Q&A: HIMSS17 speaker Kshitij Saxena on implementing system-wide upgrades

Introducing new technology into a clinical environment is never simple, but as Kshitij Saxena, MD, has proven, open lines of communication and a collective passion for improvement can guide a health system through a sea of change.

At HIMMS17 in Orlando, Fla., Saxena, chief medical information officer of New York’s Health Quest health system, will describe his own experience leading the system through implementation of dynamic physician documentation. For his presentation, he will be joined by Robert Diamond, Health Quest’s senior vice president and CIO.

Saxena spoke to Clinical Innovation + Technology to preview his presentation.

What improvements does dynamic physician documentation bring to a clinical setting?

When electronic physician documentation started eight to 10 years ago, physicians would point and click to create notes. Transcription was another option, but that takes time. With our new system, providers and physicians are able to dictate directly into the template we created, and those transcriptions become notes in real time. We merged speech recognition technology and the old template modules to create a new functionality.

It was a runaway success: our physicians loved it, we made substantial gains in productivity and provider satisfaction—plus the notes are more legible.

Which areas saw the most savings?

The physician’s time and the cost of transcriptions were both big areas of savings. In the past 18 months since the implementation of the system, our transcription costs have gone down and that has saved our organization close to $1.3 million.

How did you monitor the rollout?

We used the adoption rate and satisfaction of our care providers. After a small pilot program, we gave doctors throughout the health system the option to use dynamic documentation. Within six months of going live, we had an adoption rate of 90 percent—nearly all of our doctors were using dynamic documentation only. That’s why in June of last year, the medical executive committees of the hospitals agreed to mandate the use of dynamic documentation as the sole method of documentation, removing paper notes entirely.

Usually, putting the word “mandate” in any rollout is a death knell for the project; it’s like dropping it into a fire. The folks who implemented it for themselves made it easier for us. However, it didn’t happen on its own. We went to a lot of different department meetings to endorse the software and we sat down with department leaders to create individualized templates for subspecialties.

It’s very important to customize these templates to their workflows. You have to be careful that no miniscule detail is missed, so we conduct extensive testing and solicit feedback from subject matter experts in the field. We continue to attend department meetings because someone might say, “I need this field for the lung examination template.” Even when it’s up and running, we have the ability to work with the IT team and change it—it’s an ongoing process, it doesn’t just come to an end.

So, what’s the bottom line? How effective is this program?

In under two years, we’ve saved $1.3 million, and our return on investment analysis indicates that we will continue to see savings for many years. In addition, our physician satisfaction has increased by a staggering 400 percent.

This text has been edited for space and clarity.