Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System.

Ahmed Umar Otokiti,Avniel Shetreat-Klein,Catherine K Craven,Stacey Cohen,Bruce Darrow

doi:10.2196/25148

Abstract

BackgroundUp to 60% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide.ObjectiveThis project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout.MethodsQuantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks.ResultsThe pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6–month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible.ConclusionsThe project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement.International Registered Report Identifier (IRRID)PRR1-10.2196/25148

Highlights

BackgroundSubstantial evidence indicates that electronic health records (EHRs) contribute greatly to clinician burnout [1,2,3,4,5]
We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user
We expect that the results will reveal which sections of the EHR have the highest deficiencies while highlighting issues about workflow difficulties

Summary

Introduction

Substantial evidence indicates that electronic health records (EHRs) contribute greatly to clinician burnout [1,2,3,4,5] This burden arises from factors like EHR usability or lack thereof, perceived loss of autonomy, and documentation; this leads to less clinical time with patients and clinicians creating various workarounds to the problem with the associated potential to compromise execution of care consistent with patient safety and quality [1,6]. In an effort to alleviate the EHR burden imposed on clinicians and its adverse consequences on the quality of health care delivery, Hawaii Pacific Health implemented a program called Getting Rid of Stupid Stuff (GROSS) In this program, clinicians were asked to come forward with anything in the EHR that they thought was poorly designed, unnecessary, or just “plain stupid” [9]. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide

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