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Is Documentation Getting Your Docs Down?

June 4, 2012
by Mark Hagland
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A new survey from online community QuantiaMD indicates that documentation pressure is oppressing physicians nationwide
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Last month, the online community QuantiaMD released the results of its National Physician Wellbeing Index. The Index was based on a survey carried out in April among 5,000 physicians and mid-level providers, one that found that non-physician clinicians (nurses and physician assistants) are happier these days than are physicians, who scored their own mental , social and financial health were lower than they had scored those measures back in January (their physical health remained the same).

In results released exclusively to Healthcare Informatics, QuantiaMD’s editor-in-chief Michael Paskavitz, reported that up to 40 percent of U.S. physicians are now experiencing job-related burnout. Significantly, fully 23 percent of QuantiaMD members cite documentation-related pressures as their number-one source of job-related stress, ahead of unhappy patients, difficult coworkers, and financial pressures.

What are the results of such stress? In order, the symptoms that physicians are reporting to QuantiaMD are fatigue, irritability, muscle tension, and insomnia.

What’s more, QuantiaMD members cited a range of IT system failures and process breakdowns as being strong contributors to the likelihood of making diagnostic errors, among them: problems with lab follow-up stystems, issues around notifying physicians of urgent abnormal radiology results, issues with note-taking tools, and systems that validate that referred patients have actually gone to see specialists as directed.

QuantiaMD’s Paskavitz spoke recently with HCI Editor-in-Chief Mark Hagland regarding the results of the online community’s survey, and its implications for healthcare IT leaders. Below are excerpts from that interview.

What do the results basically say to you about physician well-being?

Well, there were two reasons why we created this index in our community: first, we are very sincere in our quest to serve and support doctors; and second, physicians are so taxed in terms of their time and attention, that it leads to these issues like burnout, for example, and that affects decision-making. And one of the problems—perhaps it’s a silent epidemic in healthcare—is the problem of information overload. And your audience is the architects of information, and physicians use that information to make decisions. And there’s a real opportunity—and risk—there. As physicians use information, it raises their levels of stress and anxiety, so there’s this multidimensional aspect at play here. So the point of the well-being survey and index is to understand where they’re struggling and being stressed.

Michael Paskavitz

Where is information overload stressing them?

There are two elements: one is the linear path of information; the other is the art side of medicine, which is judgment. And the intersection of data and decision-making is interesting. So they wonder if data is reliable and they can trust it, and what particular context can they place it in to make judgments? So there’s a healthy tension there. And the best they can do is to make sure their judgment is well-exercised and confident.

And so one of the problems is that their circuits can become overloaded?

Absolutely. And there’s some information out there about when information overload starts to contribute to decreased decision-making accuracy. I can send you a couple of slides about that that we’ve used internally.

The result that you’ve provided us exclusively was fascinating: 23 percent of your members cited documentation-related pressures as their biggest stress. What are your perspectives on that finding?

Honestly, it’s not that surprising to me, because we offer a lot of content around coding, billing, and documentation. And in my previous work in hospitals, physicians saw increasing burdens around documentation; they saw it as—I don’t want to say an ‘imposition,’ as if it weren’t their responsibility—but they’re under a lot of pressure because of throughput targets. And to them, onerous documentation, duplicative documentation, can really impact them. As you can imagine, as the industry has become so much more data-driven, the most reliable source of that data in most cases is going to be the physician. And there are so many sources drawing from that, for so many different reasons, that it makes sense that this would be a time burden. So we get all sorts of comments on the site that really reflect their increasing frustration with what they call ‘paperwork.’ So it wasn’t surprising to me at all.

What should CIOs and CMIOs take from these findings overall?

Often, administrative types and non-clinicians used to feel that their work didn’t impact patient safety, but as things have become more automated, the impact of IT professionals has never been more profound, and their ability to outfit physicians with the right tools they need has never been more critical, and the absence of that is something physicians feel on a very personal level.

So they have to make the right decisions?


Do you have any other advice or thoughts?

What’s interesting about this index and this community to us, is that very few groups think about the physician as an individual. Doctors are trained to be autonomous and make individual judgments, and so their orientation is not to reach out for support. But this shows us that their armor can break down, and they do need support. And well physicians deliver the best care. So this is really a comprehensive focus on the physicians.