By Kent Locklear, MD, MBA
After months of being stuck at home, staying socially distant, wearing face coverings, and constantly washing your hands, do you suffer from “coronavirus burnout”? While COVID-19-related inconveniences are certainly disruptive to our lives, healthcare providers have faced a burnout problem since before the pandemic, and COVID-19 is only exacerbating the condition.
This past September, the Physicians Foundation released the results of a survey of more than 2,300 physicians conducted in mid- to late August, more than five months after COVID-19 was declared a pandemic. Nearly 60% of physicians surveyed reported feelings of burnout, compared to 40% in 2018. Half of the physicians surveyed reported experiencing anger, tearfulness, or anxiety due to the pandemic’s effect on their practice or employment.
Although COVID-19 may be a burnout contributor, it is far from the only culprit. In October 2019, the National Academies of Medicine (NAM) released a report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, highlighting six goals healthcare organizations could pursue to help stem, if not reverse, the burnout crisis. Three of the goals directly relate to health IT:
- Reduce tasks that do not improve care
- Improve the usability and relevance of health IT
- Create a positive work environment
While these goals are challenging, several studies have shown that organizational interventions can reduce burnout by 10%. By doing so, hospitals and health systems may also be able to ease some of physicians’ COVID-19-related burnout symptoms.
Put meaningful and actionable data up front
Ever since electronic health records (EHR) were widely implemented, physicians have struggled to find meaningful information to act on during patient visits. The problem has deepened due to the proliferation of care quality measures that physicians must track as part of their performance measurement. By one recent count, documented quality measures have reached more than 2,500.
Many EHRs make it difficult to identify and locate relevant care gaps and other quality indicators, which contributes to physicians’ sense of frustration and burnout. Worse yet, the quality information may not even be within the EHR but rather a payer portal, which requires another login and more searching.
Instead, when the physician opens the patient’s chart in the EHR, they should be presented with a menu that automatically displays quality and cost metrics important to that physician or health system. In one click, the physician should be able to quickly scan those metrics, including information about coding gaps, care access challenges, or social determinants of health obstacles, and act on them at the point of care. The metrics should be highly configurable based on internal or payer-driven care quality and utilization management programs to ensure they are meaningful.
SMART on FHIR capability
Another option for surfacing important quality and cost information is to embed the data within the EHR using a SMART on FHIR application. SMART (Substitutable Medical Applications and Reusable Technologies) and FHIR (Fast Healthcare Interoperability Resources) are guidelines and standards that allow applications to access and display data from any EHR, regardless of vendor.
While not compatible with all vendors yet, SMART on FHIR applications are interoperable with major platforms, such as Epic and Cerner, and many others. These applications can automatically display relevant data within the physician’s workflow without requiring a separate search or additional login. They can also embed care information, coding gaps, and other data directly in the EHR instead of on an overlay, which some physicians may prefer.
This flexibility gives health systems and practices greater control over how to surface information, ensuring it is at the most logical point in the EHR workflow for each physician to view and respond.
The automatic display of relevant quality metrics helps address the NAM’s call to improve IT usability and reduce tasks (such as searching through the EHR or payer portal) that do not improve patient care. It can also reduce mouse clicks and help automate data entry where safe and feasible, both of which are a must for health systems seeking to prevent provider burnout. One study of emergency physicians during a busy 10-hour shift counted nearly 4,000 mouse clicks in that time, 43% of which was spent on data entry.
Care gap information can be delivered as an alert directly within an EHR platform’s interface, the same way any other decision support or patient safety alert would be delivered. Surfacing this information in a recognized format within the familiar EHR interface can reduce disruptions to providers’ workflow and make the data easier to act on.
Likewise, features such as automated order entry and tasking also reduce physician burden. For example, if a physician sees that a patient is due for a flu shot, entering the order and assigning it to another member of the care team should require just a few clicks.
More time with patients
While removing some of physicians’ administrative burdens can reduce their burnout symptoms, it can also offer what they want most: more time with patients. Lack of face-to-face time with patients is a challenge that has also been exacerbated by COVID-19 due to patients avoiding in-person care or choosing telehealth.
For each patient encounter, physicians spend more than 16 minutes interacting with the EHR. By delivering data where and when physicians need it and streamlining the workflow, practices and health systems can reduce that amount of time while improving physicians’ work environment and quality of life.
Kent Locklear, MD, MBA, is the chief medical officer of Lightbeam Health Solutions.