- Rates of EHR adoption and physician burnout have both steadily risen nationwide in recent years — and research shows that’s no coincidence.
Healthcare CEOs in 2017 identified EHR technology as a key contributing factor to the phenomenon that is partly responsible for pushing clinicians to retire early or leave the profession to pursue other career opportunities.
While industry leaders may have identified the culprit primarily at fault for the problem, the solution is less clear. Reticence among some clinicians to adopt new technologies will do little to stall the digitization of the healthcare industry, which surges on at an increasing pace.
However, there are certain steps various stakeholders can take to prevent physician burnout, boost physician satisfaction, and foster a work environment in which physicians and EHR technology can thrive side-by-side.
Below are five strategies to turn the rising tide of physician burnout:
Incorporate medical scribes into office visits
Physicians have cited the deterioration of the patient-provider relationship as one significant source of dissatisfaction. Federal reporting requirements mandate extensive clinical documentation, forcing providers to spend more time facing their computer monitors and less time interacting with patients.
Inviting medical scribes into physician offices during patient visits may help to give providers more face time with patients. Medical scribes can record notes throughout the visit, freeing up physicians to foster strong personal relationships with their patients.
Furthermore, research suggests the use of medical scribes during office visits may offer benefits beyond improving the patient-provider relationship.
An Annals of Family Medicine study found using medical scribes in clinical practices improves all aspects of physician satisfaction — including satisfaction with patient encounters and clinical documentation accuracy.
“Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout,” stated researchers in the study.
“When working with a scribe, physicians were much more satisfied with how their clinic went, the length of time they spent face-to-face with patients, and the time they spent charting,” the team continued.
Incorporating scribes into physician practices may improve physician’s well-being and function as a protective buffer against the demands of clinical documentation.
Simplify federal documentation and billing requirements
Regulatory bodies such as CMS and ONC are well aware that administrative burden is contributing to the provider burnout problem.
Last year, CMS Administrator Seema Verma announced several new initiatives specifically designed to reduce administrative burden on providers and shift the focus back on patient care.
These initiatives are intended to limit the number of clinical quality measures to those most critical to improving patient health outcomes as well as promote stakeholder collaboration to identify opportunities for regulatory relief.
In addition to cutting down on the number of clinical quality measures providers are required to report, many providers have also suggested streamlining evaluation and management (E&M) clinical documentation requirements.
In its 2019 Physician Fee Schedule and Quality Payment Program proposed rule, CMS heeded stakeholder advice and crafted policies designed to make E&M documentation requirements easier on clinicians.
If these policies become part of the final rule, CMS may help to curb physician burnout and restore some of the joy of practice to clinicians.
Other policies that may help to reduce provider burden — such as reducing the 365-day Merit-Based Incentive Payment System (MIPS) reporting period to 90 consecutive days — did not appear in the proposed rule.
Stakeholders have until September 10 to submit public comments advocating for the policy changes they’d like to see in the finalized 2019 Physician Fee Schedule and Quality Payment Program proposed rule.
Invest in EHR-integrated voice recognition software
Natural language processing (NLP) and voice recognition could help to ease provider burden by allowing physicians to quickly dictate clinical documentation rather than spend time typing notes.
A handful of EHR companies — including Epic, athenahealth, and eClinicalWorks — currently offer voice-activated virtual assistants designed to help with clinical documentation.
While the technology can streamline clinical documentation by sidestepping the need for manual data entry, one study found the use of voice-recognition software may lead to inaccurate physician notes.
As a result, physician notes generated through voice recognition software require sufficient review by both physicians and transcriptionists to ensure accuracy and reduce the potential for patient harm. Requiring physicians to carefully review notes negates some improvements in clinical efficiency gained through dictation.
However, allowing physicians to complete clinical documentation using the method of their choice may still have a positive effect on physician satisfaction.
While the process of recording and reviewing physician notes may be nearly as time consuming as data entry, providers will spend less time interacting with their EHR systems and computer monitors and more time facing the patient.
Encourage physicians to participate in EHR training
Some physicians grow frustrated with EHR implementations, new health IT modules, changes in clinical workflows, and other updates due to the slow, cumbersome period of adjustment that comes with change.
The learning curve that inevitably accompanies a new EHR system or health IT module implementation can slow providers down, reduce clinician productivity, and cause headaches for some as they try to adjust to a new way of doing things in the midst of their duties as physicians.
To shorten this adjustment period, healthcare organizations need to prioritize adequate EHR training for all hospital or health system staff members.
EHR training was top-of-mind when New Jersey-based Virtua Health System went live an Epic EHR implementation last October. Virtua involved all 14,000 health system employees in a rigorous training process.
“We had 37 classrooms that we needed to complete the training,” said Virtua Senior Vice President and CIO Tom Gordon told EHRIntelligence.com. “We were able to rent some space at a local college at a really good rate, and we took the clinical and operations teams and they gave as many resources as possible to become credentialed trainers for the process.”
Health system executives encouraged staff members to become subject matter experts — which they called EHR superusers — to ensure staff were able to troubleshoot problems with the Epic EHR system without outside help. These experts advised other physicians and Virtua staff members about how to effectively use the system.
Ultimately, Virtua clinicians were equipped to engage in efficient EHR use and achieve higher rates of clinical productivity in the weeks following the go-live. Physicians were also trained on Epic modules designed to streamline clinical documentation — including a voice recognition transcription module — to further reduce provider burden.
“On day one, all the providers knew how to use Epic and all the Epic smart tools,” said Gamble. “It was extra work but it has absolutely has paid off.”
Ensuring clinical staff are comfortable utilizing EHR technology in the early days after a go-live can significantly reduce dissatisfaction with EHR use and prevent physician burnout.
Specialize EHR interfaces, clinical workflows
Finally, healthcare organizations and health IT developers can help to boost physician satisfaction with EHR systems and ultimately deter the onset of physician burnout by specializing EHR interfaces.
Despite years of health IT development, physicians still struggle to navigate clunky EHR interfaces that sometimes bury important information or inundate providers with unnecessary data.
According to University of Illinois Chicago Assistant Professor of Biomedical and Health Information Sciences Andrew Boyd, MD, EHR interfaces need to be redesigned to prominently display the most relevant data based on provider specialty or care setting.
“The models can be specific disease state models or hospital models,” Boyd told EHRIntelligence.com. “Because no two hospitals work the exact same way. A physician or pediatric dentist would need a different interface than a cardiothoracic trauma surgeon based on the needs and the disease state that they’re dealing with.”
Highlighting clinically relevant information based on provider specialty in EHR interfaces may help to improve the usability of physician notes and allow physicians to quickly locate the information they need most.
Saving providers the time and hassle of searching for patient health data will allow for more efficient patient care delivery and less time engaging with EHR systems.
“If you can figure out a design interface for a hospital where they only need to spend five minutes looking up the data on a patient instead of 15, you’re saving them time that they can spend with the patient,” said Boyd.
Helping clinicians shortcut arduous tasks related to clinical documentation, EHR use, and federal reporting will help to shift the focus back to patient care and restore the joy of practicing medicine for providers.