Using EHR Optimization to Address Physician Burnout

Physician burnout is a concern for almost every executive and leader in healthcare organizations. Physicians are 15 times more likely to experience burnout than any other white-collar profession; it’s a serious problem with multiple downstream consequences for the quality of care if not addressed.

The American Medical Association recently published findings from a study about physician burnout and work-life integration which found that job satisfaction levels improved slightly between 2014 and 2017, close to pre-HITECH levels in 2011. However, physicians as a whole find themselves at increased risk for burnout compared to workers in other industries. The association has been highly critical of certified EHR technology for failing to incorporate user-centric design and reduce rather than contribute to physician dissatisfaction. The findings indicate the healthcare industry is making to address physician burnout, but much more work remains to be done.

The rapid digitization of healthcare following the implementation of the HITECH Act means that nearly all hospitals in the country have adopted an EHR system. Moreover, the blitz to launch these systems have led to unintended consequences. Utilizing technology is step one. Optimal use of efficiency features and workflow enhancement functionality is now the focus and directly impacts the ability to mitigate burnout factors such as administrative and documentation burdens.

According to Nuance Healthcare Chief Medical Officer Rizwan Pasha, MD, change is the chief culprit of physician burnout and extends beyond EHR technology to the nature of healthcare as an industry.

“Many changes happen every year. Due to the continual changes, the items a physician has adopted and is used to doing one year may change next year. These changes impact the physician workflow with different compliance requirements imposed through the use of the EHR and because they are unfamiliar disrupt the physician workflow,” he says.

Healthcare organizations are keenly aware of physician burnout and using a multitude of assessment methodologies to quantify it. Pasha notes the of Stanford Medicine and KLAS offer ways to assess physician satisfaction levels based on numerous factors.  In both assessments, the use of technology is evaluated and correlated to how technology impacts physician satisfaction levels.

 “These studies have shown specific factors related to use of technology that can impact physician happiness.  Three of the factors are workflow efficiency improvements, decreasing time spent on administrative and documentation tasks, and continual enablement of physicians to manage changes in technology and compliance regulations.  Addressing these three areas according to the study participants can greatly improve physician happiness. Those are the things that we typically recommend as a best practice,” adds Pasha.

However, it is one thing to know how physicians are faring and another to address the portion of the issue correlated to the use of technology.  How can organizations begin to harness the functionality available within the EHR and other key technologies to address the challenges? At Nuance, Pasha calls for a piecemeal approach.

“The way we address burnout is you have to think about it in consumable chunks. We talk in specialties because all physicians are different and it is key to understand the unique ways in which each specialty works and utilizes the technologies available to her/him,” he explains.

“We typically involve physician leaders from the organization and partner with them to understand their needs,” Pasha adds. “We align a physician or a clinician leader from Nuance who works cohesively with the organization’s physician leader to analyze what challenges they are experiencing and then design the improvements that would improve the physician experience.”

Designing efficient workflows and enabling physicians with available functionality matters when targeting opportunities for EHR optimization. Pasha offers the case of gastroenterology as an example.

“We first look at the things GI specialists need to take care of their patients.  An example may be the ability to access the last colonoscopy studies easily. They may not be available, so we may redesign some of the reporting functionality, so the colonoscopy studies are available to the GI specialists,” Pasha observes.

“We can arrange the workflow so that they can consume that information easily,” he continues. ”As soon as they see the patient, they'll see the colonoscopies on the right-hand side of the screen, and we can compare them to others. As a result, they can eliminate time spent searching and organizing bits of information.”

Additionally, data generated from observations of individual providers can pinpoint areas for intervention. EHR systems themselves can track this data, such as provider efficiency profiles in the Epic EHR. Data from speech recognition pinpointing how well the use of efficiency functions and the application of AI tools targeted at improving specificity and quality at the point of documentation can be combined EHR data to tell a compelling story.  Pasha indicates, at Nuance, analysis of data and understanding this story is key in how they approach optimization and act to improve the physician experience.

“By using the data from our Nuance technology and the EHR we can create targeted action plans at the organizational, specialty, and individual provider level. Creating action plans at each level of need is key to achieving improvements,” says Pasha. “We can create new screen displays and then retrain physicians on the improved workflows specific to the way they deliver care that we created for them to use. Then we measure their efficiency profiles and use of additional Nuance technologies at a later time at regular intervals — typically 30, 60, 90 days out.”

Improvements are likely to follow over the first month with improvements continuing over six months or more. So the results speak for themselves — there is no substitute for taking a comprehensive approach, at all levels within the organization and culminates in the delivery of one-on-one enablement addressing the physicians’ specific needs.

“The key is spending time with the physicians, looking at their workflows, and improving the workflow as they're seeing their patients in their clinical environment,” Pasha asserts. “By helping them best utilize features and functionality within the EHR and additional technology that they may not have been using, such as creating voice commands to help them navigate the EHR and eliminate clicks, provides a seamless experience where the technologies are seen as one vs. two separate tools and a burden.”

Ongoing education, reinforcement of skills, and evolving workflows to keep pace with compliance and treatment advances over time have a cumulative effect. “We've seen this in large organizations with multiple departments, and that behavior improvement has continued even multiple months out from the initial touch point when long-term support available for physicians,” says Pasha.

Pasha and his team are hopeful that advancing the use of capabilities available within EHRs coupled with AI enabled technology such as speech recognition and computer-assisted physician documentation will provide improvements in productivity, efficiency, and ultimately drive improved physician wellness. Utilizing technologies in an integrated, optimal manner is, according to Pasha, will be the way physicians can begin to work at the top of their licensure and focus on patient care.