The economic realities in the current healthcare environment often push leaders to focus on productivity and cost-cutting measures that all too often add to a physician's growing list of responsibilities despite their well-thought intentions.
Suffering from the day-to-day burdens of increasing documentation demands and changing technology tools — brought on by health systems' desire to stay financially fit, as well as regulatory compliant — physicians are now more burnt out than ever, according to Rick Roesemeier, manager at ECG Management Consultants. This is forcing many to reduce their clinical availability in an effort to manage a better work-life balance.
Coupled with the U.S.' worsening clinician shortage, healthcare organizations need to rethink the ways they manage their practice operations to better support and engage their physicians, or else they will face staffing issues that will complicate their abilities to deliver high-quality patient care.
"We are losing our capacity to even care for patients if we don't take care of and address our physician burnout and engagement problems," Mr. Roesemeier said.
Mr. Roesemeier — whose employer, ECG, works with healthcare organizations to develop improvement strategies and solutions — noted the EHR is a key factor contributing to physicians' job dissatisfaction, and the issues fall into three buckets.
- Declining perception of patient care. Physicians view documentation requirements as an interference to their face-to-face time with patients.
- Misalignment of workflows. There is a major disconnect between the existing EHR workflows and physicians' clinical workflows.
- Data fatigue. The EHR stores a plethora of data that can overload physicians who don't have time to devote to sorting through the noise.
Mr. Roesemeier proposed four ways healthcare organizations can better support their providers and reduce their risk of EHR-induced burnout. Here are Mr. Roesemeier's four recommendations.
1. Let physicians personalize the EHR interface. EHRs are equipped with functionalities that allow providers to customize their individual interactions with the system. When building and offering these custom tools, it is important to consider each user group who will be conducting that specific EHR task. In other words, anything financial-related must get the stamp of approval from the billing department, while anything clinical gets the physicians' OK.
Leveraging tools such as customized templates, landing pages and order sets, as well as quick text and view filters, can foster a unique EHR experience for providers that makes their documentation responsibilities easier. When it comes to adding on features, ECG Principal Robin Settle said it is more important to understand the EHR functionality at its core before tacking on apps; one exception tends to be voice recognition, which is a common solution that many organizations have found helpful in reducing documentation time.
2. Train physicians on the EHR, then train them again. While the required EHR training time for providers may be just four hours, according to Mr. Roesemeier, surveys and research have shown those who receive six or more hours of formal training before the go-live indicated higher levels of overall satisfaction. And, training shouldn't stop after that initial implementation.
ECG called this continuous training regime optimization and added that it is crucial to eliminating physicians' EHR frustrations. Organizations can build confidence and knowledge among their providers by hosting workflow workshops that demonstrate how to navigate EHR functionality, gathering care teams for practice scenarios to discuss and rehearse EHR usage, and developing e-learning reviews to boost education for clinical or business areas.
3. Align EHR workflows with clinical workflows. IT and operations can no longer be viewed as separate disciplines, Mr. Roesemeier said. It is important that each party realizes the value of what the other brings to the table when it comes to designing efficient, effective workflows and the technology needed to support them.
The vast amounts of data stored in the EHR or exchanged across facilities can be overwhelming to physicians if the data isn't aggregated in a way that produces actionable insights. To valueable to clinicians, information should be able to flow in a bidirectional, real-time, accessible and discrete way so providers can access information within their daily activities.
To achieve useful, seamless access to data, technology tools, such as machine learning and smart lists, should integrate with and assist clinical workflows — not bog providers down with extra tasks.
4. Hear physicians' wants, needs and concerns. Physicians won't always be the ones to vocalize their qualms about the technology. The onus is on leaders — including CIOs and IT departments — to ask, observe and take note of their providers' struggles.
Ms. Settle explained she's spoken with IT departments who have never received problem tickets and aren't aware of physicians' frustration and distrust in the EHR. "They'll often just suffer in silence and that's why we say you have to really go out and conduct proactive roundings, visit with those you see struggling, even in just showing up in the office and [asking] how we can make it better for you … and then [the physicians] present a whole list of questions," she said.
Ongoing improvement is a must. Healthcare leadership should collaborate with the EHR end-users to address the operational and cultural implications of the EHR and accomodate their evolving needs. Organizations should begin by measuring how clinicians are using the EHR through evaluating performance data, integrating ongoing EHR education into their existing meeting structures and providing on-demand resources or one-on-one optimization sessions to solve acute issues.
When healthcare organizations implement the right EHR improvements and support structures, physicians are more satisfied in their roles and less likely to suffer symptoms of burnout.
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