PC2069: Work Smarter Not Harder: Realizing the Value of a Dedicated Physician Builder Team

Background: Pediatric primary care (PC) provides acute and preventive care for patients from birth to early adulthood. A standard well-visit encompasses discussions about growth, nutrition, school, age-appropriate developmental, psychosocial, and mental health screening, anticipatory guidance, physical examinations, immunizations, and necessary forms and referrals. In recent years, the burdens placed on providers have significantly increased, while time allocated per patient visit has decreased. The amount of documentation including required billing and regulatory compliance requirements, within an electronic health record (EHR) system that has not been well-optimized, is a leading contributor to provider dissatisfaction and burnout.1
To optimize provider documentation tools and workflows with the goal of decreasing burden and increasing efficiency, we assembled a dedicated team of three PC physician builders (total 0.6 FTE), a physician informaticist (0.1 FTE), and a PC informatics nurse capable of designing and implementing EHR enhancements independent of the centralized EHR application resources provided. This unique program, supported by the Primary Care Network (PCN) within our free-standing academic children’s hospital, devised a 3-year plan to optimize clinical workflow to improve efficiency, patient safety, and clinical outcomes. By providing direct patient care themselves in PC, the team was able to independently identify workflow pain points, educational needs and were able to develop and deploy enhancements without the typical resource limitations, miscommunications, and back-and-forth inefficiencies that occur when subject matter experts interface with central application analysts to enact EHR changes.

Methods: Our large quaternary children’s hospital PCN cares for more than 120,000 patients across 13 sites, completing over 270,000 patient visits annually.
Highlights of the 3-year plan:
• Plan, analyze, build, and implement standardized workflows and documentation tools across the entire PCN
• Increase patient engagement by collecting standard screenings electronically, automate scoring of these instruments, and auto-populate this patient-reported data directly into the provider’s notes with personalized decision support
• Add chart review features directly within the provider workflow to reduce the need for chart search, or prior notes, for important clinical information
• Provide one-on-one onboarding, ongoing education, and educational tools for providers, focused on efficiency

Results: Following completion of numerous individual enhancements during the 3-year plan, there was a measurable reduction in the time providers spent reviewing clinical information prior to and during clinic visits (Figure 1) and in completing clinical notes (Figure 2). Based on these successes, the work of this team is being extended and expanded, with an additional 0.7 FTE of physician time added to this endeavor.

Conclusion: A dedicated team consisting primarily of PC physician builders can improve PC provider efficiency in a busy and fast-paced setting, with measurable improvements able to successfully justify the investment required. Similar programs in other specialties which deliver program-specific optimizations unfettered by central EHR resources may be equally justifiable.