How to lobby leadership so you can eliminate extra EHR clicks


When internist Daniel Dunham, MD, left Northwestern Medicine in 2015 to move across town to Rush University Medical Center, he was clicking his mouse about 600 more times a day while caring for his patients.

Both medical systems used the Epic EHR. But Northwestern’s system didn’t require him to enter his username and password every time he sent an e-prescription while already enrolled in the EHR. Rush’s system did.

It added up to about 10 minutes of extra work a day — almost an hour a week, which did nothing for patient care but contributed to doctor burnout, said Dr. Dunham during an episode of AMA STEPS Forward® Podcast on optimizing electronic medical records (Apple Podcasts | Spotify).

When he asked about changing the system to eliminate these clicks, he was told, “Epic doesn’t allow us to do that.” Having transferred from a different healthcare system, Dr. Dunham that this was not the case.

“They didn’t know it could be changed,” said Dr. Dunham, who is now chairman of the medical department at Lenox Hill Hospital in New York. “To me, it’s a plea for institutional investment to have physicians who are well-versed and experienced in understanding electronic medical records and give them the time to engage with it and try to make practices more efficient.”

Reducing physician burnout is a critical component of the AMA recovery plan for America’s physicians.

Far too many American doctors suffer from burnout. That’s why the AMA is developing resources that prioritize wellbeing and highlight changes in workflow so physicians can focus on what matters most – patient care.

The “AMA STEPS Forward® Taming the Electronic Health Record Playbook can help physician practices and healthcare organizations learn how to rein in EHR workloads and reduce physician “pajama time.”

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dr Dunham was eventually able to change the EHR on Rush. He said that doctors in other organizations who want to see change must first find out who the decision-makers are. After that, physicians need to understand the perspectives of decision makers and articulate the case for change in language those leaders can understand.

“Often decision-makers are looking for a return on investment,” he said.

Physicians may explain that increasing the physician’s workload by 10 minutes per day increases physician turnover. In turn, replacing that doctor could cost the organization anywhere from $500,000 to $1 million, depending on the doctor’s specialty. Additionally, these extra clicks make it more difficult for physicians to see patients, which does not positively impact the return on investment for physicians in the organization.

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As EHR systems evolve, physicians should be more involved in the planning phase, said Dr. Dunham.

He’s often heard business leaders wonder why doctors and other healthcare professionals say they’re dissatisfied when they’ve invested in tools to help frontline workers. His answer is that it’s probably because the investments haven’t been made in things that clinicians want.

“You really need to look for a partnership between busy clinicians and those who are doing the design,” said Dr. Dunham.

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The changes resulting from these collaborations could help bring some joy back to medicine, he said.

“We all try to make our workplaces sustainable,” said Dr. Dunham. “There have been enormous stressors in recent years. COVID is the obvious one, but for us GPs there is a lot of responsibility that we have on top of caring for patients. If we can try to minimize the time we spend outside of direct patient care, it will help eliminate our frustrations, but it will also allow us to optimize our time with patients where we are likely to spend it best spend.”

For more information, see AMA STEPS Forward® Playbook to save time.”

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