Physician Burnout and the EHR: Addressing Five Common Burdens

Physician Burnout and the EHR:
Addressing Five Common Burdens

© 2019 Health Catalyst
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Clinician impact aside, the EHR is here to
stay. With billions of dollars spent on electronic
systems, healthcare organizations aren’t likely
to step away from these investments.
CIOs are now focusing on proving the value
of EHRs and making the technology work
for clinicians.
Physician Burnout and the EHR

This presentation addresses clinicians’ often
fraught relationship with EHRs.
It identifies and burdens and considers how
new processes and next-generation analytics
platforms can position healthcare IT as a
trusted resource and value-add to all
involved in healthcare delivery.
Physician Burnout and the EHR

During my residency training, the hospital
where I worked began implementing an EHR
in the medical ICU.
This early EHR was clunky and not fully
integrated with other hospital systems, such
as the lab. That meant a lot of manual work
to document clinical notes.
But, despite these EHR deficiencies,
I quickly realized that technology would
play a key role in the future of healthcare.
The EHR and the Hope
of Improving Patient Care

At first, I saw the potential to eliminate
inefficiencies and errors that would occur in
the paper-based systems:
• Searching for charts
• Handwriting notes and orders
• Hand copying labs and vitals
• Deciphering illegible scribbles
• Waiting for hand-processed orders
Instead, with the EHR, clinicians would
easily enter and access information,
resulting in fewer errors, more standard-
ized workflows, and improved patient care.

I also remember thinking that one day
technology would do a lot more than
replace paper.
I imagined the days of having my white
coat pockets filled with small reference
books on antibiotics and medical formulas
would be history.
EHRs would help me take care better care
of my patients with smarter systems—such
as built-in guidelines and prompts based
on my patients’ diagnoses and test results.

This seemed like a logical and welcome idea
at the time, as I was faced with an ever-
increasing amount of medical knowledge to
learn and retain.
Little did I realize that instead of making
physicians’ lives easier, this promising
technology would be one of the main
reasons for an epidemic of physician
burnout throughout the country.

Clinicians cite numerous reasons that EHRs contribute to
burnout and decreased career satisfaction and thwart their
ability to deliver quality care.
The following five burdens are among clinicians’
most common complaints:
1. Less Time for Patient Interaction and
Worsened Quality of Interaction
2. An Extended Workday
3. Poor Design
4. Demands on Quality Measures
5. Cost and Maintenance
Five Clinician-Reported EHR Burdens

1. Less Time for Patient Interaction and Worsened Quality of Interaction
Clinicians must spend a disproportionate
amount of time looking at their computer or
tablet screens versus engaging with patients.
Reduced patient interaction worsens the
quality of the interaction, as the clinician
appears unsympathetic and less aware
of the patient’s personal needs and
concerns.
The patient becomes a bystander in
the care experience when she should
be its center.

2. An Extended Workday
Clinicians often can’t meet EHR data entry
demands and patient care responsibilities
during the regular workday and have to
complete reporting tasks afterhours.
Regular work after work (“pajama time”)
threatens work-life balance, as clinicians
struggle to separate their professional
and personal lives.
With 24-hour remote access to records, it
becomes a habit, and sometimes an
expectation, to work on charts during
personal time.

3. Poor Design
Many clinicians don’t find EHRs user friendly.
They often see monolithic EHRs as inefficient data
entry and storage platforms with outdated interfaces
that require excessive mouse clicks to
perform what should be simple tasks.

4. Demands of Quality Measures
While aimed at improving the quality of healthcare,
CMS quality measures have had two unintended
side effects:
1. Increasing data-entry demands on clinicians.
2. Creating a focus on fulfilling measures for
reimbursement versus quality of care.

5. Cost and Maintenance
EHRs are costly to maintain, and the time and
effort required to train staff on the systems is a
resource drain.

Easing the EHR Documentation Burden
Solutions to the EHR burden (e.g., emerging
technologies and processes) promise to shift
the EHR burden from physicians by easing
data entry and simplifying data.
This will refocus the clinician-patient interaction
on the patient and ensure that data is recorded
in a meaningful way.
What follows are suggestions that could easily
reduce the EHR burden on clinical staff:

Scribes to enter data during patient visits,
allowing the clinician to always engage
with the patient, not the screen, and have
little after-hours data reporting work.
Team-based approach to documentation
to shift documentation to other members
of the care team (e.g., medical assistants
and RNs), as appropriate.
Disruption by technology, including
smarter, personalized user interfaces,
more automated data capture, or
medically focused digital assistants.
Reevaluation of documentation to change
policies to reduce regulatory burden.
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In a letter to CMS in February 2018, the
American Association of Family Practitioners
(AAFP) described its principles for reducing
administrative burden on clinicians.
The AAFP’s proposals included minimizing
health IT utilization measures and implementing
medical record documentation guidelines, data
exchange policies, standard representation of
clinical data models, prior authorization
guidelines, measures harmonization, and
certification and documentation procedures.

Moving Focus Back to the Patient with
Better Analytics Tools and Strategies
Clinicians have spent years entering data into
their EHRs, but these workflow-based systems
don’t effectively translate the benefits of data
beyond simple tasks, such as quality metrics.
In addition, physician-entered data represents a
small fraction of what will be needed to deliver
the personalized care of the future, as socio-
economic and environmental factors (social
determinants of health) factor more heavily in
decision making.

An increasingly analytics-driven
healthcare environment challenges
healthcare organizations to effectively
ingest more data into current systems
and present it to clinicians in a
meaningful, timely way.
We are seeing more types of data (e.g.,
genomic, social determinants), more
data sources (e.g., wearable sensors),
and different data timing needs
(real-time versus near real-time).

Unfortunately, EHRs have been
designed to collect data from a specific
workflow and not to import data from
outside this workflow.
In order to meet the data needs of today
and tomorrow, healthcare needs a more
modern and sophisticated data platform.
This platform must combine the features
of data warehousing, clinical data
repositories, and health information
exchanges (e.g., the Health Catalyst®
Data Operating System [DOS™]).

An analytics platform, such as DOS, helps
health systems manage data overload by
combining data and removing silos.
The platform aggregates different data (e.g.,
EHR, lab, genomic, and socioeconomic
data) and allows predictive and prescriptive
analytics to make insights usable and
actionable for clinicians.
Aggregated data goes back into clinical
workflows, minimizing the places clinicians
must log into to access critical patient
information.

By closing the analytics loop from insight to
action, the analytics platform shows
treatment, outcomes, and cost for similar
patients to clinicians at the point of care.
Data becomes real and actionable for
clinicians, as they see and apply the value
of health data in the care setting.

The Future for EHRs: Working Smarter, Not Harder
Given the time, money, and other resources
invested in EHRs, they are here to stay.
However, as EHRs evolve to better align digital
health goals with clinician experience, these
systems will work smarter—providing the right
data, at the right time, in the right modality—
without creating harder work for users.
While efforts continue around minimizing
the EHR documentation burden on physicians,
I believe that significant improvements
enabling better patient care will come from
behind-the-scenes analytics.

The Future for EHRs: Working Smarter, Not Harder
Next-generation analytics and machine
learning around large datasets that will
augment clinical decisions.
Tools and processes that present these
insights intelligently and dynamically
back into the workflow will let clinicians
focus more on the patient, with the
confidence that better data is helping
them provide better care.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

More about this topic
Link to original article for a more in-depth discussion.
Physician Burnout and the EHR: Addressing Five Common Burdens
The Best Way to Optimize Physician Workflow
Ed Corbett, MD, Medical Officer
EHR Integration: Achieving this Digital Health Imperative
Daniel Orenstein, JD, Senior VP, General Counsel, and Secretary
6 Proven Strategies for Engaging Physicians—and 4 Ways to Fail
Bryan Oshiro, MD
Analytics in Medical Practice: How to Get Physicians On Board and Engaged
Bryan Oshiro, MD
Interoperability in Healthcare Delivers Critical Health Information at the Point of Care
Daniel Orenstein, JD, Senior VP, General Counsel, and Secretary

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Joined Health Catalyst in June 2014 as a medical officer. He earned his medical degree at
the University of Texas Health Science Center in San Antonio where he also completed his
residency in Internal Medicine. He is board certified in Internal Medicine. He started his career
as a physician at the Cooper Clinic in Dallas, Texas specializing in preventive medicine.
Prior to joining Health Catalyst he was a physician partner at Central Utah Clinic, a large multispecialty
clinic which was the first Medicare ACO in the state of Utah. He has a special interest in improving
patient care through the better use of technology and has been actively involved in clinical IT throughout
his career.
Edward Corbett, MD

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company
that helps healthcare organizations of all sizes improve clinical, financial, and operational outcomes
needed to improve population health and accountable care. Our proven enterprise data warehouse
(EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more
than 65 million patients for organizations ranging from the largest US health system to forward-thinking
physician practices.
Health Catalyst was recently named as the leader in the enterprise healthcare BI market in
improvement by KLAS, and has received numerous best-place-to work awards including Modern
Healthcare in 2013, 2014, and 2015, as well as other recognitions such as “Best Place to work for
Millenials, and a “Best Perks for Women.”

Physician Burnout and the EHR: Addressing Five Common Burdens

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