to the days of paper, of course, is not a choice. The digitization and interoperability of health records are prerequisites for achieving healthcare’s “triple aim”: reducing cost, improving quality, and enhancing the patient experience. With the right technology and focused leadership, the EHR can not only enable more efficient and better-coordinated care, but also drive physician engagement and satisfaction. In this post, we’ll describe how we did this at Privia Health, in collaboration with athenahealth.

Privia Health is one of the fastest growing independent physician organizations in the country with over 1,200 physicians in six U.S. states. While these physicians practice across 30 specialties, they are unified by a single EHR platform.

If the typical EHR has become the bane of many physicians’ existence, the EHR implementation tends to occupy its own special ring of hell — the technology equivalent of a heart and lung transplant. But, after two years onboarding more than 600 providers across 200+ locations to an entirely new platform, Privia has learned how to turn the EHR into a tool for supporting physician productivity and engagement, and establish it as a foundation for improving health care outcomes.

Define “the why.”

Unlike many health systems that, in this era of accountable care, find themselves having to re-define their vision and re-align physicians around new performance goals, Privia has the advantage of being “purpose-built” for value-based care. Physicians know from the start, for example, that they’re joining a performance-driven culture. They understand that switching to a common technology platform is essential for achieving quality goals. They know that adjusting to a unified clinical workflow and agreeing on evidence-based protocols will reduce what former Geisinger Health System CEO Glenn Steele calls “unjustified variation” in care. These are concessions for physicians used to independent practice, but they’re made in the service of a shared vision for population health.

Help doctors focus on doctoring.

Tony Schwartz, chief executive of The Energy Project, recently wrote in a New York Times column that “most companies invest in building the skills of their employees. Few of them systematically invest in building people’s capacity to perform at their best.” Medical groups and hospitals are no different. A 2014 study in the International Journal of Health Services found that doctors spend close to 17% of their work week on billing, insurance, and other administrative work. As one California doctor complained it in a comment to the Let Doctors Be Doctors site, “I am one expensive data entry clerk.”

For an EHR to become a tool for physician engagement, it needs to wick away work from physicians so they can focus on patients. This means, for starters, moving administrative work to centralized back-office service teams where it can be automated or executed at scale. With triggers built into the EHR’s workflow, tasks such as the recording of patient medications and the fulfillment of other quality requirements can be flagged for clinical staff to complete before the patient enters the exam room. This frees up the physician to focus more fully on the patient instead of the computer.

Schwartz’s research, done in partnership with Harvard Business Review, found that employees who were able to focus on one thing at a time at work were 29% more engaged. When an EHR can remove distractions and help physicians focus it is more likely to be embraced.

Get visibility down to the mouse-click.

As the adage goes, you can’t manage what you can’t measure. To effectively implement and enhance performance with an EHR, or any system, leaders need to be able to see what’s happening at the individual provider level and to intervene as needed. This level of visibility was a fundamental requirement and a key factor behind the decision to go with a cloud-based platform. As providers are brought live on the platform, a host of role-specific performance indicators are remotely monitored at athenahealth and Privia’s central “nerve centers.” How long are physicians spending with each encounter? Are they being slowed down and clicking around too much? How well is front desk staff capturing insurance information? Are medical assistants following protocols around specific quality measures? Each performance metric can be tracked not only against Privia benchmarks but nationally across the athenahealth provider network. Armed with that data, leaders can identify and intervene early and often with providers and staff who need to improve.

Create a performance “game layer.”

Physicians tend to be competitive by nature. After going through years of medical school battling over the best grades and placements, however, they find themselves in positions where they rarely know how they’re doing. Most doctors don’t know what patients think of them, what their total cost of care profile is, or how they’re doing at managing hypertension cases relative to the best performers. This is where we can learn from the world of gaming. As game designer Jane McGonigal points out in her book Reality is Broken, for work to be satisfying “it must present us with clear, immediately actionable goals as well as direct, vivid feedback.”

At Privia, physicians have a dashboard view of their own KPIs and then come together monthly in regional groups to review data with their peers. Clinical measures are put up on a screen and the 15-20 doctors in the room are listed in rank order. So, if one doctor is doing tobacco cessation screenings 95% of the time and a second is only doing it  10% of the time, the lower-performer not only knows he needs to do better but has a target to aim for next month. For many physicians who have been in independent practice for years, it’s the first time they have a read on how they’re doing and a clear sense of what high performance actually looks like.

Reward outcomes, not effort 

Physicians are motivated, ultimately, by delivering better patient outcomes. Under the traditional fee-for-service payment model, outcomes are neither closely tracked nor rewarded, and the EHR is there to mostly document and bill for services rendered. With the move to accountable care, that is changing for the better. In 2014, the first year it participated in the Medicare Shared Savings program, Privia generated over $5.7 million in savings, putting it in the top 15% of accountable care organizations nationwide. Handing physicians bonus checks for measurably improving the cost and quality of patient care reminds everyone of “the why” and reinforces that everything they did to get there was worth it.

Disclaimer: Orginal post: https://hbr.org/2015/12/how-to-make-electronic-health-records-an-asset-instead-of-a-burden