A Clinical Service Desk for Epic Users: Emphasis on Clinical

Not all Epic clinical service desks are created the same. At CereCore, our Epic help desk is focused on providing well-informed Level 1 agents backed by experts with decades of clinical expertise. This combination of experience and clinical operations understanding elevates their level of support, going above and beyond what is provided by analysts with only a technical background but without clinical insight. More recently, CereCore began amping up the knowledge sharing and education by offering Epic certification to service desk agents.  

To better understand the partnership of our clinical service desk and our clinical operations analysts, we interviewed CereCore experts and captured their thoughts on creating a model for clinical service support to meet and exceed client and user expectations today and to establish the foundation for well-educated agents with career growth in mind. 

Chris Wickersham: The service desk perspective... 

Chris Wickersham, CereCore’s Director of Customer Support offered these answers to help us understand the strategy behind Levels 1 and 2 support and why it makes a difference that those answering calls also understand healthcare operations and have deep EHR understanding. 

Why is it so important to have both clinical and technical knowledge for service desk support? 

• Our goal is to respond to the appropriate questions with the right level of resources. We want our Level 1 resources to handle as many calls as possible, because that reduces the number of touches by Level 2 resources and keeps them focused on more complicated tasks and issues escalated to them by Level 1. The strategy at play is called “Shift Left,” a familiar term for technical services. What’s novel here is application of the model in a clinical setting. Applying Shift Left methodology in the clinical setting drives greater satisfaction to clinicians as this is where a heavy majority of the work stoppage issues originate.  Shift Left:
  • Distributes work to the right level of expertise resulting in faster problem resolution for Epic and other issues.
  • Lowers the cost of the support call because Level 2, with a higher rate of pay, dedicate their time to more complex issues, optimizations, and projects that drive transformations in the organization.  
  • Enables hospital’s L2 Epic experts to progress on optimization projects such as those with specific benefits to patient care or revenue cycle.
• Our Level 1 representatives collect pertinent details, work to resolve issues on the first call as often as possible. They escalate to Level 2 resources only when it’s an Epic-related question or issue that requires additional knowledge or access. Many of our Level 1 representatives are Epic certified, so they are able to help with a variety of issues without involving Level 2. 

Having certified and well-trained agents to shift work left is an investment. What is the benefit to providers and patients?  

• Well trained agents help providers get back to delivering quality care. That's their most important job. They capture the incident and work to resolve it right away – on the first call in many cases.  Or, they help direct it to the right support team if the caller has reached our team in error and really has an issue with another system.  
• When our Level 1 agents are unable to address a call about Epic on their own, they are trained to document and troubleshoot the issue thoroughly so Level 2 resources can go directly to analysis and resolution.  
• We also value commitment to appropriate access. We work with clients to employ a strategy that starts with minimal access to Epic databases. From there we use analytics to discover patterns in common issues and evaluate areas where if we had more access, we could resolve even more issues through Level 1 support. Other support strategies often start with broader system access than support teams need, which introduces risk for inadvertent changes or even misuse of private information.  

How does CereCore’s approach to optimizing the support analyst role differ from other organizations? 

• Our Epic support team has critical system understanding which transfers from one customer to another because the Epic system itself is the same. But every hospital or hospital system uses different workflows and security processes and can operate under regulations that vary by state. That’s where access to clinical experts makes CereCore different. Our support team’s system knowledge is supported by members of our organization with clinical knowledge specific to areas of the hospital, lines of business, and compliance standards that give our clients a much larger pool of expertise to depend on than an IT support services organization that lacks clinical and system expertise. And our Level 1 analysts are stronger for it. Our collaboration across support and business areas means they grow to understand the operational side of healthcare in addition to growing their Epic knowledge. 
• Our Level 1 analysts report being satisfied with the professional development opportunities they are provided. They feel well informed about their current position, and they know they are on a path for advancement opportunities at CereCore in the future. Since launching our support desk training program with the goal of increasing the number of analysts with Epic Certification, our team engagement scores have increased. Analysts on our Level 1 team feel proud of our first resolution metrics, because many times they get immediate feedback from provider or nurse about how they can get back to their patient or how much time it saved them.  
• Another satisfier is related to the kind of work each analyst does. For Level 1, it’s satisfying to resolve issues on their own and to build on the knowledge required to resolve more and more calls. For Level 2, it is much more fulfilling for them to employ specific system and workflow knowledge such as guiding a provider through the appropriate order or locating a patient on a patient list. Meaningful work and connection to the impact is important to both levels. 
• With our model, Level 2 analysts are more focused on projects, not break/fix tickets or issues that require beginner or intermediate level knowledge. And, of course, our support team counterparts at facilities love that we get any calls in the middle of the night and they don’t! We help some of our customers with 700 Epic incidents a month and others with as many as 6,000 monthly incidents, so it’s a clear source of satisfaction for our clients of all sizes. 

What’s your vision for the clinical support service desk of the future? 

• Next up for us will be further investment in automation. Today, we use automation to help with queue manipulation and call routing which means we answer physician and clinical calls three times faster than if they were to call into the standard line. That’s just the tip of the iceberg. We also look at automation through the self-service portal to get the incident to the appropriate group with the right information for resolution without involving a pass through step. For example, there is no need for a service desk analyst to update a medication within the formulary. Routing that incident or request directly to the pharmacy group speeds up time to resolution and reduces cost through limiting touches on an incident. Automation is key to the success of any clinical service desk because it can result in measurable efficiencies for both analysts and customers.  
  

What’s your best advice for service desk leadership teams? 

• Simple. Keep the customer and the patient experience your focus, invest in talent and help them develop professionally, apply tools and automation to keep everybody involved more satisfied, and master the metrics game. Metrics prove the value of automation, professional development, top notch talent, and more. 
• If it’s too much to run your support desk well, then find a partner who knows healthcare first. We have worked with clients who chose other service desk vendors, and they did not understand healthcare operations. On the CereCore Podcast, both Jeremy Taylor, CIO Thomas Health Systems and Rick Keller, SVP and CIO Ardent Health Systems speak to the difference that can be made working with a partner that has strong understanding of healthcare operations.   

Stephanie Murray: The EHR analyst perspective.... 

Stephanie Murray, CereCore’s Senior Director of Epic Services offered these answers to help us understand the significance of having EHR analyst support with clinical operations experience working together with an informed L1 and L2 service desk organization. 

Why is having both clinical and technology knowledge so important to our approach to service desk support? 

• By combining clinical and technical knowledge our analysts have a more thorough comprehension of not just the functionality, but the workflows the Epic functionality is intended for. Having that level of understanding allows for a more empathetic conversation with any users that might call in for assistance, making the support a more efficient and pleasant experience.  

What are the anticipated outcomes of combining clinical and technology knowledge? 

• For example, if a clinician is calling in with a question about medication reconciliation, an analyst who understands why and when med-rec happens will be better able to answer the user’s questions versus someone who just understands the pure functionality of the system. The context around a user’s question is typically key to understanding what or why they are asking their question.   

How do trained agents, experienced advisors, and expert escalation teams impact providers and ultimately patients? 

• Having well-trained and experienced staff allows us to configure, implement, maintain, and support systems in a way that enables providers and clinicians to focus more on patient care because the functionality enables their workflows instead of inhibiting them. Well-trained and knowledgeable support staff are better able to explain why things are configured in a certain fashion and how the users can take advantage of this configuration to complete their documentation or workflow requirements more efficiently.   

What are some of the risks associated with applying technology knowledge of Epic without knowledge of clinical operations? 

• Knowing what a piece of functionality does is different than knowing how it should be implemented and where it plays its operational role. Without both sides of the coin, you are at risk for an incomplete or inefficient workflow, confused users, and/or being out of compliance. For example, if you only know what a button does, but not when that button should be clicked or how that button relates to a user's daily activities, that is going to make it very difficult to understand where to place the button so that it is clicked when a user needs it.  
• Additionally, not understanding both the operational and functional aspects of technology limits one's abilities to assist users with questions they may have about how things work within the context of their role and responsibilities.  
• We want to give users efficient and empathetic support. Typically, if support is focused only on telling the user what functionality is available versus how that functionality can be used to complete the user's work, they are not going to be able to resolve the user's question.   

What’s a good example of how knowledge of a workflow that varies by hospital and clinical operations knowledge helps with Epic performance, usability, adoption, etc.? 

• One of the draws to using Epic is its configurability. This is both a benefit (because you can in essence configure anything within the system to meet your workflow needs), and a challenge (because there are so many configuration options it is a real possibility that you will set something up that is inconducive to an efficient workflow). Combining an understanding of your facilities' operational expectations around what documentation needs to be completed, what timestamps need to be logged, and what compliance measures need to be reached with an understanding of the functionality that is available to you to meet those needs is a key knowledge intersection that strong design, implementation, and support analysts have. 

How does CereCore’s approach to optimizing the EHR analyst role differ from other organizations? 

• CereCore focuses on ensuring our analysts and support staff have a clear understanding of not only the system's functionality, but how that functionality plays a role in meeting operational goals and compliance requirements. By enabling our analysts and support staff to understand how functionality supports user workflows, we are not only better able to support our users, but we are also able to offer our analysts work that is more targeted to their skill set.