Physician Burnout and the EHR: Addressing Five Common Burdens

May 22, 2019

Article Summary

So far, the EHR hasn’t delivered on its original intent to improve patient care with more efficiency and personalization and lower cost. Instead, physician users blame the systems for worsening their experience and the quality of their care in significant ways:

1. Less time for patient interaction and worsened quality of interaction.
2. An extended workday.
3. Poor design (difficult to use).
4. Demands of quality measures.
5. Cost and maintenance.

Despite these challenges, the EHR is likely here to stay. Health systems have invested heavily in their electronic reporting systems and are now focused on making these technologies and processes work for the benefit of patients and providers. CIOs are working towards better aligning digital health goals with physician experience for an environment where EHRs enable smarter, not harder, work.

Physician's Burnout and the EHR infographic cover

The digitization of healthcare promises significant improvement, including more efficient and more personalized care at lower costs, but it has also brought challenges to the industry. Notably, clinicians have reported feeling burdened by the reporting demands of EHRs—responsibilities that take away from their time and focus on patients. These burdens are so weighty that they’ve become a chief cause of physician burnout.

Clinician impact aside, the EHR is here to stay. With billions of dollars spent on electronic systems, healthcare organizations aren’t likely to step away from these investments. CIOs are now focusing on proving the value of EHRs and making the technology work for clinicians.

The article addresses clinicians’ often fraught relationship with EHRs. It identifies and burdens and considers how new processes and next-generation analytics platforms can position healthcare IT as a trusted resource and value-add to all involved in healthcare delivery.

The EHR and the Hope of Improving Patient Care

During my residency training, the hospital where I worked began implementing an EHR in the medical ICU. This early EHR was clunky and not fully integrated with other hospital systems, such as the lab. That meant a lot of manual work to document clinical notes. But, despite these EHR deficiencies, I quickly realized that technology would play a key role in the future of healthcare.

At first, I saw the potential to eliminate inefficiencies and errors that would occur in the paper-based systems (e.g., searching for charts, handwriting notes and orders, hand copying labs and vitals, deciphering illegible scribbles, or waiting for hand-processed orders). Instead, with the EHR, clinicians would easily enter and access information, resulting in fewer errors, more standardized workflows, and improved patient care.

I also remember thinking that one day technology would do a lot more than replace paper. I imagined that instead of having my white coat pockets filled with small reference books on antibiotics and medical formulas, EHRs would help me take care better care of my patients with smarter systems—such as built-in guidelines and prompts based on my patients’ diagnoses and test results. This seemed like a logical and welcome idea at the time, as I was faced with an ever-increasing amount of medical knowledge to learn and retain. Little did I realize that instead of making physicians’ lives easier, this promising technology would be one of the main reasons for an epidemic of physician burnout throughout the country.

Five Clinician-Reported EHR Burdens

Clinicians cite numerous reasons that EHRs contribute to burnout and decreased career satisfaction and thwart their ability to deliver quality care. The following five burdens are among clinicians’ most common complaints:

1. Less Time for Patient Interaction and Worsened Quality of Interaction

Clinicians must spend a disproportionate amount of time looking at their computer or tablet screens versus engaging with patients. Reduced patient interaction worsens the quality of the interaction, as the clinician appears unsympathetic and less aware of the patient’s personal needs and concerns. The patient becomes a bystander in the care experience when she should be its center.

2. An Extended Workday

Clinicians often can’t meet EHR data entry demands and patient care responsibilities during the regular workday and have to complete reporting tasks afterhours. Regular work after work (“pajama time”) threatens work-life balance, as clinicians struggle to separate their professional and personal lives. With 24-hour remote access to records, it becomes a habit, and sometimes an expectation, to work on charts during personal time.

3. Poor Design

Many clinicians don’t find EHRs user friendly. They often see monolithic EHRs as inefficient data entry and storage platforms with outdated interfaces that require excessive mouse clicks to perform what should be simple tasks.

4. Demands of Quality Measures

While aimed at improving the quality of healthcare, CMS quality measures have had two unintended side effects:

  1. Increasing data-entry demands on clinicians.
  2. Creating a focus on fulfilling measures for reimbursement versus quality of care.

5. Cost and Maintenance

EHRs are costly to maintain, and the time and effort required to train staff on the systems is a resource drain.

Easing the EHR Documentation Burden

Solutions to the EHR burden (e.g., emerging technologies and processes) promise to shift the EHR burden from physicians by easing data entry and simplifying data. This will refocus the clinician-patient interaction on the patient and ensure that data is recorded in a meaningful way:

  • Scribes to enter data during patient visits, allowing the clinician to always engage with the patient, not the screen, and have little after-hours data reporting work.
  • Team-based approach to documentation to shift documentation to other members of the care team (e.g., medical assistants and RNs), as appropriate.
  • Disruption by technology, including smarter, personalized user interfaces, more automated data capture, or medically focused digital assistants.
  • Reevaluation of documentation to change policies to reduce regulatory burden. In a letter to CMS in February 2018, the American Association of Family Practitioners (AAFP) described its principles for reducing administrative burden on clinicians. The AAFP’s proposals included minimizing health IT utilization measures and implementing medical record documentation guidelines, data exchange policies, standard representation of clinical data models, prior authorization guidelines, measures harmonization, and certification and documentation procedures.

Moving Focus Back to the Patient with Better Analytics Tools and Strategies

Clinicians have spent years entering data into their EHRs, but these workflow-based systems don’t effectively translate the benefits of data beyond simple tasks, such as quality metrics. In addition, physician-entered data represents a small fraction of what will be needed to deliver the personalized care of the future, as socioeconomic and environmental factors (social determinants of health) factor more heavily in decision making.

An increasingly analytics-driven healthcare environment challenges healthcare organizations to effectively ingest more data into current systems and present it to clinicians in a meaningful, timely way. We are seeing more types of data (e.g., genomic, social determinants), more data sources (e.g., wearable sensors), and different data timing needs (real-time versus near real-time). This greater data volume and depth increases the need to make data actionable and valuable to clinicians and the EHR a true partner in their work.

Unfortunately, EHRs have been designed to collect data from a specific workflow and not to import data from outside this workflow. In order to meet the data needs of today and tomorrow, healthcare needs a more modern and sophisticated data platform. This platform must combine the features of data warehousing, clinical data repositories, and health information exchanges (e.g., the Health Catalyst® Data Operating System [DOS™]).

An analytics platform, such as DOS, helps health systems manage data overload by combining data and removing silos. The platform aggregates different data (e.g., EHR, lab, genomic, and socioeconomic data) and allows predictive and prescriptive analytics to make insights usable and actionable for clinicians. Aggregated data goes back into clinical workflows, minimizing the places clinicians must log into to access critical patient information. By closing the analytics loop from insight to action, the analytics platform shows treatment, outcomes, and cost for similar patients to clinicians at the point of care. Data becomes real and actionable for clinicians, as they see and apply the value of health data in the care setting.

The Future for EHRs: Working Smarter, Not Harder

Given the time, money, and other resources invested in EHRs, they are here to stay. However, as EHRs evolve to better align digital health goals with clinician experience, these systems will work smarter—providing the right data, at the right time, in the right modality—without creating harder work for users. While efforts continue around minimizing the EHR documentation burden on physicians, I believe that significant improvements enabling better patient care will come from behind-the-scenes analytics; namely, next-generation analytics and machine learning around large datasets that (e.g., genomics, socioeconomic data, national guidelines, local disease patterns, local treatment patterns and effectiveness, and cost) will augment clinical decisions. Tools and processes that present these insights intelligently and dynamically back into the workflow will let clinicians focus more on the patient, with the confidence that better data is helping them provide better care.

Additional Reading

Would you like to learn more about this topic? Here is an article we suggest:

EHR Integration: Achieving this Digital Health Imperative

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Clinically Integrated Networks and ACOs : Past, Present, and Future

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