An EHR optimization that actually wins over physicians?
Like all healthcare CIOs, Joel Vengco, chief information officer at Springfield, Massachusetts-based Baystate Health, has no shortage of pressing projects competing for his attention.
Whether it's working to drive operational efficiencies across the $2.5 billion health system, improving the usability of an array of applications for clinical end users, spearheading community engagement and patient outreach for population health management or working on analytics and "knowledge management," it all make for a busy workday.
That's all in addition to the imperative of constant innovation: Beyond just being Baystate's CIO, Vengco is the founder of TechSpring, an innovation center based at the health system where IT vendors are given secure access to real patient data to speed the development of new technologies.
"So there are lots of things to focus on as a CIO – notwithstanding all the security issues we've got to focus on too," he said.
But even with so much going across Baystate – five hospitals, an academic medical center, 90 medical groups, a health plan with about 250,000 members, "a Next Gen ACO that we manage, and we're getting into a Medicaid ACO" – Vengco has generally felt pretty on top of things.
Except, until recently, with one important initiative.
"The big project we've still yet to quite crack the nut on is: How do you optimize the EHR? How do you optimize the workflow for a clinician?" he said.
Work for providers, on a day-to-day basis, just gets more burdensome, said Vengco. "They've got to document, they've got to bill – and then they have to see the patient at some point. And then that 15-minute visit becomes a 20- or 30-minute visit because you're doing all this other work."
So Vengco posed a tall task to his IT team: Optimize the electronic health record and improve workflow for Baystate's clinicians. But do it, crucially, in a way where the clinicians take to the new approach voluntarily, because it works better for them, rather than having to be told to do so.
"That was the challenge," he said. "To leverage our current legacy EHR, Cerner, but then really enhance it without ripping and replacing it."
For help, he turned to Palo Alto, California-based Praxify, whose recently unveiled MIRA app can augment existing EHRs, integrating with legacy systems to improve workflow.
Touted as being designed by and for physicians, the app offers capabilities such as "glanceable" interfaces that can surface key patient data for faster documentation and review, and dictation tools that enable voice-activated order entry.
The app gives clinicians the "data and the functionality they need within one or two touches or clicks," said Vengco. "In our case, it's more of a mobile design, using the heuristics of swiping and all the mobile capabilities you're using in your day to day life.”
To Praxify, he also had some clear instructions: "We can't spend two years doing this, we can't spend millions of dollars putting you guys on top of Cerner. That doesn't create value. What creates value is doing it in three to five months and actually getting adoption by the providers without me mandating use," said Vengco.
"That challenge, happy to say, has been met," he said.
Praxify connects with Cerner, using APIs, in just two or three months, he said. "Now we're going full force with a production deployment to our health system. And some of the preliminary feedback is that providers, who are some of the hardest customers, are saying they definitely want to use this,” he said.
"We had a hospitalist, probably one of the most vocal critics of our EHR, initially said she wasn't going to use Praxify," said Vengco. "She said it was just another technology burden."
Not long after trying it, she returned to the CIO with glowing reviews. "She said, 'This is amazing. It's incredible.'"
Across Baystate, "we've seen efficiencies of, on average, 40 percent if you compare it to the way the EHR was previously being used," said Vengco. "They love the fact that they can get it on any mobile device. They love that, instead of taking five or seven or 10 clicks, it's a swipe, or a touch. It's efficient and fast. They love the design of it. They love that they can dictate.”
Because it connects directly to the EHR, there's no concern about a loss of data. “And the design is intuitive enough that we don't have to do five or seven hours of training – it's a 20-minute discussion and they're off and running," he said.
The point, said Vengo, is that "I want them to adopt it themselves. If I give it to them and it goes viral, and they take to it, that means it's intuitive, it's optimized, and that makes me happy because the providers are happy."