November 26, 2024
Mosaic Community Health was founded in 2002 by the community, for the community, with a mission to make high-quality health care accessible to all. As Central Oregon’s first community health center, Mosaic served nearly 700 patients in its first year. Since then, they have grown into a multi-specialty federally qualified health center (FQHC), now providing comprehensive care to more than 27,000 people annually across 16 locations in three rural Oregon counties.
Like other OCHIN network providers, Mosaic’s nearly 450-person staff work diligently to ensure local residents have access to high-quality, patient-centered care, meeting them where they are regardless of their ability to pay. However, they also face the dual challenges of increasing demand and the rapid pace of change in health care, often spending a disproportionate amount of time on non-patient-facing tasks.
“Time is our most valuable commodity, and when our time is taken away from patient care, this can directly lead to burnout,” said Beau Gilmore, MD, Mosaic’s medical director of clinical informatics and pediatrician. “We hear it every day—people are tired, they don’t have enough time to see patients … but our patients are asking to see us more, and we want to meet that need. So how do we do that? How do we give providers more time when you feel like your time is taken up by so many other things?”
Supporting providers to optimize care
Challenges such as staff shortages, limited financial resources, and the ever-changing landscape of technology, compliance, and billing requirements are placing significant strain on the entire health care industry. While large health systems may feel the burden, smaller organizations in rural and underserved communities, like Mosaic, are often hit the hardest.
More than 1 in 3 OCHIN network providers report feeling burned out, leading to turnover and instability. These pressures negatively impact care delivery and threaten the long-term viability of our nation’s health care system.
To address these challenges, Mosaic leveraged a range of OCHIN tools and resources to create an exceptional experience for their providers, revamping their training and support structure to improve communication, enhance education, and equip staff for success in their daily work. They implemented role-based electronic health records (EHR) training during onboarding for new employees and created a video training library to support ongoing learning. Additionally, they leveraged OCHIN’s guidance to develop an EHR Super User program that provides advanced training, continuous education, and support for users who may be facing challenges.
Their project aimed to improve clinical efficiency through education, ensuring patients receive evidence-based, affordable care that improves their health while also prioritizing provider well-being.
“I think efficiency is the positive foundation from which everything else is built. So if I am more efficient in my day and I’m not being dragged down by my In Basket work or my administrative tasks, I can use my time to practice at the top of my license, staying up to date on research, helping my peers, and taking care of myself so that I can then be well and convey that wellness to others,” Gilmore said.
Improving clinical efficiency through education
To accomplish this, Mosaic took a three-pronged approach. The first prong focuses on enhancing role-based onboarding, tailoring EHR training to each employee’s specific job functions.
“This role-based new employee onboarding program was redesigned by our dedicated technical educator, Jennifer Brazil, who brings extensive Epic experience. She recognized opportunities within our training environment and leveraged them to ensure new employees reached a certain competency level before starting in the clinic,” Gilmore said.
Following this role-based training, new providers transition to shadowing experienced providers and meeting with a Super User to ensure efficient EHR use.
“The training environments that OCHIN supports … are super valuable for us to simulate what a day looks like for a provider moving through a visit,” Gilmore said, explaining how they developed role-based scenarios that allows a new nurse to work through an anticoagulation case or a new provider to handle an office visit for knee pain.
The second prong—ongoing support—focuses on “elbow time” with Super Users, who help struggling providers needing extra support. Mosaic also provides education at clinic-based, team, and quarterly provider meetings, as well as through emails that announce upcoming changes and offer tips and tricks. A video library offers targeted, on-demand resources.
“If you have two minutes in your day and you want to learn how to build a speed button or a macro, you can go to that video library and pull that video off,” Gilmore said.
The third prong emphasizes continuing education, with in-person lunchtime training focused on OCHIN Epic tools like In Basket, notes, and orders.
“The last thing that I want is the tool that we use every day to deliver care to our patients being a barrier to that care being delivered,” Gilmore says. “Providers are expected to do CME (Continuing Medical Education) every year because the way we do medicine is constantly changing. Why shouldn’t we do the same with the tool that we’re using every day to deliver that medicine?”
Enhancing communication and provider well-being
With OCHIN’s support, these initiatives have delivered significant, measurable results. One notable outcome is improved communication, with annual surveys revealing a 20-25% increase in communication effectiveness.
“People appreciate all the information they receive about upcoming changes and how it’s being delivered to them,” Gilmore said.
The ongoing “elbow” support has led to other important impacts, such as improved EHR experience for clinicians. Documentation length has also decreased by about 2,000 characters, and chart closure time has improved significantly, with up to 95% of charts closed within 48 hours in some cases.
"We're also seeing time given back, which is the main crux of this, is how do we give people time back,” Gilmore said. “And that ranges anywhere from 20 to 90 minutes back in any given day for people to go home, be with their families, get outside and pursue whatever makes them well."
Scaling training and support
Mosaic plans to expand role-based training and develop additional role-based scenarios. They also aim to extend the Super User program to support new hires in health IT and front desk roles, in addition to medical and behavioral health providers, medical assistants, and registered nurses.
“There are lots of resources that we’ve used, and I’m really thankful for the way that OCHIN has supported us in enabling our team to get the most of our EHR,” Gilmore said.
Results from OCHIN’s KLAS survey have also helped Mosaic identify opportunities to enhance their clinicians’ experience and well-being. Gilmore highlighted that OCHIN’s emphasis on measuring key factors like training and burnout has inspired Mosaic’s leaders to create their own metrics for evaluation. Starting next year, these efforts will include offering more individualized training sessions for providers, designed to advance their skills, help them keep pace with rapid changes, and ultimately give them time back at the end of the day.
“If you feel like the tool that you have in front of you is built for you, personalized for you, customized for you, and you know the shortcuts with it, the tool doesn’t stand in your way anymore,” Gilmore said. “It’s a tool to make your work easier. It’s a tool to make your job better. It’s a tool to provide that evidence-based care at the bedside that … enables you to help your patient go home safer and cared for.”
Gilmore also appreciates OCHIN’s collaborative model, noting that he has been engaging with other members more than ever to exchange ideas and address shared challenges.
“OCHIN as an organization has really tried hard over the past couple of years to connect us with other network members to help in that shared problem solving and help us not feel like we're doing this alone,” he said. “And that community-mindedness—that team-mindedness, really—helps promote culture, collaboration, and mutual improvement, and that's been a really powerful thing.”
Their focus now is on scaling this program thoughtfully, which takes time and a strong team. As a result, they are looking to grow their clinical and technical education teams to keep up with these goals. Mosaic is also exploring ways to meet staff where they are, ensuring protected time for training and offering educational repetition across formats and in multiple ways.
“That’s definitely one of the most important things,” Gilmore said, “so that regardless of your learning style, regardless of what role you’re in, regardless of what your time looks like, you have different ways to engage this education so that you can clinically improve your skill with the medical record, improve your efficiency, and hopefully get home to your family sooner.”
