JULY 1, 2021
Leverage Your EHR for Physician Burnout Relief
BY Michael T. Harris, MD and The Forward Health Group
Over the past twenty years, there has been a dramatic reengineering of the administrative tasks that make up the clinical, financial, and operational workflows of clinical practice. Health care organizations have, appropriately, made enormous investments of time, energy, and, yes, money, into the electronic health record. Most, however, have unwittingly left some of the EHR’s most powerful tools untapped. For too many physicians, nurses, and other health care professionals, the promise of improved efficiency quickly yielded to the painful reality of many late hours completing EHR documentation. The checking of a box or two with a pen on a charge slip was converted into complex, multi-layered clicks and selects and text blocks. Even prior to the pandemic, there was growing focus on the sustainability of this “new” model of care delivery. Research into clinician well-being has established that burnout is increasing and that there is a direct correlation between physician wellness, compassion, and quality of care. There is also a growing collection in the literature reporting the unthinkable increase in physician suicides across the country. And many physicians are leaving their organizations (either for what they perceive to be an easier place to work, or to leave the profession entirely), leaving in their wake the frustrating, time-consuming, and expensive prospect of replacing them.
The pandemic has only amplified the burdensome aspects of workflow bloat. Alerts, messages, notes, calls, documentation, results, orders, and now the explosion of telehealth visits…the growing volume of the daily transaction feed has necessitated long hours of laptop work on evenings, weekends, and even during well-deserved vacation.
Even when the clinician is not scheduled for patient care, she is getting further behind because the messages continue to pile in. Compounding the issue, financial fears of health care systems have led to cuts in care team staff like Medical Assistants and Nurses, as well as administrative staff, leading to further pressure on the front-line clinicians trying to deliver care. It’s a mess.
But within the disease itself lies the cure.
While physician burnout is clearly multifactorial, the EHR contains an enormous untapped source of data that can reveal the specific origins of workflow inefficiencies and can therefore suggest solutions. Harvesting clinician-centric EHR data reveals a clear, common-sense pathway to bring rapid and sustained relief to the stress and strain. Targeted EHR data measurement can quantify the volume and nature of messages as well as the amount of time spent on these administrative tasks (including time of day and day of week – how many Sunday evenings are your physicians spending catching up on their charting?). Clinical leadership, supported by objective data, can and should retake the reins of the EHR and drive the reengineering of the platform to prevent low-value clinician activities from ever hitting their screen. As but one example, the varied workflows of mammography screening today have the potential to lead to up to 50 individual messages for each patient that needs a scan, too many of which unnecessarily appear on the physician’s screen. Prompts to order a mammogram, alerts that a mammogram “care gap” has not been closed, confirmation of a mammogram appointment, changes to the appointment, and more lead to so much background noise that the one message that truly matters, the results, often get lost in the shuffle. By re-leveraging the EHR to improve workflows, a new approach to mammography could be streamlined so that almost the entire process can be managed without distracting the physician from her real work. If an exhausted primary care physician only received one message per patient about mammography (i.e., the results), she would be in a far better position to provide compassionate, high quality care for all her patients.
Health care organizations have failed to fully capitalize on the power of their EHRs to simplify, rather than complicate, patient care workflows. With renewed focus on leveraging the technology they already have in place, leaders can, with little effort and marginal investment, dramatically and sustainably improve the care of their clinicians, as well as that of their patients. Organizations that do this will be better positioned to recruit and retain staff, improve clinician engagement, prolong careers, and can expect better patient outcomes.