EHR can help providers. A lot has been said about how exactly EHR can help everyone in the health care. However, when providers implement EHR the physician productivity and patient satisfaction suddenly drop. The factor often unaccounted for is how the new technology blends with the end users, and the time it takes for the new technology to prove its ROI. We are several years into implementing the EHR systems across the country, but the numerous surveys continue ringing the alarm on the physician burnout that is at an all-times high. EHR and increased computerization are among the top 3 causes of burnout, as reported by the physicians.
HIT Paradox
The study funded by the American Medical Association (AMA) shows how physicians are overloaded with bureaucratic and clerical work that is not related directly to patient care:
“For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work,” according to Annals of Internal Medicine. “During the office day, physicians spent 27% of their total time on direct clinical face time with patients and 49.2% of their time on (electronic health records) and desk work.”
According to the 2016 Medscape Lifestyle report, the burnout among US physicians “has reached a critical level.” The severity of the burnout was measured on the scale of 1 (lowest) to 7 (severe). Most specialties rated the severity of their burnout at 3.85 – 4.74.
The top 3 causes of burnout (again, on the scale of 1 to 7) are:
- Too many bureaucratic tasks – 4.84
- Spending too many hours at work – 4.14
- Increasing computerization – 4.02
A Mayo Clinic NEJM Catalyst Insights Council survey polled clinical leaders and executives on the same issue. 96% of respondents agree that physician burnout is a serious or moderate problem, which remains largely unaddressed inside the organizations. As the top reasons to address the problem, the respondents cite decreased quality of care (63%), the effect on the attitude of the rest of the team (38%), and physician suicide (8%).
Here, again, the top causes of physician burnout are:
- Increased clerical burden due to the use of EHR – 62%
- Increased productivity requirements/expectation – 51%
Ironically, EHR is the reason the productivity expectations increased. The use of EHR is reported to disrupt the established workflow, forcing the physicians to “carry their workload into off-hours, or “pajama time.”
Why You Should Care
- The burnout causes errors and poses a direct threat to the lives and well-being of both physicians and patients. Most likely, the surveys do not reflect the full picture because they are based on volunteer respondents’ answers. What about those who refused to participate? They are likely to avoid the subject of burnout because a) it can raise questions regarding their ability to deliver at their workplace; b) fear of being stigmatized (as any mental issue tends to lead to stigma).
- The staff engagement in any new strategy a provider is deploying to cut costs or ensure compliance is fruitless without the physicians’ buy-in.
- The physician burnout is a symptom of the loss of enthusiasm for work, emotional exhaustion, depersonalization, sense of low personal accomplishment, feelings of cynicism, a decreased level of compassion and involvement with patients and staff.
- The domino effect of the physician burnout can and does have a devastating effect on health care. According to the US Bureau of Labor and Statistics’ Real Sector Growth, health care has a -0.6% decline in productivity every year.
- Physicians with a high level of burnout choose part-time practice, early retirement or leaving for other industries (pharma, insurance) as a way out. With the medical staff shortage on the one hand and the growing population on the other, providers can not afford to lose clinical talent.
Technology IS The Solution When Done Right
HIMSS17 saw a number of sessions featuring success stories of providers using innovative solutions to address the physician burnout and increase productivity.
“Perfecting the Mobile Solution” demoed how Palmetto Health-USC addressed the issue of physician burnout (due to the clerical/EHR documentation overload) by adopting a mobile solution. Relying on a Windows 10 medical tablet with a digitizer stylus, the provider was able to not only improve physician productivity but also alleviate the physician burnout.
Benefits of a medical tablet, as reported by Palmetto executives:
- Improved patient-doctor communication, eye to eye contact
- Doctors review charts before going into the room → more dedicated visit and saved 2-3 minutes per visit
- Faster note completion and triage, ability to take history from patient in the hallway effortlessly
- Ability to document anywhere
- Improved workday and productivity
- Decreased patient wait times
- Small technology footprint
- No negative impact on workflow
- Reduced login times, improved security
- Reduced eye fatigue from looking at the tablet
- Improved efficiency with dual screen mode
- Easy to move with or without cart
- Easy to share and clean the device
Benefits of a medical tablet, as reported by physicians:
- Provider satisfaction – 71%
- Device easy to use 83%
- Reduced time spent after work documenting 64%
- Faster documentation 46%
- Improved access to health records 54%
- Improved security of patient records with reduced need to print, secure network, fingerprint access
- Improved patient communication and education at bedside 54%
- Improved workflow and reduced login times 64%
- Reduced transcription costs
- Fewer desktops needed
The factors that contributed to the successful implementation of the mobile solution at Palmetto:
- Larger screen, digitizer stylus, support for full-size mouse and keyboard
- Extended battery life
- Corporate shared device (not BYOD)
- Dragon dictation support
- EHR-ready
- Ability to manage/support the devices on-site
- User-friendly interface with manageable learning curve (Win 10)
- Support for high-quality medical imaging and X-ray image printing
- Fast and secure logins with biometric reader/RFID SSO/Smart Card or CAC
A similar experience was reported at the HIMSS17 “Mobile Innovation and Telehealth in Emergency Care” session featuring the outcomes of Emergency Telehealth and Navigation program (ETHAN). The medical tablets running ETHAN used by the ambulance teams help the Houston Fire Department reduce the overload of the very ambulance teams and increase their productivity by 44 minutes (from 83 in regular teams), and reduce the flow of low-acuity patients to the overcrowded ERs.
If the team’s assessment of a patient is that of a low acuity, they initiate a video conference with a remote physician. The latter makes an assessment and offers alternatives to an ambulance ride to the ER. We covered it in detail here.
Conclusion
An EHR-ready Windows medical tablet with RFID SSO, fingerprint, CAC/Smart Card and barcode reader, antimicrobial casing, hot-swap batteries, rugged case, carrying handle and strips does alleviate the physician burnout caused by technology because:
- It is easy to use – familiar Windows interface, minimum learning curve. Security is made simple requiring minimum user effort.
- It is safe – antimicrobial casing kills the pathogens, IP65 sealed bezels enable cleaning with liquid chemical solutions for ultimate disinfection.
- It is reliable – with durable, military-grade battery or hot-swap batteries that let you swap them without powering off the device and losing data.
Another way to reduce the negative effect of technology on physician and nurse burnout is to use maneuverable and lightweight non-powered medical carts with ergonomic medical computers with hot-swap batteries, which provide the full-shift uptime and flexible charging options. This configuration eliminates the nurses’ strain of having to charge the cart or the laptop frequently. It also reduces the cost of IT because our hot-swap batteries are durable unlike those of your regular powered medical carts that need frequent replacements.
P.S. While the AMA and other professional organizations might get busy lobbying to reduce regulations regarding clerical work, the providers and HIT vendors must work towards interoperability and ease of use of their solutions. Check out our Key Takeaways from HIMSS17 here.