- The causes of physician burnout are legion — technology, regulation, reimbursement — but the solution may be as simple as completing certain EHR optimization activities.
Mississippi's Memorial Hospital of Gulfport is tackling physician burnout head on with a nine-step EHR optimization program that looks to minimize inefficiencies in physician EHR use, particularly when and how physicians document patient encounters.
In this conclusion to a two-part interview with Memorial's David Northington, MD, the CMIO addresses the factors contributing to physician burnout and the hospital's solution to this growing problem through system-wide EHR optimization plan.
As Northington explains, enabling the hospital's Cerner EHR technology to serve physician workflows begins with an evaluation of current provider EHR use and leads ultimately to the dissemination of EHR best practices borne out of pilot projects and the insight gained from them.
While modern-day EHR technology still has many improvements to incorporate to mature as a useful physician tool, its usefulness in the here and now depends on unifying disparate sources of patient health data into a navigable format that decreases the time required for providers to find the most relevant information on a patient during face-to-face encounters.
EHRIntelligence.com When did physician burnout become a major concern for Memorial Hospital of Gulfport?
David Northington: I don't Memorial is unique to that — it's an industry standard. What really started to alarm me is that at least 20 percent of our physicians are now spending "pajama time" at home (or in the care or in whatever spare time they have) finishing their work. I consider this completely unacceptable.
The physician population with the Affordable Care Act, HITECH Act, and all that has gone through massive change. Our workload and taking care of patients is still there and growing, but our time for seeing our kids and our spouse has been lessening and lessening. So I have deemed 2016 the year of efficiency and the goal of that term is that our physicians will not only be able to get through their clinic on time but finish all of their work and be able to go on home on time. The fear is that it's not that physicians who hate the Millennium product — it's going to be their children, spouse, the baseball games that they miss, and everything else that they can't do because they can't get their work done. This leads to physician burnout. This leads in to revolt and everything else that is going on. We have to respect and give back the time to physicians, and it's all about efficiencies and helping them do that.
Listen to the Xtelligent Media Podcast with AMA President Steve Stack, MD
EHRIntelligence.com: What initial steps did the hospital take to address physician burnout as related to Cerner EHR use?
DN: As this has been a budding problem, I went back to our Cerner partner and said we need to partner up on this because not only is it good for your organization and company but we would be happy to help lead the way on getting efficiency return on investment.
And what does efficiency mean? It means that the chart is done on time so that the patient-centric view for the poor soul who ends up in the emergency room that night has the information in the chart and not in a saved document that's coming out two weeks later. It also means improved A/R time, improve revenue cycle time. It improves throughout the whole stream of the hospital by getting these documents done on time and in real time where most of the information is probably better than looking at it two weeks later after you can't remember all of what took place.
EHRIntelligence.com: What came out of these conversations with your EHR partner Cerner?
DN: We're doing this nine-step program using the Cerner Advance piece to evaluate our individual physicians and practices. I will be the first one to tell you that I love Cerner Advance, but it's an onion to peel because it doesn't demonstrate quality, it does not demonstrate all the information that it should. In fact, I was just finishing up a phone call with Cerner people saying that we need to marry saved documents with the Advance program so that we can get a more realistic picture and score people in the green, which may be my saved documents biggest offenders, and that doesn't correlate. We have initiated our nine-step program and we're looking at everywhere from mouse miles to clicks to get our physicians to be able to flow efficiently through the chart and finish it as they finish with the patient in real time with the metrics to get them home on time.
EHRIntelligence.com: What is it about current EHR technology the contributes directly to physician inefficiency?
DN: In this day and age, in year 2016, I do not accept the functionality of any EHR today, but I will accept the functionality of what it's supposed to be ten years from now. I use myself as an example — not everybody does this. I'm still a practicing hospitalist.
Before going into a patient's room, I sit down in front of the computer, I view other physicians' notes (inpatient/outpatient), I review the results on the patient, I put in my mind what this patient should look like if I hadn't seen them before. Then I go into the patient's room and talk about my findings, concerns, and listen to what they are telling me. Then I go back out, open up the chart, start my ordering and documentation process before finishing it. So it's three times that I'm really working on this patient to create one document. You can imagine the future — and we're starting to see this in some rooms we're working with — doing this all in front of the patient with an interactive system that is recognizing the conversation that we're having with the patient and showing them what's going on from the CAT scans or lab reports, and as you walk out the door that document is completed. You're learning, studying, and communicating with patients.
That's the next generation of the EHR. That's a much more efficient way that takes it down from doing it three times to one time. That hasn't been completely embraced yet, but that's where I imagine we're going when you really start getting return on investment.