Lessening the burden of healthcares’ greatest stressor
With all the issues surrounding healthcare in this country, it surprises many to learn the most consistent source of stress—and ultimately burnout—in physicians/clinicians is the documentation process brought upon by electronic medical records (EMRs).
But then you think about it… when treating a full patient load, it’s somewhat natural that paperwork takes a backseat, at least until the end of the day. Consider the tasks you leave for the end of the day – probably not your favorite parts of the job. When the volume of patients reaches a certain level, it becomes impossible to keep up with the paperwork. Keeping the back log manageable becomes the goal, rather than completion of all records.
So maybe it really is no surprise that physicians mention the hours of data entry and logging records when asked about their greatest stressors. How can the profession adjust to avoid this problem reaching a breaking point? Niki Buchanan, general manager of Population Health Management at Philips, shared a few ideas.
ADVANCE: Can you clarify exactly what is meant by physician burnout?
Buchanan: Physician/clinician burnout is the overwhelming exhaustion and dissatisfaction that comes from delivering care in today’s shifting world. Caring for others is already a time-intensive and emotionally strenuous profession, and with an increasing focus on quality and value-based care, there is a higher demand for physicians to report quality metrics and perform administrative tasks. This additional work can unintentionally take time away from the direct patient care that is central to medicine. Physicians spend the majority of their time serving not the needs of the patient, but of the technology – in fact, for every hour physicians spend with patients, they spend another two hours on the EMR and other administrative desk work. The ultimate disconnect between the design of EMRs and the end-user experience is feeding a modern-day healthcare crisis of physician burnout. The increased computerization of their practices can be associated with troublesome effects such as lower patient satisfaction, compromised care quality, an increase in medical errors and more.
ADVANCE: In your experience, has the era of EMRs worsened this problem? How?
Buchanan: Healthcare continues to be one of the most under-regulated industries in terms of clinical workflow and process, but EMRs require a lot of process. By design, EMRs were never intended to be used as a longitudinal record; instead, they were intended to focus on each individual encounter. While the technology is engrained in our health systems today, the various platforms and their patient data have remained siloed. With no set standards in place for EMRs, the option for non-standard fields and free-text inputs, and disparate systems across providers and departments, reporting and comparisons of patient files is extremely difficult. All of this significantly impacts clinician workflow – and the very benefits EMRs bring to patient care. And while this leaves the physicians frustrated, it also leaves the patient trying to navigate a sea of non-standardized practices across their caregivers.
Despite how frustrated and overwhelmed physicians are, EMRs are not going away – health systems’ population health programs and incentive plans are now predicated upon having an EMR in place. It’s time we rethink the functionality of EMRs to improve physician and clinician job satisfaction, and enable physicians to focus their time and attention on high quality patient care, while also taking care of themselves in the process. This would entail becoming better, more effective and efficient users, reclaiming some of the time spent on EMR work, and improving physician satisfaction. EMR optimization will be powered by technology for better and smarter data capture, but also by healthcare organizations focusing on their workforce and helping their clinicians become better users.
ADVANCE: Do you know of any organizations who are aware of the problem of physician burnout, and taking steps to remedy it? What are some of those steps if so?
Buchanan: The American Medical Association (AMA) has conducted multiple studies that comprehensively analyze physician burnout. One such study found that physician dissatisfaction was nearly 30 percent higher to that of the general public, and have conducted this research consistently for various specialties. The AMA also has a host of recommendations to improve work-life balance, and believes a major approach to combating burnout is to create team-based care. For physicians undernourished by the rewards of delivering direct patient care, redesigning team work can help shift the EMR burden, by assigning data collection and data entry to other members of the clinical team. The AMA has also created online burnout assessment modules so physicians can gauge early-warning signs of burnout that they may be ignoring.
There is also a lot being done by various organizations in terms of assessing EMR usability. For example, the National Institute of Standards and Technology (NIST) is a leading organization working to establish technology usability guidelines. This attention to usability also includes EMR’s visual display, where organizations like the Association for the Advancement of Medical Instrumentation is working to create more user-friendly interfaces.
ADVANCE: Do you have any ideas for further measures that can be taken by organizations?
Buchanan: There is a necessity to redesign clinical workflows towards a value-based care reimbursement model. If this is done correctly, it pushes all clinicians in a care team to work at the highest level of their respective license, and segments administrative tasks to those who know how to identify efficiencies. This change to a team-based approach instead of the physician being solely in control of the care is certainly an adjustment, and could at first appear to be a financial burden, requiring additional resources. For example, it oftentimes puts the physician as the leader of a team, requires the hiring of various levels of nursing licenses, and may even include supporting staff member needs such as psychology or behavioral specialists. However, the long-term benefit of a care team approach, where everyone is focused on serving at their personal skill level, benefits patient outcomes, patient satisfaction, and ultimately the ability for the physician to treat the most complex and challenging cases.
Additionally, health systems should rethink the role artificial intelligence plays in improving workflow efficiencies and data visualization to help streamline processes and fill gaps in care. Employing data analytics technology that brings individual platforms together into a single view, or stratifies patient populations by risk so that physicians can focus their attention on those who need it most, can help providers reclaim time previously spent on the EMR.
ADVANCE: Other than EMR complications, what are the leading factors that contribute to burnout?
Buchanan: Keep in mind, physicians are just like us! They have a life outside of work and families to take care of. However, they carry the extra burden of being responsible for the health of large and diverse patient panels. Additionally, as the rules surrounding healthcare reimbursement are being rewritten with the implementation of MACRA, physicians across the country are attempting to get up to speed quickly on program requirements. And, on top of it all, healthcare is undergoing an aggressive M&A period, where independent and even affiliated physicians have to spend time on their business models, many times without the learned skills to do so.
Also, we know that the increasing consumerization of healthcare will continue to drive the need for health systems to incorporate patient-reported outcomes through home monitoring systems. There is nowhere to capture that data today in a traditional EMR set up, but this data will truly offer the most up-to-date and valuable insights needed for the caregiver to reduce costly ER visits. Physicians don’t even want to discuss this, however, as they expect the technology vendors to figure this out so they can continue to practice.
Physicians are often overworked and pulled in multiple directions. We must equip them with the right tools to make processes as streamlined as possible. If physicians have access to a single, actionable longitudinal patient record at the point of care, they can feel secure that there are no gaps in their view of a patient such as medication management or unknown risk factors. It is our responsibility as partners and vendors to enable technologies that take the data back to the physician’s point-of-care, to break down the barriers of interoperability, and to leverage the digital systems in place today to improve both the provider and the consumer experience. Let’s let the doctors practice and do what they do best clinically. Seamless technology integrations that offers reliable access to patient data and enables seamless care can help keep burnout at bay, and simultaneously improve patient outcomes that benefit us all towards the value-based care models coming our way.