Case study

Reducing EHR time throughclinical documentation tools:
A speech-driven efficiency study
Sutter Health West Bay Medical Group Clinic,San Francisco
Organizational profile
Documentation burden was a pain point for clinicians at Sutter Health.
An internal team led by Dr. Matthew Sakumoto, chief medical information
officer (CMIO) Sutter West Bay Region, decided to perform a study tounderstand how the organization’s enterprise-wide speech solution
3M™ M*Modal Fluency Direct could help address documentation burden.

The study
1 clinic location
7 clinician
participants2 surveys(baseline andconclusion)
2 training sessions

Sample survey questions:• How much time do you spend each day in the electronic health record(EHR)?
• What part of the EHR workflow requires your greatest time and effort?
• Rate the ease of your documentation experience with and without
3M Fluency Direct.

Result highlights:

47minutes 80%
of average daily timesavings achieved by
one physicianof participants
indicated it was easy
or very easy to use
3M Fluency Direct todocument in the EHR

Study participants
lowered theiraggregate timespent in the EHR,
moving from the 75th
percentile to less timethan the average Epic®
user at Sutter Healthfor that specialty

Case study: Reducing EHR time through clinical documentation tools: A speech-driven efficiency study

Tackling documentation burden
According to Dr. Sakumoto, the project team’s purpose in conducting the efficiency study was clear: “There’s a big
push for clinician wellness. The impetus for the study was clinician wellness and decreasing documentation burden.”Sutter Health’s 3M Fluency Direct contract included training and onsite engagement with 3M’s solution advisor team,whose charge is to augment utilization of 3M solutions and, in this case, help with such an initiative. Dr. Sakumoto
saw this as an opportunity to increase knowledge and usage of the tool – not only for real time dictation, but also forstreamlining tasks like order entry and EHR navigation. “Voice commands and macros were high on my list,” he said.
“Could we use them to get time spent on orders down?”

Ready, set, study!
The project team selected a small primary care office in San Francisco for the study. “It was a ready, willing anddiverse group,” Dr. Sakumoto said. “They fall on the early adopter curve of technology.” The participants also
represented different roles, including physicians, physician assistants and nurse practitioners, with varying levelsof experience with 3M Fluency Direct. To set a baseline for the study, they completed a survey about theirexperience documenting in the Epic EHR with and without 3M Fluency Direct. Then, it was off to training.
Sutter Health’s dedicated 3M solution advisor held two hands-on training sessions. The first focused on the speech
recognition component of 3M Fluency Direct. The second covered the solution’s productivity tools, such as using
speech-enabled smart phrases and navigation commands to help standardize and automate routine tasks within the EHR.
The study took place over the next quarter. “In other technology adoption studies I’ve done and intervention studies
I’ve seen, there’s a honeymoon effect that first month,” Dr. Sakumoto said. “But if you can maintain it for threemonths, the chance of sustaining it beyond is high. We ended the study there and started asking, “What can welearn from this? What’s scalable and repeatable?”

Evaluating the results
The project team reviewed results through quantitative and qualitative lenses. Objectively, they looked at time spentin the Epic EHR. For some study participants, the change was significant. The clinician who experienced the greatest
difference went from spending an average of 120 minutes a day completing notes in Epic before the trainings to73 minutes a day after the trainings – which translates into 47 fewer minutes documenting in the EHR each dayon average.

Study timeline

March 16

April 25

June 19

July 26

Survey conducted togather baseline data, firsttraining session covered
basics of 3M Fluency
Direct and study began

Second training
session covered
productivity tools

Status checkwith 3M andDr. Sakumoto

Study ended,second survey
conductedand feedback
gatheredCase study: Reducing EHR time through clinical documentation tools: A speech-driven efficiency study

Average time spent in EHR notes per day for one study participant

3/16
Training 1
4/25
Training 2

Result highlights:

120 minutes per day:Average time to complete daily notes
before training

73 minutes per day:Average time to complete daily
notes after training

This physician benefitted from some additional one-on-one time with the3M solution advisor. The individualized instruction around speech commands
enabled the physician to create their own commands, including some thatstacked to perform multiple steps – reducing clicks and helping boost
productivity. “With this standardization of workflow, you don’t have toremember the sequence of five or six different clicks,” Dr. Sakumoto said.
“You just have to remember the magic words to accomplish a specific task.”“My goal is to save time and get back sanity,” Dr. Sakumoto said. “Everybody
is so busy; even getting back five minutes is huge. The biggest thing is finding
room to breathe – time to think gives you more time to care.” This was certainly
the case for another participant who previously spent time updating the patient
record during lunch, on breaks and after work – and now has gained back somepersonal time.
For clinicians who already had high usage of 3M Fluency Direct, the training did
not have as much of an impact. “One physician was only spending 20 minutes
in Epic notes per day,” Dr. Sakumoto said. “If you already have a pretty small
baseline, it’s hard to make improvements on that. If you’re spending above theaverage amount of time, dramatic effects are possible.”

47 minutes per day:Average time savings since
training“My goal is to save timeand get back sanity.
Everybody is so busy;
even getting back fiveminutes is huge. The
biggest thing is finding
room to breathe – timeto think gives you moretime to care.”—Dr. Matthew Sakumoto,CMIO Sutter West BayRegion

Case study: Reducing EHR time through clinical documentation tools: A speech-driven efficiency study

As impactful as time savings can be, there’s more to the story. “Even if total time didn’t change, but the clinician’sperception of their time spent was better – to me that’s a win,” Dr. Sakumoto said. “I actually care more about thesubjective change because that’s the clinician wellness piece. If they’re happy, I’m happy.” To help evaluate theparticipants’ documentation experience, the project team conducted a closing survey.

Key takeaways and lessons learned
With quantitative Epic data and qualitative survey feedback in hand, the project team uncovered some key takeaways.
Using 3M Fluency Direct improved the study participants’ documentation experience. In the final survey, 80 percent
of respondents said it was easy or very easy to document in the Epic EHR with 3M Fluency Direct, and 40 percent
reported it was either difficult or very difficult without 3M Fluency Direct. A lack of technical background did notprevent clinicians from experiencing positive results – in fact, a physician with only a basic technology backgroundachieved the greatest productivity improvements.
Customization tended to correlate with enhanced productivity. Initially, the project team hoped that training theparticipants on a standard set of productivity tips and speech-enabled commands would lead to efficiency gains foreveryone. However, they quickly discovered that different navigation commands, macros and smart phrases wereimpactful for clinicians depending on their role and Epic workflows – making customization a driver of efficiency. Whileit may not be feasible to offer one-on-one training to all clinicians, the Sutter Health team is considering persona-based
training that would allow clinicians with similar documentation needs and workflows to take advantage of productivityboosting functionalities related to their role.
Strong users of the solution became advocates for the tool. Study participants have promoted 3M Fluency Direct
with other staff in a number of ways. When one participant was using the speech dictation functionality but not theproductivity tools, other participants encouraged them to set up speech commands. Participants have also asked Dr.
Sakumoto to make sure new staff get 3M Fluency Direct access. “Having those champions on the ground in the clinicis huge,” Dr. Sakumoto said.

Looking to the future
Because the study demonstrated that 3M Fluency Direct helped ease documentation burden for participants, theproject team plans to identify lessons learned in order to expand the training and improve adoption across other clinics.
For Dr. Sakumoto, increasing adoption of speech-enabled clinical documentation is also an important mindset shift
and step toward the future. “Ambient documentation is coming,” he said. “Clinicians will need to verbalize the physicalexam as they’re doing it. Training clinicians to think and act differently takes time. So starting them with saying theircommands out loud now – rather than when the technology is here – was definitely a strong motivator of mine going
into this pilot.”

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As with any case study, results, outcomes and/or financial
improvements should not be interpreted as a guarantee
or warranty of similar results. Individual results may varydepending on a facility’s circumstances.
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Published 02/24
70-2011-9507-3