EHR Happy Hour (Even Without Alcohol) Smooths Out Kinks for Docs

Marcia Frellick

July 08, 2019

Two phrases that may seem mutually exclusive — electronic health records (EHRs) and happy hour — are at the heart of an innovative strategy to help family physicians tackle documentation frustrations.

Once a month, physicians at University of Missouri at Columbia have been gathering with their laptops for hour-long "EMR Happy Hours" to work out problems with documentation and workflow.

The coleaders of the group, Margaret A. Day, MD, and Jeffery L. Belden, MD, part of the 60-faculty family medicine team at Missouri University Health Care, published their thoughts about the program today in the Annals of Family Medicine.

"We learned that the collegiality and the creation of a social support was really important, and just acknowledging that the inefficiencies are often in the tool and the workflow — and not with you as the individual providers," Day told Medscape Medical News.

Although there is no alcohol involved, Day said they landed on the "happy hour" label to steer people away from thinking of the gatherings as a gripe session. "We did make sure to clarify that EMR Happy Hour sessions would be a sober (but fun!) learning opportunity with the caveat to only use your 'spirits' in the way of enthusiasm during work hours in our workplace," she told Medscape Medical News.

How it Works

The gatherings are purposely small — typically three to 10 people — so that faculty and members of the EHR staff can work with physicians individually and fix problems in real-time.

Day said they focus on low-effort, high-yield solutions rather than problems that need a lengthy consultation with the vendor.

Solving such problems may just require a colleague telling a peer what a certain button does or how a setting can be changed. Some problems are better answered by the practice's tech department representative, who also attends the meetings, so those too can be answered in real-time.

Focusing on the quick fixes does a couple of things, Day said. One is that it keeps busy doctors coming back. When physicians can knock problems off their checklists and leave with a way to work more efficiently, they make time for the meeting.

Physicians can also register EHR wins instead of lamenting that they are dealing with the same problems they have had for months or years, she said.

Restoring control and feeling effective addresses some of the core causes of burnout, Day notes, though she says they haven't formally tied these meetings to an anti-burnout strategy.

Though the size of the groups has remained intentionally small, the program's reach has grown substantially through the years as each physician who attends a meeting is asked to share what he or she learned at the meeting with two or three other clinicians to widen adoption of efficiencies.  

In addition, at least two other Missouri departments have either started the happy hours or plan to implement them, Day said.

Top Shortcuts

Day gave some examples of workarounds that have come out of the meetings.

One is changing a setting so that emails are automatically deleted from an inbox once acted upon. That saves the step of reviewing the inbox later and manually deleting each one.

Another is using an autotext function to pull in a phrase such as "your complete physical exam" with one keystroke. The function can be used to insert a few words or entire templates.

They also devised a way to change the settings so a physician can review 3 years of a patient's results with one click. Without that, the default was having to click on the banner, select a new date range, and then clicking OK.

Unexpected Benefits

The happy hours have brought about some unexpected benefits, Day said. They found that the learning went both ways and faculty found themselves expanding their knowledge as group members brought problems to them.

Leaders also learned from surveys that peer support was more crucial than they imagined.

In addition, the meetings help build positive relationships with the EHR in a medical environment in which they have been vilified. For example, in a recent Medscape poll nearly half of physicians said EHRs had hurt quality of care.

Where to Find the Time?

Any new initiative in medicine is likely to elicit questions about finding time, and the EHR happy hour was no exception, Day said. But they found something interesting: the people who kept coming back were those who used the EHR the most.

"We thought that really went against the theory that busy clinicians wouldn't have time to come to happy hour. In fact, our most busy clinicians were there almost every month," she said.

One key to finding a time that works is to look at times when the physicians were already gathering. At the University of Missouri, that was Wednesday mornings, as those were already reserved for faculty meetings. Residents soon became interested in the concept and have since implemented them — "at least happy half-hours" — in their didactic half-days, Day said.

Another tip to make the meetings effective is to be willing to throw out the agenda if the group comes in with other specific concerns, Day said.

What's Next

After 4 years, the monthly meetings have taught core users most of what they need to know, Day said. They are now transitioning out into the clinic settings and are being held on a more as-needed basis, such as after a software update.

This is the first article published on the program, she said, but she hopes others will try the program at their own institutions.

In December, leaders will talk about the happy hour approach at the Society of Teachers of Family Medicine Conference on Practice and Quality Improvement

The authors have disclosed no relevant financial relationships.

Ann Fam Med. Published online July 8, 2019. Full text

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