RWJBarnabas Health is the largest health system in New Jersey. It serves more than five million patients annually across nine counties and employing 33,000 people – making it the state’s largest private employer. As a national health system leader, RWJBH recognizes clinician burnout as a complex workplace syndrome affecting not only physicians, nurses and staff who deliver care to patients, but also patients and their families.

THE PROBLEM

The health system’s clinicians are the lifeblood of the organization and help it deliver the best possible care to its patients. They should be empowered with the right tools and technologies that allow them to do their jobs as efficiently as possible.

But electronic health record systems require clinicians to click through dozens of screens to find the information they need to make treatment decisions for patients. Clinician burnout is a national problem, and the EHR has been shown in many studies to be a significant contributor.

PROPOSAL

“EHR systems are largely static, displaying information in the same way to every healthcare provider for each patient,” said Dr. Stephen O’Mahony, vice president and chief health information officer at RWJBarnabas Health. “This contributes to frustration and inefficiency, because users are required to search across many screens with numerous clicks to find the information they need.”

So the health system went with health IT vendor Wellsheet to help with the problem.

“Wellsheet is powered by an intelligence that knows who the provider is and the patient being treated, and is able to anticipate the most relevant information to display to the clinician,” O’Mahony said. “These capabilities deliver a better experience for our physician users, reducing the burden of the EHR and increasing their productivity.”

"EHR systems contribute to frustration and inefficiency because users are required to search across many screens with numerous clicks to find the information they need."

Dr. Stephen O’Mahony, RWJBarnabas Health

Beyond efficiency and provider satisfaction, the ability to surface and highlight key information to providers at the point of care enables the health system to deploy key quality improvement initiatives. For example, the vendor’s technology is able to mine key information from echocardiogram reports in order to highlight cardiovascular gaps in care that need to be addressed for patients. By making it easier for clinicians to do the right thing for patients, the health system can ensure the best quality of care possible, O’Mahony added.

MEETING THE CHALLENGE

Wellsheet is integrated directly into RWJBarnabas Health’s Cerner EHR to make it a seamless part of the clinician workflow. For clinicians, it feels like a feature within the EHR. Because the vendor’s integration with Cerner is entirely API-based, it did not require a significant investment in time and resources by the health system’s technical team to integrate, and was ready for use by providers in production in less than six weeks.

“It’s really incredible how such a lightweight integration process was able to give Wellsheet access to all of the pertinent clinical information required to make informed treatment decisions for patients,” O’Mahony remarked. “We initially deployed the technology into our inpatient setting, and it is now in active use by more than 1,000 physicians of many specialties across all seven of our Cerner hospitals.”

Some of the heaviest users of Wellsheet are hospitalists, cardiologists, pulmonologists and endocrinologists, to name a few. RWJBarnabas Health is now piloting the new technology in the outpatient setting.

RESULTS

“We studied Wellsheet’s impact closely and the results are the reason we signed an enterprise contract to expand across the health system,” O’Mahony stated. “Our study involved both a quantitative data analysis from Cerner’s reporting module, called Lights On, and a multiple hospital survey. Our analysis focused around three main dimensions of value.”

The first was provider satisfaction, which the health system gauged based on opt-in usage, which grew rapidly to more than 500 users in about eight months, as well as a survey based on the industry standard System Usability Scale. In this survey, on a five-point Likert scale, physicians rated the EHR with Wellsheet at an average of 4.55 compared to 3.27 before the introduction of Wellsheet.

“The second dimension of value that we studied was provider efficiency and productivity,” O’Mahony recalled. “For this, we looked at the number of minutes per patient the physician needed to spend in the EHR, a number tracked by the Cerner EHR system itself. This dropped from approximately 24 minutes with the EHR alone to only approximately 13 minutes after the introduction of Wellsheet, an over 40% drop and meaningful time back for providers to spend with patients. We also saw the number of patients a provider was able to see grow by more than 20% as a result of these efficiency gains.”

The final dimension of value was quality of care. For study purposes, RWJBarnabas Health focused on the TAVR procedure. Wellsheet was able to uncover hundreds of patients who met criteria for this procedure based on unstructured text in echocardiogram reports and surface these candidates to the cardiology team to consider for further evaluation while they were still in the hospital.

ADVICE FOR OTHERS

“We are now able to integrate technology partners who are complementary to the EHR vendor for solving problems for their providers,” O’Mahony noted. “With the API connectivity that the vendors have opened up, it is possible to deliver a better clinician experience when accessing clinical information without large integration, build and maintenance effort. Not only can this lead to improved quality of care, we can now use technology to contribute to wellness instead of adding to the burden.”

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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