The value of physician builders + compensation models: Q&A with Peninsula Regional Medical Center CMIO Dr. Mark Weisman

Mark Weisman, MD, chief medical information officer at Salisbury, Md.-based Peninsula Regional Medical Center, discusses the benefits of physician builder programs in healthcare systems and why its important for these individuals to continue training and IT practice.

Responses have been lightly edited for clarity and length.

Question: A study from KLAS Research identified that providers have higher EMR satisfaction if they have a physician builder in their specialty. What is the status of physician builders in healthcare systems today?

Dr. Mark Weisman: It appears the 'controversy' of having physician builders has resolved, and over the years thousands of providers have been trained. But now the question arises about letting them actually touch the sacred IT space and allowing them to build.

During a recent trip to Epic for more physician builder training, I took an informal survey of the colleagues in my class about whether their system allows them to build, or are they taking the course to just get some more knowledge. The more progressive medical centers recognized the benefits years ago and have teams of physicians working together with analysts to create dynamic tools. However, some systems are still resistant. The usual concerns come up, and they are the same ones we heard when the original debates around creating physician builders started years ago.

Q: What are the common concerns surrounding the creation of physician builders?

MW: The concerns are:

• Will the providers break something?
• Will they make more work for our analysts?
• Why should we pay them to build when we can use analysts for a fraction of the cost?

We don't break things because they teach us how to be safe in class and there are guardrails in place. I have yet to hear of the hospital that gets taken down by a physician builder working in a nonproduction environment. We don't make more work for the analysts; I have never heard of a system that added physician builders and had to make their application analysts work overtime to do it. We do make different work, and I would argue more meaningful work for the analyst by bringing that clinical expertise to the build. I suspect the real roadblock is around pay.

Q: How are providers compensated for their time spent on IT activities?

MW: I have seen different models for paying providers for build time. Options range from [work relative value unit] credits for employed providers to a stipend to help offset the loss for some clinical time. I typically hear providers devoting 0.2 [full-time equivalent] to informatics and build time, although most work more hours by building on their own time simply for the love of the work. Depending upon the specialty, that can equate to $40,000 to $60,000 a year for a physician and about $20,000 less for a nurse practitioner. So now it is simply a return-on-investment calculation, but a difficult one to perform.

It is unlikely you can calculate a hard return based on increased visits or higher productivity in their specialty because most providers I know are not looking to optimize their EMR experience so they can squeeze in another two patients a day. The value comes from a more engaged provider workforce, a focus on quality with the decision support tools, less turnover in providers and staff and patients that appreciate having their provider sane again. I can't put a dollar figure on those benefits, but it is real and it is valuable.

Q: Does it make a difference if providers are actually building the tools, or is simply having the training enough?

MW: I have been in a system where providers can build and I have been in one where they could not, and the advantages of an active builder program are clear. The skills grow the more they are used and the learning is ongoing, and typically done through self-exploration while trying to solve a problem. Those that simply obtain the training and then talk about the tools for an hour a week with some analysts quickly forget the lessons they learn. Their skills stagnate and while learning still occurs, it is at a slower pace. They are certainly better off having some training rather than none, but the benefits from that training fade over time and with each upgrade.

Q: How many of the builders in your class do you estimate will actually build tools for their colleagues to use in the EMR?

MW: It was split about 50-50. Those that couldn't build were definitely envious of the ones that could and planned to go back to their system and advocate for them to do the right thing. From my observations, these are bright and capable providers that care about their colleagues and want to make a difference for their health system. You can also tell they were motivated. How? Simple. They were in Verona, Wis., for training in January, and you have to be a motivated individual to volunteer for that trip!

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