Nationwide Children's CMIO Jeffrey Hoffman on how he reduced EHR burdens for clinicians

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Jeffrey Hoffman, MD, is the chief medical information officer of Columbus, Ohio-based Nationwide Children's Hospital, which has more than 1,300 medical personnel and saw 1.4 million patient visits in 2017.

Dr. Hoffman started his work at Nationwide Children's 15 years ago as a pediatric emergency medicine physician, gradually shifting his expertise to clinical informatics as the healthcare industry evolved.  In 2013, he became one of the first physicians in the county to become board-certified in clinical informatics.

Dr. Hoffman also works as a clinical associate professor of pediatrics, family medicine and biomedical informatics and chief of the division of clinical informatics at the Ohio State University.

Becker's Hospital Review caught up with Dr. Hoffman to discuss the primary initiative he will focus on in 2019 and his view on healthcare innovation.

Editor's Note: Responses were lightly edited for length and clarity.

Question: Which one strategic initiative will demand most of your time and energy in 2019?

Dr. Jeffrey Hoffman: The one that is going to demand most of my time is a large-scale program to modernize our enterprisewide EHR system, Epic. We implemented Epic nearly 15 years ago, at a time when major customizations were necessary to meet the unique needs of a pediatrics facility and pediatric providers.

Over the years, we have found ourselves allocating an increasing proportion of our IT resources to maintain these customizations. As Epic has evolved, many of these are no longer necessary or useful. To take full advantage of our EHR investment, we have committed to a complete overhaul of our Epic system, replacing customizations where appropriate and leveraging the technology as much as possible. This effort is going to require solid leadership and effective governance, much of which I will directly coordinate and oversee. In that regard, the year ahead will be both exciting and challenging.

Q: Healthcare takes a lot of heat for not innovating quickly. What's your take on this?

JH: I often hear this sentiment from physician colleagues, patients and families and friends in other industries. On the surface, healthcare looks like any other customer-centric service industry, such as retail or banking, where technological innovation is increasingly being demanded by customers and subsequently embraced by companies. However, healthcare organizations face unique challenges that dictate a narrower scope and slower pace of innovation.

The most obvious challenge is the regulatory environment in which healthcare operates, specifically HIPAA-related privacy and security requirements that often inhibit cutting-edge innovations. These limitations lead many healthcare institutions to use extreme caution when considering, much less implementing, new and innovative technologies.

Aside from the regulatory barrier, most institutions have a strong patient safety focus that forces examination of any new technologies in terms of the potential for patient harm. While I see great potential in a variety of technologies, including mobile apps, voice assistants, artificial intelligence and blockchain, I believe the healthcare industry will likely remain much more cautious in their innovations in comparison to others.

Q: When was the last time your organization responded to concerns or needs expressed by physicians? What unfolded?

JH: Physicians often point out the burdens EHR systems have placed upon them. Some of this may be unavoidable. Some burdens, however, can be addressed, and listening to provider concerns often leads to meaningful change.

A frequent complaint from providers is the large number of pop-up best practice alerts they are presented with and must address during their busy workday. Like most organizations, we have implemented many alerts over the years to address a variety of quality, safety and compliance needs. Although we closely scrutinize new requests, we had not been particularly diligent about keeping track of the overall volume and performance of alerts in the system. Not only was the ever-growing number of alerts and their individual performance creating frustration for our physicians, but they were also contributing to the potential for alert fatigue and subsequent patient harm.

In response, our leadership decided to substantially reduce the volume of these alerts while simultaneously maintaining the safety net of our alerting system. While it would have been easy to merely turn off high-volume alerts, we focused instead on improving the quality and targeting of these alerts to deliver the right message to the right physician at the right time in their workflow. We found other alerts that could be equally effective as passive notifications, such as a banner. In other cases, alerts were found to be no longer necessary and were safely retired.

In just a few short months, we were able to reduce the volume of these pop-up alerts by over 50 percent, and we now have a process in place to ensure new alerts are well-designed from the start and monitored on an ongoing basis. Although it was a challenging area to address, we have our frontline physicians to thank for bringing this important issue to the forefront.

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