Improving Patient Care with Optimized EHR Systems Featuring Dr. Kim Furry

Electronic health record (EHR) systems can be powerful management tools, but using them improperly can present challenges for physicians and patients. In this episode, we dive into the role of EHR systems in support of value-based care. Our guest, Dr. Kim Furry, a seasoned orthopedic surgeon and an Epic-certified Physician Builder, unveils the intricate challenges physicians encounter while building and augmenting EHR systems. Discover time-saving techniques, the importance of data quality, and enhancements that can improve physician efficiency and patient care.

KEY TAKEAWAYS: 

• Physicians spend a significant amount of time on EHR tasks, like documentation and management of alerts and messages, diverting valuable time from direct patient care.

• The performance outcomes in healthcare heavily depend on the efficiency of the EHR system build and usage.

• Customizing EHR systems to suit individual workflows is central to optimization, however, focusing first on data integrity and quality is imperative.

LISTEN TO THE EPISODE:

 

 Transcript:

Daniel J. Marino: 

Welcome to value-based care insights. I'm your host, Daniel Marino. As we've discussed before, certainly around position, well-being, and improving position. Well, being one of the areas that it tends to be a big challenge for physicians is the use of their Ehr, and it's not so much I think, using the functionality. The EHR. I think, as many physicians have gone through the implementation over these past, many, many years, they view they they've learned how to use this system. The EHR. And have learned how to, I think, delivered patient care both within and around the EHR. So that's a good thing. However, the EHR has definitely continued to create a lot of challenges for physicians and I think those challenges have come in in in a couple of different areas. I think one is that positions have and continue to spend a lot of time in their EHR documenting activities, working through messages, managing alerts, and so forth, all outside a lot of the direct, patient care, activity that they have either within their clinics or with patients. And that creates a lot of challenges, and frankly, a lot of dissatisfaction for physicians.  

I think the other thing that we see here, too, is because, as we think about value-based contracts, there's a lot of performance outcomes indicators and so forth, that are really dependent on the EHR we extract all of those data points. We extract all of those outcomes from the HER, and we use that to not only track the care that we're doing to patients, but we evaluate the performance of our value-based contracts. So if information is not entered appropriately, then physicians may not necessarily get credit for the good care that they are providing. So I'm really pleased today to have a soon to be strong physician, builder in epic somebody who we worked with for a number of years. Dr. Kim Furry. Dr. Furry, is a board certified orthopedic surgeon. She right now is going through a lot of epic training. She's worked on epic for many years and is becoming an epic builder really to support some of her colleagues. And with the idea that really, we're going to enhance a lot of the functionality of the system. Kim. Welcome to the program. 

Kim Furry:

Thank you, Dan. It's great to be here.

Daniel J. Marino: 

So, Kim, you worked on epic for a while, and you've heard probably a lot of the challenges and the complaints and dissatisfaction from your colleagues. From your perspective. What are some of the leading challenges that you see from physicians that really is kind of standing in the way of them, practicing efficiently, either through epic or another. EHR.

Kim Furry:

I think many of the challenges are basically the time that you spend in any EHR, and it seems like it depends on how you utilize the EHR. But some physicians are spending, you know, concentrating on the EHR. During the current visit as well, and instead of attention to the patient. This is a complaint you get from any patients as well. That the doctors just looking at their computer and typing away and not really paying attention to me. So that's a big challenge, I think. Is that patient interface. And the time is a big one, I think and taking that time upfront. We may talk about this later as well to customize it so that it works for you. The EHR could be a big burden, but it can also be a big time saver if you take the time to customize it. 

Daniel J. Marino:

Yeah, I definitely think that as we as you think about creating efficiencies in the care delivery model, the EHR can certainly help right? So if you could be, if you can connect 

better connect the physician with their with their clinical assistant. Obviously, that helps if there's particular integration that occurs with the specialists that would help. But there's integration that really, that occurs with maybe the lab result right or some other radiology report. I think that would help. But it is really dependent on that integration. And I sort of feel like we're still at the point where that integration is really not efficient. 

Kim Furry:

No, you're right, it's not efficient, and I think it also depends on the system you're in. 

Many people have, you know, it's a contain system like Kaiser, or something like that, where I'm getting my labs in a Kaiser lab. Geyser probably is similar. I don't know exactly. But you're all your specialists are in Kaiser. All of your labs are probably in Kaiser and that's probably more integrated. You know where I am in Colorado. It's a 20 hospital system with a few in Kansas, a few in Newton, the rest in Colorado. But we get our labs at very many different places. And so those getting imported into our HER is not very efficient and they don't communicate so well. The same with reality studies and imaging reports and things like that getting those uploaded into our system so we can look at it directly, is burdensome on the staff. 

Daniel J. Marino:

and not always doesn't always occur right right? Right well, and I think tying that then in with even the in basket management, also is a big challenge, you know, early on, and probably I want to say, the mid 2000s. And for about 10 years after that we did a tremendous amount of EHR implementations. And we really focused on incorporating physicians. Physician super users to design the system that really works well for the physicians practice style and basically integrates a lot of the efficiency that are important, but I can remember it was probably about 4 or 5 years ago. I was talking to one physician and he brought up an interesting point, he said. You know, Dan in basket management is probably the biggest challenge that I have right now. It probably adds 3 additional hours to my day. And I was like, Wow, I mean, that to me was just was unbelievable. And you know, physicians put in a lot of time anyways. But then adding in 3 more hours to their day, clearly takes away from their personal time right time that they could spend with their family and just real challenge to keep up.

Kim Furry:

That's huge, I've been on epic for 8 years now, and my first start practice in 2000, you know. The MA would come to me at various points in the day with a number of messages, and I would respond to those messages, and then boom! You know that that took minutes at the most. And it was it was done. My part was done occasionally I had a follow up with calling a patient about something but for the most part she'd asked me the question I'd answer. I'd give her an order, or whatever calling this prescription, she would call it in. I wouldn't have to sign off on anything. And that was very efficient, I think you know. And remember that 3 hours that you said on investment management at the end of the day that doesn't include all the other documentation and other work that he had to do. It was administrative or chart review, or notes written for school release, or whatever it is right. Authorizations. 

Daniel J. Marino:

Yeah so when you add in all of that, oh, my goodness, if you have a 6 or 8 h clinic. You're probably spending another 4 h at least on top of that.

Kim Furry:

Exactly. So. I think people can build. There's a couple of things I have to say on that one about 3 years ago, probably our system. My healthcare system, the the medical group kind of went through and created a bunch of different rules on what we might want to keep and not. And we deleted like hundreds of thousands, maybe even a million. I can't remember the number, but it's hundreds of thousands of in basket messages that we're sitting in people's in baskets to just get them out there and try to clean it out and start with a cleaner slate right? And then what really needs to go to the physician? What can go to an Ma. Or a nurse to try to create some triaging capabilities there and then, if you take the time again, it's taking the time upfront, which is going to save you a bunch of time on the back side to build quick actions so that, you know when you get an abnormal lab, I'll just give one for me. I would be as I do, some mossy process Karen for Julie, for extra care, and so I would check vitamin d levels, and I had, you know, patient vitamin d level was such and such no change. So I have a quick message. I just have to click one button, and that message would go to MA. So I'm to keep taking the same vitamin d level. If I wanted to go up to 2,5000 one button for each of those it would go to the MA. It would sign a note, and the ma would call in that prescription or calling that recommendation, right? 

Daniel J. Marino:

So it seems like a lot of the efficiencies that you've experienced really comes down to how the system was built?

Kim Furry:

somewhat, how the system was built, and then those quick actions are how I built them. Right? So the system allows that my system is built such that I can do that, and you know EHR's are not one. Size fits all. You buy the base. You may buy different modules for the Phoenix, for oncology, for cardiology, whatever it is. But your system has to buy those modules. But when you buy it, it's still kind of like the basic build right? And your own system. Builders will customize that to any, customize it and improve it to improve the efficiencies.

Daniel J. Marino:

Right. Yeah. So you just can't get the module right. I mean you really, from what I hear you say, you really need to take the time to build it correctly. You really need to take the time to figure out how you can create efficiencies in a new care delivery model, integrating with the EHR. Not just by the module and hope. It's a panacea.

Kim Furry:

Absolutely, and it's not just you customizing it for your work flow. Your system has to customize it for your system as well. And I've been on the so epic has. So that that dissolves, or that gives you an idea of who I work with. For my Hr. But epic has these steering committees and steering boards really for the different specialties. So for the last 3 years I've been on the stream board for orthopedics, and that's a group of orthopedic from around the country, and we give epic ideas on what things they should build. And so there are some things that we've all customized in our own institutions, But what we're trying to import upon them is the importance of building some of these things for the system itself, so that when somebody purchases the bones component. Then some of these things are pre-built into that bones component, and the system itself doesn't have to reinvent the wheel right?  

Daniel J. Marino:

Right. Right. Well, if you're just tuning in, I'm Daniel Marino, and you're listening to value-based care insights. I'm here today talking with Dr. Kim furry. We are discussing. Both the challenges and some of the opportunities around maximize performance of your HER and Kim so is your is you're talking about the build in my mind. I guess it comes down to 2 things, one the system needs to be built appropriately. So it does create efficiency. So you're not actually putting in a lot more time. But you're creating some efficiencies both to improve patient care and obviously to make it easier for the physicians. But I think the second part of the build is around how we're capturing the data I can remember early on when we were doing EHR implementations, you know, for instance, if we were capturing and he will go in a one C result of a patient one, the naming conventions. We're all different. 2. There were probably 2 or 3 different areas where we could put it into the EHR. Has that resolved itself, or is that still an issue? 

Kim Furry:

I think it's still an issue. I think the problem is, we can only find the data that's in this discrete data field. So even if I'm even if I'm writing a note right? Say, I want to do research on total recovery and range emotion, or whatever it is right. Whatever I want to do for total needs. Unless I write my note in what's called note writer, and I put the range motion and note writer. I will never find that range of motion. So if I just have a smart phrase and I dictate the range of motion this visit, or I type it in. I'm not ever going to be able to retrieve that data. Likewise many of the quality metrics that we need, especially from a hospital standpoint. It's largely related to revolves around nurse. It's nursing dependent in there. And so if I say my note something about it coty catheter associated urinary infection. but it's not in a flow sheet somewhere that's never going to be 5. 

Daniel J. Marino:

So even though you may be doing it, even though you may be performing it. You're not capturing it appropriately. So as you start to extract the data, you're not going to know you're not. You're not going to be able to get the results. You're not going to be able to get credit for the work you're doing 

Kim Furry:

Exactly garbage and garbage out. So if you're not tracking it correctly, and have it mining. The chart notes is super hard mining, the data discrete data fields much easier. But some of that stuff is there either doesn't exist to this week data field, or it's missed, or it's put in incorrectly, or whatever and some data will be missed. 

Daniel J. Marino:

Well, one of the things that I've heard you say, a number of times. You really need to build the system to ensure that you're trusting of the data and many of the physicians 

Struggle with that right? So when you pull reports, they don't believe the reports, and I think some of the reasons why they don't believe the reports is they feel like. Well, it's not a good representation of the care that I'm delivering to the patient. 

Kim Furry:

Right. That's exactly true. And even if you look at surgical time. So you know. Say, acl time is on average 55 min or something like that, right? And we're trying to create my surgical block time. But in reality I put in. I put in a request for an acl plus repair and a level minuscule repair, so that takes my 55 min for each one of those and creates my block for that case. At what 100 1,500 min? 50 min right? Which is really not the case, because that doesn't include everything for each of those cases. And so when they try to tell you that this is your Olympic averaging. We're going to schedule this case for 3 h. You're like. No, it's it's not a 3 h case, you know. Little example of where the data misinforms downstream effects and then has a big problem there. 

Daniel J. Marino:

So when you're when you're working with physicians, you know, and I know you're just starting to get into this, I give you a lot of credit for now diving into to a lot of the the epic training and becoming an epic builder. I think that's I think that's fantastic for the for you and the organization and your colleagues. In your mind. Where do you see starting, or, let's say, better integrating with the physicians or with the system to enhance some of the bills? 

Kim Furry:

I think some of the things I'm learning. And I, to be honest, I don't know how much of this goes into background like for our Vpa warnings and flashes there, there are ways that you can build this that it looks at if this and this, but not that, then I'm going to flash right. I'm not going to flash for everything that doesn't have a tsh in the last 90 days. I'm going to flash. If it's been, if it's if it's been ordered in the last 5 days, I'm not going to flash because it's been ordered. However, next time I come up, if it hasn't been delivered so say I come up in another 15 days, and it hasn't been, the patient hasn't gotten about their tsh, it it will flash 

Daniel J. Marino:

so maybe the notifications are certainly one area, right where some improvements. 

Kim Furry:

Notifications, building of order sets can be improved as well. And become more efficient you know, pre checking some of the things and only showing the pre-check, having things so that they're not all fully expanded. So you don't have to scroll scroll scroll, so they're all collapsing. If you want to go into this particular order or this part of a note, you know, like our so notes. For our build, you know, the subjective, objective or always end plan are always collapsed. So when you want to read the subjective, you can just open that up and same for the objective or the assessment plan so less scrolling, less clicking, those types of things. 

Daniel J. Marino:

So when I was working with one of my colleagues not too long ago, and he's in a similar role, kind of an epic position super user. One of the things that he really focused on was reducing the clicks, the unnecessarily non-necessary alerts, and in some cases he actually turned some of the notifications off for the physicians. Is that something that that you see as a benefit that that other folks should look into? Or is it really a case by case situation per physician?

Kim Furry:

No, I think also, some should look at it. I think there are alerts that shouldn't fire. I think one of my phone all just said in order to kind of finish reading a sleep study, or it wasn't remember what it was, but he had like 30 some clicks to do that. When I mentioned it to 1 one of the builders, I wasn't a builder at that time. And you know they were able to get that way down. So I think less than 10. So you know, what we don't know. We don't know, either. And so people have to bring some of their issues to us, and then we can optimize some of that workflow as well over time. 

Daniel J. Marino:

Yeah. Well, and again, I think to have somebody like you that that is an epic builder that you know begins to get trained. And really, you know, you sort of build those internal capabilities. I think that's all important. Many organizations. And we used to see this all the time when we were going through our EHR implementations. You don't know what you don't know to your point, right? So you don't know what the system can do for you to really enhance your clinical workflow. So a lot of times what physicians do, or what organizations do is they build around what they know, which is either a previous EHR. That wasn't very efficient, or maybe their paper environment. And I, even though many organizations have been on epic, for you know. 10, 20 years. In some cases, I don't think they've really gotten past that. I don't think they've really gotten past the point where that efficiency has really been built into their clinical work workflow, using epic or Cerner, or any of the EHRs as a tool to, to really enhance patient care. 

Kim Furry:

No, I agree completely. I think you can make it. You can make the order says you can make. The Vpa. Is somewhat dynamic, right? So if somebody's allergic to penicillin, and you have this order set and it recognizes patients allergic to penicillin. It's not going to give you the penicillin options. It's going to give you the alternatives and say that there is a penicillin algae, and these are the alternative antibiotics. They're not allergic to penicillin. Then that's not even to show up. They're just going to give be given the option for penicillin,

Daniel J. Marino:

right? So the system, like, you know. If I can try to, then the system becomes intuitive right to what's occurring to with the patient, but also then it's better informing the physician.

Kim Furry:

Correct exactly. but you have to build it such that it does those dynamic the charts and recognizes something. 

Daniel J. Marino:

Yeah, build the algorithms and and all of that. So so far, listeners today, you know, are there in in your experience? Are there a couple of quick wins? Are there a couple of key things that maybe folks should be focusing on that that would really help the physicians? Efficiencies. And and really, maybe the satisfaction with the HER.

Kim Furry:

yeah, I think so. I think taking the time to customize it for yourself. I know it takes time, and nobody wants to do that at the end of a busy clinic. What I would say is, when you first start on an HER. Is a time to start that customization process, because most of the time when you transition to an EHR. Your clinic schedule has been shortened quite a bit to give you time to kind of work through that. That doesn't last for very long, and most people are just trying to find their way through the woods and weeds at that point in time, so they don't take the time, but very as quickly as you can, and even if you haven't done it, starting now take 30 min a week and take your top diagnosis that you think whether it's Chf. Or near arthritis or whatever it is, and create a plan, create a patient information sheet create a physical therapy order for your Pt. Whatever it is. Create a order set that's customized for your totally pre-OP and host out. Most of them come with a pre opt totally, and a post office totally, but you need to customize it for your yourself. You know. Pre-check the buttons that you want. Check to me to put your name into the physician. You need to put your hospital into the location and if you take that half hour once a week for your top 10 diagnoses in the course of 3 months. You're going to have most of it built, and that's going to save you hours literally on the back side.  

Daniel J. Marino:

Yeah, I love that. Yeah, II really do. II think that's great advice. I mean, take, you know. Take a look at your top diagnosis. Codes, take a look at and really focusing even 30 min a day, probably time well spent to invest in in improving a lot of a lot of the activities there and then, what about the data, Kim re real quick? Is there some things that organizations can do to run some reports that validates the data that they're putting into their Hr. Reflective of the care that they're delivering. 

Kim Furry:

I might put that question back on you.

Daniel J. Marino:

Well, I would say yes. To tell you the truth, we negotiate a lot of the value based contracts and work with a lot of the payers in the organization. So I would say, Yes, build, or you know, do your checks and balances to make sure. That you know the data that's being entered is clearly reflective of of the care that's being delivered. So II couldn't. II definitely think that that's the case.

Kim Furry:

How does that occur that I don't know how that occurs. I don't know how we can validate some of that data without a lot of manual work

Daniel J. Marino:

Well, this has been fantastic, and I know it's a topic that is top of mind with many of our listeners, particularly our physician listeners. If anybody has questions for you any thoughts, anyways, that they can get a hold of you?

Kim Furry:

Yeah, absolutely. Email is probably the best or text. Me call me, either those are fine. My cell number is (970) 903-7540. And my email is, Kimfurry@cetura.org. 

Daniel J. Marino:

Wow! That's great. Well, again, this has been a great discussion. And again, I think congratulations to you, taking the initiative and moving forward with these certifications and becoming a position builder in epic. II think you're going to be great. You clearly have the passion for it. So thanks again for coming on the program. Really appreciate it.

Kim Furry:

Thanks for having me. It's been great.

Daniel J. Marino:

and thank you to all of our listeners for tuning in today. Really appreciate it until the next insight. I am Daniel Marina, bringing you 30 min of value to your day. Take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners