How EHR Innovation Platforms Cut Clinician Burnout for Value-Based Care

EHR innovation platforms that complement value-based care models could help address clinician burnout, according to preliminary findings from an American Academy of Family Physicians (AAFP) Innovation Laboratory study.

While clinician burnout is a concern across the healthcare industry, it is especially high among family medicine clinicians. Half of family physicians report one symptom of burnout, according to 2020 research.

"We're seeing folks decide that maybe medicine or primary care is not right for them any longer, or they're discouraging colleagues or their children from going into the specialty," Steven Waldren, MD, MS, AAFP vice president and chief medical informatics officer, told EHRIntelligence in an interview.

The administrative burden associated with EHR documentation is one of the main drivers of clinician burnout, Waldren said.

"We have docs going part-time or saying that they need two extra half days of admin time a week to be able to practice like this," he added.

Burnout presents significant retention challenges for health systems. Clinicians who are very dissatisfied with their EHR have almost three times the proportion reporting they are likely to leave compared to clinicians who are very satisfied with the EHR.

And with more healthcare organizations embracing value-based reimbursement models, which with them bring more quality measure reporting requirements, the problem of administrative workload is likely only slated to get worse.

However, Waldren noted that the right coupling of reimbursement models and EHR systems can help drive clinician satisfaction.

"EMRs were built based on a fee-for-service model where documentation and billing are the most important piece, not how you do the care delivery," Waldren explained. "Health IT had been automating the business of healthcare, not the delivery of healthcare."

As part of its Innovation Laboratory, AAFP partners with members and industry stakeholders to drive innovation and help improve the family physician experience.

"It was pretty obvious before, but blatantly obvious when we were doing the labs, that the fee-for-service model puts a lot of constraints on physicians," Waldren said. "There were new models out there that were more prospective and value-based. A couple of docs that we spoke with had shown that that really had decreased a lot of the burden."

However, Waldren noted that some healthcare organizations that had adopted direct primary care reimbursement models experienced EHR integration challenges with third-party solutions for prospective payment billing and patient engagement with their EHRs.

AAFP set out to see what EHR tools could help primary care organizations adopt alternative payment models (APMs) and ultimately landed on an EHR innovation platform from health IT vendor Elation, commonly used in the direct primary care space.

"This solution got started in the direct primary care space, where it's really about the doctor providing care to the patient," Waldren said.

The retrospective study assessed 11 primary care physicians' experience with the EHR platform related to administrative burden, clinician burnout, and ability to deliver high-value care, compared to prior EHRs.

Most (10 out of 11) lab participants adopted the EHR combined with partial or full implementation of value-based or direct primary care payment models.

"Prospective payment models allow docs not to worry as much about having people come into the office to get paid," Waldren explained. "Both those practice payment models leverage other modalities to deliver care, like telehealth, remote patient monitoring, secure messaging, and patient portal."

"Having technology that can help manage the patient relationship over time is important," he emphasized.

All 11 lab participants reported a significant decrease in burnout, more time with patients, smaller panel sizes, and higher practice satisfaction.

Further, nine out of the 11 physician participants who reported burnout at the start of the study found that all burnout was eliminated after using the EHR platform in combination with adopting an APM.

Lab participants said the EHR implementation helped ease burnout through improved documentation workflows and integration with other technologies.

All direct primary care lab participants integrated two tools with their EHR: one for membership management and another for patient engagement via text, email, phone, and telehealth.

"That integration decreased the burden for them to make them feel like they were confident to be able to adopt these types of models," Waldren noted.

AAFP is working to increase its level of evidence that EHR innovation platforms can help family medicine practices decrease clinician burden by recruiting information from 100 of its doctors.

"We'll be continuing to talk with our members that are adopting these types of prospective payment models and leveraging these technologies that we think are the characteristics of an EHR innovation platform," Waldren said.

"There are a lot of potential things that can reduce the admin burden for our docs and other physicians, but we need to have some proof that these things actually decrease burden in practice," Waldren pointed out. "That's what we're trying to focus on moving forward."