Physician burnout is an unfortunate reality in the healthcare industry, as doctors and clinicians cope with time-consuming technologies and complex electronic health records that infringe on time spent with patients. Luckily, there are innovations that can help circumvent the issue.
At times, the problem of complex technology can be addressed with adjunct tech that streamlines processes and saves physicians time, curbing long hours spent on documentation. At other times a tech-light approach is favored, with an emphasis on change at a more philosophical level.
Increasingly, hospital and IT executives are recognizing the need to utilize one or more approaches to the problem. And that makes sense. The reasons behind burnout, after all, are many.
The conundrum is that technology can both fuel burnout and be a fix because there are more things causing burnout than just EHRs.
"It is a multifactorial problem," said Vinay Vaidya, MD, vice president and chief medical informatics officer at Phoenix Children's Hospital. "If you look at it, there are pressures coming to physicians from various quarters. Some of these are administrative burdens."
Physicians are expected to do more and more in less time, he said. Before technology became ubiquitous, is was challenging to measure true performance. It's much easier now, but in the past few years, as EMRs have become adopted almost universally, it's been a difficult transition for doctors, as many have become overwhelmed with monitoring every aspect of the patient and their performance.
Dike Drummond, MD, CEO of The Happy MD, said overwhelming doctors is at the root cause of burnout because so many are expected to meet certain quotas and spend more of their time in a digital environment than they bargained for when entering the profession.
"We want you to see 30 patients a day, but here's this EMR, and we want you do do that too," said Drummond. "So they spend two hours in front of a computer for every hour they spend in front of a patient. You're in a HIPAA-compliant environment, which means when you log onto your computer you're going to have a complex logon, and in most environments you don't have a tap-and-go procedure where you can scan your badge automatically. There are a lot of clicks wasted. That takes time."
Here's what worked at Phoenix Children's
Phoenix Children's recognized that it needed a way for physicians to capture essential patient information quickly and efficiently, without too many clicks or slow-down at the point of care. The hospital looked for ways to improve documentation by creating specific disease templates, saving physicians time on administrative documentation tasks.
The hospital turned to Medicomp Systems, which offered disease templates and a level of documentation expertise that ultimately kept many physicians from taking their work home with them.
The approach enabled Phoenix Children's to convert electronic documents for the EHR at a very granular level.
"You can develop a documentation template very quickly for just about any type of clinical situation," said Jay Anders, MD, Medicomp Systems' chief medical officer. "All of those terms can now be resorted and transmitted by their coded understructure. The interesting thing Phoenix Children's did was take that data and created a set of dashboards to send the information back to the clinician so they can assist patients at the point of care."
According to Vaidya, the results have been positive. While there are some outliers, most of the clinicians on staff approve. Rheumatologists are completing 86 percent of their notes by 5 p.m. on the date of service, and another 10 percent the following day. The hospital estimates it captures quality measures 99 percent of the time.
As an added bonus, costs went down as well.
"Within a couple of months of each clinic going live, the cost of their transcription went down by 5 percent," said Vaidya. "That translated to more than a million in savings.
"It's not the only answer," he said, "but it is our responsibility to make it easy and give back to the patient and physician the data they need. "We are not (the Centers for Medicare and Medicaid Services). We cannot determine how many times you have to electronically sign a prescription. There's not just one problem, or one solution -- it's multifaceted."
What other hospitals can learn
Adopted more broadly, the approach has the potential to address an increasingly pervasive problem. Peter Liu, in a paper written for Google Brain, said most time-consuming aspect of
the administrative work is inputting clinical notes into the EHR software, documenting information about the patient including health history, assessment and treatment plan.
Much of the documentation requirements are viewed as drudgery and is a major contributor to career dissatisfaction and burnout among clinicians. And patient satisfaction is affected by the intrusion of this work into time spent with patients.
Drummond, for his part, is leery of technological solutions, since it's EHR technology that appears to be exacerbating the issue. He advocates for onboarding more physicians and medical assistants to combat an already-worsening physician shortage, yet another cause of burnout.
"We need more bodies to handle the load," he said. "Long term, give me EMR interoperability and an interface we can use."
"Once you've been out of medical school for 15, 20 years, you settle into your practice, you've seen it all and done it all, and things get to be a little boring," he said. "You've got an EMR and the load is challenging, and you've still got 15 years to go. Older physicians, they're generationally behind the eight ball. They've been gutting it out for a while. That's often very stressful. And even the idea of retirement for them is stressful because a lot of them don't know how to not work for their money."
What's needed, said Drummond, is change at the leadership level to match technological changes, and the key is for that leadership to establish an atmosphere of trust.
"Change is accelerating," said Drummond. "At the same time, the growth in the aggregate level of trust between doctors and their administrators is in the basement and not going anywhere, except for a few far-flung organizations. "You want an organization that, when the big changes come, has a habit of recognizing work overload and tweaking their systems to adjust the hands on deck to the amount of work that needs to be done."
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