- Regulatory reform allowing clinicians to cut down on their documentation requirements would improve accuracy, enable better use for research, and help cut down on overall physician burnout, according to recent research published in the Annals of Internal Medicine.
A US physician is a “data-entry clerk,” and will typically need to document diagnoses, physician orders, patient visit notes, and an increasing amount of low-value administrative data, wrote Downing et al.
“To justify billing to such payers as the Centers for Medicare & Medicaid Services, physicians must specify diagnoses from long and confusing arrays of choices relating to each test or procedure and document a clinically irrelevant number of elements for the history of present illness, review of systems, and physical examination,” researchers explained. “Documentation requirements in the United States are a relic of fee-for-service and will make even less sense as we move to new payment mechanisms.”
Comparatively, EHR use abroad is significantly different, the team noted. There are often higher levels of physician satisfaction with EHRs, and other countries do not have nearly as much compliance and reimbursement documentation requirements.
Moving toward a value-based payment system in the US will not be enough to ease physician burnout, researchers explained. The Merit-based Incentive Payment System (MIPS) and other incentive programs come with their own documentation requirements.
Additionally, other countries in which researchers reviewed EHR use often used a fee-for-service model and “few are truly single-payer systems.”
EHR vendors also cannot take full blame for administrative burden and the potential for physician burnout, the researchers maintained.
“Indeed, the EHR vendors that benefited from the federal stimulus have disproportionately focused on developing robust financial and compliance features, perhaps at the price of usability,” the team wrote. “However, U.S. hospitals demanded these features in search of financial sustainability in a market with seemingly insatiable needs for documentation.”
Documentation and billing regulations will play an important role in easing additional burden, and simplifying those requirements will benefit patients and the healthcare system itself.
Researchers suggested that regulators replace the current documentation requirements and incentivize providers to do less. Natural language processing and voice recognition could also help in that process. Furthermore, a team-based approach will let all team members “operate at the highest level of their licenses will also be essential.”
“Enabling medical assistants to complete more documentation and enter protocolized orders,” researchers recommended. “Some even advocate for patients to contribute to their physicians' notes directly as a strategy to increase both clinician efficiency and patient engagement.”
Physician burnout has previously been shown to be a common issue at healthcare organizations. Eighty-three percent of clinicians, clinical leaders, and healthcare executives said that it was an issue, according to research published in a New England Journal of Medicine (NEJM) Catalyst report.
Nearly eight out of ten registered nurses, 64 percent of advanced practice nurses, 56 percent of clinical leaders, and 42 percent of healthcare executives said physician burnout is a problem at their organizations.
“Clinicians feel the impact of burnout by reducing their hours, switching to administrative roles, or leaving health care altogether, taking them away from why they chose medicine in the first place: to treat patients,” report authors wrote.
The NEJM study also indicated that changes to regulatory requirements could help ease physician burnout, with 82 percent of respondents suggesting stakeholders hold interventions to target the organizational level rather than the regulatory level or individual level.
Additionally, those surveyed said that easing administrative burden could also help, and that other staff members – such as medical scribes – could take over certain administrative tasks.
“There is broad agreement on the need for more face-to-face time between clinicians and patients and less time spent on the electronic medical record and documentation,” researchers explained. “A little over half of survey respondents recommend offloading clerical tasks to scribes, pharmacy technicians, or population health facilitators.”
There was slight improvement as a 2016 NEJM report showed that 96 percent of providers found physician burnout to be a problem at their organization. Even so, 60 percent of those surveyed in the 2018 survey said that physician burnout will get worse.