Mitigating Specialty Clinician Burnout with a Customizable EHR

A bespoke EHR system optimized around a clinician-centered, specialty design can mitigate clinician burnout, according to a study published in JMIR Publications.

EHRs are one of the top clinician burnout drivers, and especially so among specialists who might need different EHR functions. The study authors said this difference should reflect in EHR implementation and optimization.

“Specialty-specific or bespoke EHR is a promising approach to overcoming the limitations of general-purpose EHR and mitigating physician burnout,” explained the study authors. “A bespoke EHR is an EHR custom designed to meet the unique needs of providers in a specific specialty or care setting. Bespoke EHR can prevent clinicians from spending a significant portion of their workday sifting through large amounts of clinical data for the specific data elements they need.”

Researchers at The University of Texas Health Science Center in Houston designed the Epilepsy Tracking and optimized Management engine (EpiToMe), a bespoke EHR system centered around epilepsy care to assess the impact of clinician burnout.

The bespoke EHR system distributed documentation and reporting workload between technicians, clinical fellows, and physicians. However, EpiToMe was not a replacement EHR system for a health system’s parent EHR system. It is a complementary EHR solution that relied on the parent EHR to exchange patient information and epilepsy-related orders. After exchanging patient data, EpiToMe captured additional patient data.

The bespoke EHR system leveraged an HL7 messaging system to exchange information between EpiToMe and its parent EHR system to optimize clinician workflow tasks. It then sent patient data to the parent EHR with one push of a button, explained the research team.

“Implementation of an HL7 messaging engine enables EpiToMe to interoperate and exchange information with general-purpose EHR systems, resulting in significantly reduced or eliminated redundant data entry,” the researchers noted. “Our HL7 messaging engine also makes EpiToMe scalable: New clinical centers can be added in EpiToMe as long as their EHR platforms offer service to support HL7 communication standards.”

Clinicians utilized EpiToMe for over 15,000 electroencephalogram (EEG) reports, 2,500 epilepsy monitoring unit daily reports, and 1,300 epilepsy monitoring unit phase reports for over 6,500 unique patients.

Following data collection, clinicians answered a 10-question survey. The research team found that the bespoke EHR system eased EHR documentation and mitigated clinician burnout, and 96 percent of survey respondents preferred EpiToMe over the health system’s EHR system for specific tasks, such as reporting and billing.

The specialty-specific and physician-centered interface design helped improve clinical efficiency for users. For example, the average delay time for an EEG report is nearly 15 hours. But when the clinician utilized the bespoke EHR, her respective patients obtained their EEG reports within the same day.

The research team noted the small sample of survey participants and a lack of participant independence, such as potential bias in survey results, as study limitations.

Looking forward, the study authors said their methodology, design principle, system design, and interface elements can be utilized for other specialties outside of epilepsy care. As a result, a similar bespoke EHR system could streamline EHR documentation and mitigate burden across many healthcare settings.

The research team said a similar bespoke EHR system is being applied at UTHealth Neurosciences.

“Working closely with physicians, we used an interface-driven development approach to create EpiToMe de novo, to embody physician preferences and optimize clinical workflow for epilepsy care while ensuring interoperability with the parent HER,” concluded the study authors.

“EpiToMe offers an exemplar pathway to mitigate physician burnout and improve the quality and productivity of care by combining physician-centered design with the latest advances in information technology in a bespoke EHR system.”