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Physician burnout: electronic health record optimization takes center stage
Dr. Varsha Misra Associate General Manager – Healthcare Presales and Solutions Group | September 15, 2020
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Like people in other professions, physicians bear many burdens. However, the very nature of life-and-death decisions that the doctors take, and their long hours, have always led to discussions about burnout issues prevalent in the profession. Patient overload, high patient and societal expectations, depressing mortality, and the morbidities that physicians manage, have all traditionally contributed to this issue. The latest culprit that is taking the most blame is the increasing adoption of technology expected from the physicians, especially Electronic Medical Records (EMRs).

On behalf of Stanford Medicine, The Harris Poll was conducted on Electronic Health Records (EHRs) with more than 500 participating Primary Care Physicians (PCPs).

  • 62% of the time devoted to each patient is being spent in the EHR, and almost half of office-based PCPs (49%) think using an EHR detracts from their clinical effectiveness.
  • Seven out of 10 physicians (71%) agree that EHRs greatly contribute to physician and clinician burnout.
  • Six out of 10 physicians (59%) think EHRs need a complete overhaul.

Burnouts are common across industries–what is special about physician burnout?

Physician burnout is a concern for patients, healthcare system, governments, and regulatory bodies alike. It has a negative effect on healthcare systems and, therefore, on patient care quality and safety. It also contributes to a decline in the number of practicing physicians. Burnout trickles down through the larger healthcare system, leading to lower patient satisfaction as well as higher rates of medical error and physician turnover.

How is Healthcare Information Technology contributing to the burnout?

Regulatory and bureaucratic demands of the medical practice, such as charting and paperwork, topped the list of the reasons for the burnout for all generations, followed by long hours. The EHR was also cited quite often as a primary culprit in Healthcare Information Technology for professional dissatisfaction and burnout.

If EHR implementation was assignment no. 1 for Chief Medical Information Officers, EHR optimization is clearly assignment no. 2. Healthcare systems are devoting considerable resources to EHR optimization efforts but, first, they must figure out what to optimize and how.

Some of the most important EHR capabilities are areas where physicians believe the technology is falling short. Out of several features, some features that are probably contributing the most to the burnout are a lack of an intuitive user experience, multiple screens and applications to switch between, poor interactions between patients and providers due to documentation requirements on EMRs, and disruptive clinical workflows.

Currently, EHRs are functioning more as a basic technology or administrative tool to help with coordination, the billing/revenue cycle, and quality measures reporting. However, the actual utility of EHRs should have been for disease prevention/management, clinical decision support, and patient engagement. This would help improve patient outcomes, increase efficiency, and contain costs.

Opting for a cloud health strategy would be the best option to achieve these. It’s combination with rapidly evolving technologies like Big Data analytics, Artificial Intelligence and Internet of Medical Things improves efficiencies and opens up multiple avenues of streamlining healthcare delivery.

Another issue has been the huge focus on implementation with respect to continuous improvement, which stands relatively ignored.

Short Term Goals

  • Improve EHR user interface design to eliminate inefficiencies and reduce screen time
  • Shift more EHR data entry to the support staff
  • Use of highly accurate voice recording technology that acts as a scribe during patient visits
  • Provide more real-time and relevant clinical decision support tools for physicians during patient visits
  • Offer more modular versions of EHR software, such that it can be more customizable to specific practice needs

Long Term Goals

  • Interoperability (system-wide information sharing) deficiencies solved.
  • Availability of both structured and unstructured medical data to fully realize its potential
  • Improved predictive analytics to support disease diagnosis, prevention, and population health management
  • Integrated financial information in the EHR to help patients understand the costs of their care options
  • Making virtual care a standard part of medical practice
  • Harnessing the Internet of Things in medicine by integrating connected medical devices into clinical workflows
  • Integrating social data sets into the context of patient health within the EHR workflow

Technology itself as the prescription for burnout

The improvement (short term and long-term goals) that physicians want to combat physician burnout is majorly focused on the development of tailored clinical decision support tools and truly intuitive EHR interfaces. It will draw providers’ eyes to the most pertinent data points. The need is for consolidation of information in the EHR with speed, reliability, and capacity. It provides clean and shared data along with a full longitudinal view of unified care record

Technologies like Cloud help streamline clinical workflows for clinical documentation, allowing clinicians faster, easier access to the relevant information they need. By moving to the cloud, healthcare professionals can focus on providing a better patient experience and engagement. From offering remote care to storing Electronic Medical Records (EMRs) that can be accessed anytime from anywhere during the patient's journey, cloud is playing a pivotal role in the entire process of enhancing the patient experience and high physician satisfaction.

To align with above, there is a shift from on-premises EMR to Cloud based EHRs as it allows data to be stored in multiple locations away from the physical walls of the health practice and providers, payers and other stakeholders can assess Electronic Medical Records securely from anywhere. Cloud-based EHR allows for more open architecture and flexible connectivity between systems. The high levels of provider satisfaction, lower costs, and ease of deployment associated with cloud based EHR systems have helped to bolster their popularity at different healthcare setups.

The emerging focus of cloud service providers is also on multi-cloud use, especially for larger enterprises and point solutions for virtual care, care coordination, analytics and data interoperability to address the needs of medical professionals and reduce physician burnout.

Reducing administrative tasks and streamlining workflows

According to the Annals of Internal Medicine, for every hour of face-to-face care, physicians spend nearly two additional hours updating health records and managing desk work.

“Voice recognition, as well as AI-powered Natural Language Processing (NLP), are central to many of these technologies, aiding in the age-old practice of notetaking and dictation, long carried out by medical scribes. For example, by leveraging Amazon Transcribe Medical's transcription API, Cerner is in initial development of a digital voice scribe that automatically listens to clinician-patient interactions and unobtrusively captures the dialogue in text form.”

Restructuring patient data

We are seeing that providers are dedicating an unnecessary amount of their time to deciphering patient data, even when they are face-to-face with patients. Patient data is both structured and unstructured. Structured data is easily visible but unstructured data as clinical notes, imaging reports, pathology reports get buried in health records. It leads to endless scrolling. Inability to find the right information, physician ends up looking for same information across multiple sources.

Artificial intelligence is one of the most robust technologies being utilized to improve not only records and point-of-care intelligence, but also how we analyze patient health information to predict potential health issues and make diagnoses.

Artificial intelligence is one technology being utilized to improve not only records and point- of- care intelligence, but also how we analyze patient health information to predict potential health issues and make diagnoses.

Redirecting care

Today, most in-clinic primary care appointments are, in large part, dedicated to cases that may not need in-person visits for proper treatment such as urinary tract infections (UTIs), colds, and pink eye, among other ailments. The industry is beginning to utilize technology to determine the route of care, and ultimately tell patients if they need an hour-long in-person doctor’s visit, a quick video call, or a chat with an automated service to get them the prescription they need.

The biggest challenges to reduce physician burnout

  • Fragmented IT in healthcare
  • Cost to the physician/practice
  • Lack of concern on the part of EHR vendors to improve user experience for physicians
  • Lack of favorable government policies
  • IT security

Setting up a physician profile with their primary medical specialty, years in practice, gender, age, weekly patient volume, patient population, and practice setting, are also other key factors.

Duration of EHR usage are factors that also need to be kept in mind during EHR optimization.

Has COVID-19 impacted physician burnout?

The COVID-19 pandemic presents the US healthcare system with a mind-boggling array of challenges.

Between tracking outbreaks, staying abreast of the latest information on effective treatments and vaccine development, and keeping tabs on how each patient is doing, the entire medical community is chronically overwhelmed.

COVID-19 has led to a shortage of physicians, clinicians, and staff personnel in various subspecialties over the last few months. Keeping staff healthy, both in mind and body, should be of the utmost importance.

While physician burnout is, unfortunately, not new, clinicians, physicians, and other staff are dealing with several facets right now that risk taking burnout to the next level.

An overhaul of the EHR is long overdue. It must go beyond fixing the user interface or improving interoperability. It must address the fundamental problems exposed by the pandemic. To address these needs, the Electronic Health Record must transition from an emphasis on a person’s medical record to an emphasis on a person’s plan for health.

While EHRs are good at “recording” - keeping track of what happened to the patient, they must evolve to address the “health” part by helping providers plan for the next steps. This points the way to how the next generation of EHRs would look like. The new generation of Electronic Health Record would be “plan centric” and would include a library of care plans for specific situations, creating a master plan for each patient, care team collaboration beyond geographies, and care settings. This change is being driven by the value-based care model and the problems exposed by the COVID-19 crisis. This transformation has been embraced to address the plaguing disease of physician burn out to a greater extent.