EHR Documentation Gender Differences Key to Address Clinician Burnout

Female physicians are at a higher risk for clinician burnout from EHR documentation compared to their male counterparts, according to new research from EHR vendor athenahealth.

Researchers analyzed athenahealth de-identified user data for over 14,000 clinicians spanning a variety of medical specialties such as cardiology, neurology, and primary care.

The research revealed that while female clinicians schedule fewer encounters per week compared to male clinicians, both genders spend the same amount of time on cumulative patient documentation per week.

Overall, female clinicians’ documentation minutes per patient encounter is at least 20 percent higher across most specialties, the study found.  

For instance, female cardiologists’ documentation time per encounter is 62 percent higher than their male counterparts. Similarly, female neurologists’ documentation time per encounter is 40 percent higher than male clinicians.

The researchers also found that female clinicians spend a higher percentage of their EHR documentation time outside of patient appointment hours.

These findings could be indicative of several things, such as a gender difference in the breakdown of office visits versus procedures, according to Jessica Sweeney-Platt, athenahealth VP of research and editorial strategy.

“For example, in cardiology, it may be that female physicians are doing more consults while male physicians are doing more stress tests and echoes,” she told EHRIntelligence in an interview. “It may also be the case that male physicians are more likely to work with physician assistants and nurse practitioners. We haven't had a chance to look at that yet, but that's possible.”

Sweeney-Platt suggested that it is possible that female clinicians may gather more information from patients, therefore they may have to spend more time documenting it.

“I was talking with a colleague of mine who is a female physician,” she said. “In her experience, she said that women tend to be a little more diligent about documentation.”

“Every individual physician is going to have a different approach and a different story to tell,” Sweeney-Platt acknowledged. “It's a little nerve-wracking talking about gender differences because you run the risk of sounding super stereotypical in some instances.”

However, she noted that uncovering these gender differences is key to understanding how to improve clinical documentation workflows and address clinician burden.

“Over time, we will continue to use this research as a set of insights that we want to talk to our customers about, and we will continue to try and tease out some of the stories behind the data,” Sweeney-Platt said.

She emphasized that the research underscores the importance of the shift to value-based care.

“We know that female physicians are spending more time documenting each of the visits that they do, and yet there's still this financial pressure to do more visits because of the volume-based incentive that most of our system operates under today,” Sweeney-Platt said.

“It would be better for patients and clinicians if the focus were more on the quality of the care and the outcomes for the patients, as opposed to the number of office visits that each individual physician conducts,” she added.

Sweeney-Platt noted that the shift to value-based care would play to the strength of the way that female physicians, at least on paper, tend to practice and interact with their patients.

“It's so important for all sorts of reasons, gender differences in documentation being one of them, to continue this shift from volume-based economic incentives to value-based economic incentives in healthcare,” she said.

Sweeney-Platt said that team-based care models and delegation health IT could possibly help mitigate clinician burden and bridge the gender gap in clinical documentation times.

Delegation is about top-of-license work, Sweeney-Platt said. In other words, delegation helps ensure that physicians are doing tasks that only physicians can do, nurse practitioners are doing tasks that only nurse practitioners can do, and so on.

“At a certain point, you have to recognize that if you're delegating bad processes, it's just going to make life miserable for someone else,” she noted. “That's not going to solve the problem long term. We want to make sure that the tools that our customers use make it easy for the right person to do the right thing, and to do the thing that generates the most benefit for that patient.”

“For example, one of the things that we're focusing on a lot right now is order tracking tools so that care team members can keep tabs on in-house referral orders so that the physician doesn't have to do that,” Sweeney-Platt explained.

She said that delegation tools can help support care plan documentation and follow-up work in-between visits.

“A lot of that can be done by members of the care team, other than the physician,” she explained. “Now, a lot of that depends upon having other members of the care team to whom one can delegate. That's not something that we can affect with our products, but we're hoping that the workflows that we are designing will make it easier for that delegation to happen when those resources are present.”

She also noted that the vendor has been working on creating pre-encounter workflows to aid clinician burden.

These workflows aim to help care team members complete work that's needed for the visit in advance so that it doesn't all have to happen once the patient is sitting in the waiting room or the exam room.

The tools also help staff tee up templates for the visit and get the right orders prepped based on what the patient is coming in for, which serves to lower the documentation burden that needs to happen within the visit.