Revision as of 17:44, 28 April 2024

Introduction

Historically, any build conducted in the EMR has been conducted by developers employed by the vendor, or analysts certified to conduct such build, hired by health systems. However, there has been both interest in and beneficial effects of Physician Builder (or Provider Builder) programs. Through these programs, physicians (or providers) can obtain certification or accreditation as builders, demonstrating adequate understanding and expertise using the build tools in their EHR. Typically, the various analyst groups of a health institution have a large queue of work tasks to complete. This often leads to delay in smaller project completion and implementation in production environments. Through the use of physician / provider builders, such smaller projects can be completed in parallel with the build team, with appropriate review, allowing passionate physicians / providers to contribute build changes that are important to their specialty or practice in a more expedient way. Those clinically practicing builders have a unique knowledge base of current state workflows and envisioned future states. Such providers understand the pain points of the day-to-day workflow and can potentially suggest or implement changes that may reduce burnout.

Builder Programs

The two EMRs with the largest market share in the United States are Epic and Cerner. Both of these vendors have created a physician/provider builder certification track to empower these users to learn the necessary skills and knowledge to effectively contribute build to their electronic health record systems.

Epic's build program is known as Physician Builder [1], while Cerner refers to their program as Physician Architects [2].

These programs typically involved an in-person visit to the respective vendor's campus to engage in synchronous classwork to obtain certification. However, during and following the SARS-CoV-2 pandemic starting in 2019, a virtual option was created to complete the training.

Epic now offers both in-person and virtual physician builder courses. Epic differentiates the credentials provided to those who complete the course in person or virtually. The former receive "Certification" as a Physician Builder, while the former receives "Accreditation." While Epic states they consider these two credentials to be the same with regard to knowledge acquired, Honor Role, and Good standing, the distinction remains.

Epic allows any user who is an active employee of a health system licensing their EHR to complete the builder training at no cost. Further, once certification has been achieved, such users can obtain a waiver to take additional, more advanced courses, at no additional cost.

Value of Physician/Provider Builders

The value of such builders has been demonstrated to the vendors, which has lead to them creating a robust pathway for training and certification [1].

Bilingual Experts

Physician/provider builders are "bilingual." Through their certification they obtain the necessary technical knowledge of how build is conducted in their respective EHR. They also are clinical experts in their respective specialties. They are able to "speak the language" of both technical and clinical needs, which can be an invaluable resource to their HIT analyst colleagues. These builders can cut down on the research and correspondence between a requestor and the IT department by more clearly conveying the build request using the terminology used by analysts when building in their respective EHR. Physician/provider builders have a unique perspective and may be able to supply suggestions and/or solutions that may have otherwise been overlooked.

Physicians/providers are also uniquely positioned to offer evidence-based medicine solutions to the EHR. When given the tools to act, can build high-quality, up-to-date workflows that adhere to professional guidelines and recommendations, more so than their HIT analyst colleagues who may be removed from the review and implementation of such evidence-based practices.

Increased EHR Satisfaction, Reduced Burnout

Physician/provider builders are uniquely empowered to make or advocate for changes within their EHR as they have real life, practical experience using the EHR on a daily basis. They are able to identify the pain points, unnecessary redundancies, and overly complex workflows that directly impact their colleagues and themselves. By empowering these users to actively contribute to solutions, they may develop a sense of ownership, and therefore feel that their concerns or the concerns of their colleagues are taken seriously and addressed in an expedient fashion. Such efforts can directly reduce the fatigue and burnout produced by spending large amounts of their clinical day interfacing with their EHR.

Accelerated Implementation of Requests

Health system's IT departments are generally inundated with multiple projects/requests at any given moment. They must balance the demands of the greater system, a queue of requests from end users and/or clinical informaticists, and the bandwidth of their limited personnel. Requests that do not have large systemic impacts can be delegated to physician builders, to be built semi-independently. This can lessen the overhead burden on the analyst team and streamline the build process for both parties, resulting in greater efficiency and optimization of the EHR.

Compensation Models

Volunteer

Some physician/provider programs are comprised of strictly volunteer members. In addition to their typical clinical work week, they may agree to spend additional time working on solutions for the EHR. Such a system is heavily dependent on the drive of its members to improve the current state of their EHR to address pain points and burnout.

Departmental Budget

At some institutions, funding for physician/provider builders stems from their clinical department. These users are offered clinical buy-down time, resulting in less of their full-time employment being dedicated to direct patient care. They can then use this protected time to complete build tasks for the department employing them, serving as a champion of their department, to advocate for their specific departmental needs.

IT Budget

Similar to the departmental structure above, some builders may be compensated in part by the health system's IT department. The builder has a split source of income, from their clinical department and IT department, positioning them uniquely to serve as a liaison between the two departments. Such a compensation model may provide the builder with a sense of belonging within both groups, and may serve to break down institutional silos separating the IT department from the clinical practices their work directly affects. This may lead to a greater sense of purpose and drive systems-based solutions through a unique perspective.

References

1. https://galaxy.epic.com/?#Browse/page=1!68!600!100020447

2. https://web.cvent.com/event/8742cb7f-c626-4548-9ec9-3e8083397125/websitePage:eed56d8e-50ef-4a88-81d6-e5a7d2d0634f

Submitted by Eric Epstein