Over the last decade, government funded Electronic Health Record (EHR) incentive programs produced a steady increase in EHR adoption across U.S. healthcare organizations. Although the goal to increase adoption was an astounding success, many clinicians claim EHR’s are a primary contributor to a nationwide epidemic known as physician burnout. According to physicians Bruce Sigsbee and James L. Bernat,
“the prevalence of burnout is higher in physicians than in other professions. A national survey of 7,288 physicians found that 45.8% of the respondents exhibited at least one symptom of burnout” (Sigsbee & Bernat 2202).
Whereas physician burnout has always existed, the radical increase in recent years typically associated with EHR adoption threatens a new generation of patients and physicians alike, as burnout results in reduced work hours, relocation, depression, and even suicide. According to these authors physician burnout encompasses three domains including “(1) emotional exhaustion: the loss of interest and enthusiasm for practice; (2) depersonalizations: a poor attitude with cynicism and treating patients as objects; and (3) career dissatisfaction: a diminished sense of personal accomplishment and low self-value.
Although often circumstantial, evidence correlating EHRs to physician burnout continues to rise. U.S. physicians often spend more hours in their work day interacting with their EHR systems than their patients. Indeed, a 2016 study showed
“physicians from family medicine, internal medicine, cardiology, and orthopedics spent nearly 2 hours in the EHR and on other desk work for every 1 hour of direct patient care” which inevitably results in longer work days (Arndt & Beasley 420).
Technological factors such as rigorous clinical documentation required by Meaningful Use (MU), inbox management, patient portals, and a redistribution of tasks previously performed by clinical staff to clinicians has led to drastic increase of clinician workload (Arndt & Beasley 421). Moreover, remote availability of EHRs via smart phones and portable tablets enables incessant work patterns outside of work or after working hours.
However, contradictory evidence makes it difficult to determine whether EHRs are more burdensome than effective or partially at fault when evaluating physician burnout. It is true every individual is different and their life experiences are likely to have just as much an impact on their daily performance as EHRs. Furthermore, new research conducted by HealtheLink, a health information exchange in Buffalo, NY suggests
“sixty percent of patients responded ‘no’ when asked if clinicians spend too much time on a computer during the typical appointment while 51 percent indicated that they believe using EHRs makes healthcare safer” (Tom Sullivan 1).
Despite patient opinions, EHR vendors and healthcare organizations can develop dynamic solutions to decrease interaction time with EHRs and hopefully, reverse the trend of physician burnout. Clinical Informatics professors, YT DiAngi and CA Longhurst, and Information Technology professor, TH Payne, describe innovative approaches to decrease EHR interaction and physician burnout in their text, Taming the EHR (Electronic Health Record) – There is Hope. Some approaches include;
- Redistribute Data Entry Tasks to the Healthcare Team, Including Patients
Clinicians are tasked with burdensome data entry procedures. However, patients and other clinical team members including medical scribes can be included in creating the history and narrative. Patients can complete integrated e-questionnaires regarding their health history. This approach creates further patient engagement and reduces interactions with EHRs (DiAngi, Longhusrt, Payne 2).
- Refine Encounter Documentation and Limit Clicks
As already discussed, MU requirements have expanded the role and intensity of clinical documentation. In order to decrease clinical documentation time, EHR vendors can invest in free text, dictation to transcription, and voice recognition dictation functionality. Such tools exist but are not typically included in EHR applications. New ways to extract data from unstructured text, such as natural language processing (NLP), may advance the science of documentation (DiAngi, Longhusrt, Payne 2).
- EHR and Workflow Coaching
In an environment where healthcare organizations and EHR systems are rapidly consolidating, initial one-time training during implementation is not enough. Healthcare organizations must prioritize physician wellness and support ongoing evaluation and training. Organizations can work with their EHR vendors to report on clinicians’ time in the EHR and perform direct observation of workflow patterns. Clinician and vendor feedback can identify pain points and create flexible solutions that fit into the clinician’s practice style (DiAngi, Longhusrt, Payne 3).
As healthcare shifts from fee for service to value based payment models, the role of EHR documentation will need to be refined. Intensive collaboration between vendor and organizations has the potential to identify burdensome EHR practices and in turn, develop innovative solutions that assist physicians in achieving their daily mission; providing the highest quality of care for their patients, and for themselves.
Arndt, G. Brian; Beasley, W. John; Watkinson, D. Michelle; Temte, L. Jonathan; Tuan, Wen-Jan; Sinsky, A. Christine; Gilchrist, J. Valerie (2017). “Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.” Annals of Family Medicine, Vol. 15, No. 5, September/October 2017.