I hear it more and more from my colleagues: They’re feeling burnt out.
Studies of physician satisfaction find that doctors are reducing the number of patients they see, and report feelings of emotional exhaustion, loss of enthusiasm, and depersonalization of patient care. The most recent study by the Physicians Foundation found that nearly half, 49 percent, of the doctors surveyed said they “often or always experience feelings of burn-out [sic].”
Another study by the Mayo Clinic reported that 54.4 percent of responding doctors reported having at least one symptom of burnout, and a report from the National Center for Biotechnology Information showed that medical errors are “strongly related to a surgeon's degree of burnout.”
As I explained in a recent Doctors’ Hours Podcast hosted by Jane McCloskey, Senior Coordinator, Doctors’ Hours Program, in Client Services at MEDITECH, burnout represents one of the greatest threats to our national healthcare system, in terms of the investment to properly train skilled doctors that is lost and the higher cost, lower efficiency environments of care that patients must then navigate.
What is encouraging is that other research is beginning to show that adopting a fully integrated EHR system can reduce adverse events for patients and relieve at least one of the main stressors for doctors.
It’s important to note, though, that adopting an EHR system won’t solve the issue of burnout by itself — one recent study shows that the current electronic environment can actually be toxic for providers.
The “call to arms” for our industry, then, is to bring together health care organizations and individual providers to ensure the proper integration of the EHR into their workflow.
It requires a high level of communication and coordination among providers and the management of their practices — and it puts the burden on EHR companies to design their solutions around what will work best for individual doctors, nurses, and specialists.
Some of the most important global opportunities to improve the provider experience with EHRs are:
- Continuity: Design a one patient, one electronic record system to navigate the continuum from hospital to home
- Mobility: Produce a web-based EHR, accessed by handheld devices, for better patient engagement at the point of care
- Usability: Personalize the EHR experience to meet the specific needs of each provider and their practice.
Why are these opportunities important? Consider how I used to work in the days before EHR: I’d spend a lot of my time gathering data; first, from oversized paper charts buried in faraway file rooms, old-school dot matrix printouts of lab data that were filed and refreshed once a day into a paper chart — which was almost never in the correct slot of the chart rack, then finally from the patient through conversation and examination.
Next, I would sit down to hand-write a summary of the encounter as well as my plan for diagnostic and therapeutic interventions. Proceeding to the orders section, I’d spend even more time translating the care plans into writing and adding them to the chart, which could actually pose more risk to the patient because of my admittedly poor penmanship and the lack of clinical decision support. And if I needed to do any further research, I’d have to spend more time at the library and then return to the chart, paper, and pen to add more information and orders. Finally, I returned the chart to the unit or office secretary.
But that was the process. And for the most part, that was the acceptable norm. By today’s standards, it seems like we sat on the porch and watched the grass grow.
With today’s EHR systems, order entry moves at warp speed. It’s made that part of our workflow a lot easier.
However, with this innovation — new levels — comes burdens, what I call the “new devils.” Expectations have dramatically changed: The entire environment of care, because of the improved efficiencies now afforded in this digital age, demands that I immediately analyze the continuous data dump into a patient’s EMR, synthesize error proof care plans, then digitally translate those care plans via CPOE without error.
What I have witnessed over the past 25 years is not only the sped-up order entry process, but the complete redesign of every clinical process that affects the delivery of healthcare. And the collateral damage from this delivery redesign is the transformation of workflow for every healthcare provider.
Where we’d previously been able to gather info, document our impressions and chart our plans, now we’re reacting to the uncoupling of this integrated process with disjointed and fragmented workflows to capture info, sporadically generate orders, and produce a document — typically long after the patient encounter and diagnostic/therapeutic interventions have been completed — that often incompletely illustrates the patient experience.
This disjointed, fragmented disruption of our workflows is one of the primary determinants of physician burnout.
This is where the EHR vendor comes in, by creating and maintaining systems that can assist providers with these key elements of their work:
- Info gathering: Helping doctors find all those needles in the haystacks and minimizing the pitfalls associated with data dumps into EMRs
- Order planning/Order entry: Simplifying and safeguarding the process that turns ideas into actions
- Documentation: Eliminating the mouse, microphone, and extra clicks that slow communication handoffs
MEDITECH recognizes that there’s a connection between patient safety and healthcare worker safety: if we take care of our providers, our providers will do a better job of taking care of their patients.
When I think of this principle, I’m reminded of the book Creating Magic: 10 Common Sense Leadership Strategies From A Life At Disney, by Lee Cockerell.
In the book, Cockerell explains how Disney emphasizes the cast members’ experience before the guest experience. Now is the time to apply this principle to healthcare organizations.
That’s why MEDITECH has made a big investment over the past five years in its user-centered design principles to produce its new Web-based solutions. The new platform features a design that’s so much better than any of us as physicians could have imagined. It’s simple to use and it’s easier to transition from patient info to order planning/order entry to documentation. It really is a smarter solution for today’s healthcare environment.
In every care environment — outpatient, emergency room, or inpatient — the new MEDITECH Web system helps physicians minimize the risk of an adverse event compared to earlier platforms. With MEDITECH’s commitment to doctors and dedication to delivering solutions that improve the environment of healthcare, the possibility of using an EHR to reduce physician burnout is very real.
To hear more about specific topics covered in this podcast, reference the timestamps below:
- What challenges are physicians facing? 0:44
- What is burnout and its effects? 3:42
- What’s the solution for burnout? 6:06
- What’s on the horizon for EHR? 8:57
- What’s the MEDITECH solution? 10:12
- Final thoughts 11:55
Visit the Doctors’ Hours podcast page for interviews with leading physicians on a wide range of healthcare IT topics.
Sources and Additional Materials:
2016 Survey of America’s Physicians: Practice Patterns & Perspectives, The Physicians Foundation
Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014, Mayo Clinic Proceedings, Vol. 90 Issue 12 (December 2015)
Burnout and medical errors among American surgeons, National Center for Biotechnology Information
Frontline Hospital Workers and the Worker Safety/Patient Safety Nexus, The Joint Commission Journal on Quality and Patient Safety, Vol. 39 No. 4 (April 2013)