By Matt Phillion
When the healthcare industry examines ever-growing burnout and staffing shortages, EHRs continue to top the list of reasons clinicians find themselves frustrated enough to step away. A report from Behavioral Health Tech finds that roughly 75% of healthcare workers may leave the industry by 2025. Professionals report that they spend twice as much time doing manual, EHR-related tasks as they spend with their patients.
Hospital-based physicians report spending 37 minutes on each patient, but 25 of those minutes are spent with the EHR according to a recent Stanford Medicine poll.
What can organizations do to ease the burden on their staff and help staunch the bleeding of skilled professionals from the field?
“It’s said that the EHR is a double-edged sword and if it’s not done well, it creates problems,” says Nancy Pratt, senior vice president of clinical product development for ClinicComp. “As we look at the measurement of quality and reimbursement over the past 20 years, we can see there’s an immense amount of data collection going on in the hospital.”
Provider organizations now have to supply all of this data to payors and groups doing benchmarking, Pratt notes.
“This has driven a substantial amount of data entry requirements, and it’s one of those things that becomes tiresome especially when products don’t interoperate well and you’re having to re-enter the data over and over again,” says Pratt.
Regulations now require EHRs to interoperate, Pratt points out, but that wasn’t always the case, and it’s still not a perfect system.
“It is a recent requirement and there’s still information blocking. There’s still a lot of that burden out there,” says Pratt.
On the other side, documentation comes into play to ensure providers get paid, and that administrative burden falls onto physicians and other care providers.
“The medical staff carry that burden. Someone comes in with this condition or another but it didn’t count unless the physician wrote it down, and this creates a big burden on them when it comes to documentation,” she says.
Add this to the perennial burden of clinical documentation itself and it adds up to a lot of time on administrative tasks for the provider, Pratt says.
“So much research has been done in the last few years about how much time is asked of providers in the EHR,” says Pratt. “And we’re able to measure this electronically: the staff who were more burned out overestimated how much time they spent in the EHR” because the frustration made that time feel greater.
Meanwhile, there is a powerful correlation between how much time providers spend after hours in relation to burnout.
“You go home and have all this documentation to deal with,” says Pratt.
Some of this comes from inefficient processes, she notes.
“A lot of EHRS are framework products you can then build and configure internally so you’ve got very different operations from place to place. When things are not intuitive, it’s not easy to figure out where you’re going find the data you’re looking for,” says Pratt. “From a patient safety perspective, you don’t want too many clicks to find what you’re looking for.”
Some organizations have become more focused on effective training, but many systems are still not particularly friendly. There’s too many clicks, information is not easily found, systems don’t interoperate.
“Or you get a deluge of information and you’re then dealing with cognitive overload,” says Pratt. “We can put a lot of stuff on the screen, but it’s getting the right mix of what you need that’s the trick.”
At the end of the day, you cannot fix system defects and bad design with training, Pratt points out.
“If people are training to a workaround because the product doesn’t work well, that’s just not effective,” she says. “It’s annoying to providers.”
An evolution of efficiency
The industry is evolving in the right direction, Pratt says, but to be more efficient the technology needs to be well-managed and well-maintained. But where do we start?
“There are some things vendors can do right out of the box, opportunities to listen to providers,” says Pratt.
Consider continuous uptime, for example.
“In 2023, we shouldn’t have scheduled downtime” for the EHR, she says. “Having downtime is ridiculous when you can have enough redundancy built in; the technology should be high reliability and continuously available. It should be seamless for users, it should be 100% available, and it should be fast.”
Some of this comes from infrastructure, some from system design, where the product is designed to go offline and archive—and this can befall any organization. A small, rural hospital might see delays like this due to low bandwidth or poor internet quality, but a big teaching hospital can see slowdowns because of the amount of data being handled.
Products with built-in downtime will have to change if the consumers demand it, Pratt says.
“We have the technology to stay up and running 100% of the time,” she says.
Another approach to improved efficiency is considering the human-computer interface. When it comes to UI, it isn’t a one-size-fits-all problem to solve.
“When it comes to intuitive design, we need to listen to the medical staff,” she says. “There’s no one type of workflow for physicians, but rather many types of physicians doing different types of work with different ways to get their job done.”
There’s opportunity to make navigation easier, surface key information, and make the right data easier to find.
“We can design systems so the data isn’t hidden,” says Pratt. “We talk a lot about safety with hospital staff. We don’t generally have people in the IT department driving patient safety. Usually safety crosses all boundaries, but IT safety is fairly unique and involves its own unique risks.”
Cross training is incredibly important, Pratt says, getting IT and healthcare providers talking and understanding each other’s roles to create improvements to the system.
“It takes a lot of transparency to between the IT and patient safety teams,” says Pratt.
Jumps forward in technology
Thinking back to the administrative burden factor, products need to be able to remove the repetitiveness that is driving so many professionals away.
“It has to be smart enough to not have to reenter the same information over and over again,” says Pratt.
Emerging technology can work wonders for removing the repetitive typing and interactions that add to the administrative burden as well. Voice navigation has come a long way, well beyond classic dictation.
There’s plenty of buzz around AI as a way to create efficiencies, but it should be approached with care.
“There are huge opportunities, but where it’s made mistakes, those are legendary as well,” says Pratt.
There are reasonable places where AI can be used to take care of some of the grunt work providers deal with every day so that those providers can spend more time with the patient.
“There’s ripe opportunity for technology to make the system smarter so it can operate without someone having to manage every single step,” says Pratt.
To make the next leap forward, Pratt notes, there needs to be the right balance of regulatory oversight.
“We need regulations and guardrails so we don’t create problems and harm, but on the flipside, when we’re having to create screens to comply with data collection requirements at some point we have to ask ourselves what’s too much. There’s a lot of nuance,” says Pratt. “I’ve seen the case where measurement and recording burdens got bigger and bigger every year, and I think we may want to consider breaking up the burden of what we’re asking clinicians and providers to do.”
To win the battle of burnout and attrition, improving technology can be a huge asset—when done right.
“Nobody wants to be the product everybody hates,” says Pratt. “We’re interested in speed, reducing inefficiency, improving UI. It should be apparent to you with minimal training how to use it, and we want systems that anticipate what the user needs.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at email@example.com.