A single Tylenol order requires 62 clicks. The same alert bombards an isolated provider 70 times daily – not a single time driving the desired action. And clinicians can spend nearly 4.5 hours wrestling with electronic health record (EHR) systems instead of treating patients. This isn’t just inefficiency; it’s a crisis contributing to clinician burnout and $265 billion in clinical variation waste.
The majority “suffer in silence,” as one CMIO confided in me. While others complain into the abyss of the EHR, often dramatically (see Dr. Adam Wright’s “Cranky Comments” paper), lean informatics and IT teams don’t have the capacity to tackle the thousands of parallel workflow malfunctions continuously sprouting up. This burden contributes to the estimated $265 billion in wasted healthcare spending due to clinical variation, but is also key to mind-bending clinician workarounds and operational inefficiencies. A burden I’ve studied from every angle as a practicing emergency room physician, informaticist, and startup founder.
On average, hospitals we work with at Phrase Health, including large multi-hospital academic organizations and regional community systems, juggle 700 order sets, over 500 alerts, thousands of note templates, and many other knowledge-based tools – a perfect storm of complexity that’s overwhelming IT teams and frustrating our healthcare workforce. This technological burden is more than an inconvenience – it contributes to clinician burnout. Don’t believe me? As one nurse’s final EHR comment read before quitting: “Today is my last day as a nurse and these notifications are the reason why.” Another clinician with years of professional training wrote: “f- off this is the 10th f-ing time I have hit do not order.” Thousands of comments like these, picked up in our sentiment detection system, are on top of many other stressors leading to turnover costs that can exceed $1 million per physician.
But the impact extends beyond administrative inefficiencies and workarounds. Poorly built and unmonitored EHR workflows create quality risks through distrust in the system recommendations, while redundant interventions increase the challenge of ensuring embedded content is aligned with the newest guidelines for safety and regulatory compliance. These EHR inefficiencies cascade through healthcare organizations, creating large amounts of technical debt that drain millions in lost productivity, contributing to costly work to complete tasks, and impacting clinician wellness.
Clinically curated insights and AI-driven management platforms are fast emerging to transform these EHR challenges into strategic advantages. Optimized clinical decision support that is native to the EHR is shown to be effective at driving appropriate behavior change, while advanced and curated insights enable workflow optimization based on user behavior. Indeed, we witnessed one regional health system cut extraneous bacterial antigen orders by 57%, saving over $700,000 annually by allowing a process improvement manager to leverage our technology. Our anomaly detection algorithm identified an alert at an academic medical center for venous thromboembolism prophylaxis, a potentially life-saving reminder, that stopped working as intended. During the intravenous (IV) fluid shortage emergency, yet another organization reduced non-essential IV fluid usage by 40% through easy-to-use data tools.
The real-world impact of the advances can prevent millions of dollars in resource waste from monitored workflows and deliver safer care, while simultaneously reducing the administrative burden of continuously monitoring the underlying content. These outcomes directly translate to enhanced patient care, while operational leaders remove bottlenecks and simultaneously regain hours previously lost to EHR sleuthing.
Healthcare organizations can no longer treat robust EHR monitoring as a one-off IT initiative or side project – it’s fundamental to organizational sustainability. While informatics and IT leaders work to balance patient safety, operational efficiency, and regulatory compliance, they often lack the capacity and tools to tackle accelerating EHR complexity. Yet, solutions exist today that can transform this challenge from a source of frustration into a strategic asset. By implementing clinically-informed tools that keep watch over complex workflows and reduce unnecessary variation, organizations can recover thousands of staff hours, improve patient care, and realize significant cost savings. The choice is clear: continue struggling with EHR technical debt and inefficiencies, or act now with proven solutions that maximize the value of these critical systems.
