Surveys suggest that more than half of U.S. physicians show symptoms of burnout, and other studies have linked burnout to work process inefficiencies and administrative and documentation burdens, particularly the use of electronic health record (EHR) systems.
A time and motion study by the American Medical Association and published in the Annals of Internal Medicine in the fall of 2016 found that during office hours physicians spent nearly 50 percent of their time on EHR tasks and desk work. Researchers concluded that for every hour physicians provide direct clinical face time to patients, nearly two additional hours is spent on EHR and desk work within the clinic day, And, outside office hours, physicians spend another one to two hours of personal time each night doing additional computer and other clerical work. A separate study published in the Annals of Family Medicine last fall also found that primary care physicians spend more than one-half of their workday, nearly six hours, interacting with the EHR during and after clinic hours.
In light of the ongoing administrative and documentation burdens that providers face, healthcare leaders are concerned about physician satisfaction and the link to patient safety and care quality. According to the Agency for Healthcare Research and Quality (AHRQ), physician burnout can threaten patient safety and care quality when depersonalization leads to poor interactions with patients and when burned-out physicians suffer from impaired attention, memory and executive function.
To proactively address provider burnout, executive leaders at Cleveland-based University Hospitals accelerated a partnership with the health system’s EHR vendor, Allscripts, to address EHR usability and workflow issues, with the aim of making the EHR system more user-friendly, seamless and interoperable.
“This notion of physician burnout, or stress to physicians in their workplace, is something that has been brewing and getting progressively worse over last three to five years,” Cliff Megerian, M.D., president of University Hospitals’ Physician Services, says. In his role, Megerian oversees a physician network comprised of 2,500 physicians across the 18-hospital health system.
Megerian also is a professor and surgeon, and, as a practicing physician, he sees firsthand the usability issues with EHRs. “The EHR is a fairly recent innovation; it was mandated as part of the American Recovery and Reinvestment Act, so many mature physicians have grown up in an environment where they were dictating and having their dictations transcribed or they were writing on paper. This is a fairly new burden, within the last decade, and I think it is stressing many physicians because many believe it is forcing them to spend less time with their patients and more time with the computer.”
As part of its efforts to address provider burnout, UH conducted physician surveys and responses to those surveys point to the administrative burden of the EHR, as well as other regulatory hurdles, as an ongoing source of stress. “The reason this has risen to the forefront is because the survey results are showing that it’s the EHR,” Megerian says, adding, “And the survey results show that it’s agnostic as to which brand of EHR is being used.”
UH project leaders took a number of steps to help minimize administrative burdens and streamline physicians’ workload. The end goal, Megerian says, was to reduce the amount of time clinicians have to deal with counter-intuitive solutions, giving them more time to spend with patients, and thereby reducing the likelihood that they suffer from burnout and decreased job performance.
The project team, which consists of UH’s IT team and Allscripts’ team, first addressed stability issues in the EHR platform. “One of the earliest complaints was that the system was logging me out, or the system was going down, and we have been very successful in working with Allscripts, as well as our own IT people, in making the system a lot more stable, and the amount of downtime has logarithmically decreased,” Megerian says.
The project team also worked to create a bridge between systems to provide a more unified view and better access to information across the 18-hospital UH system, or what’s called OneUH. “Many hospital systems that have EHRs have different versions for different platforms, so you have an inpatient system, an outpatient system, a system that works with your oncology patients, and another system for cardiology, and they may be under the same vendor, but they are different. We worked with Allscripts to create a bridge between the systems,” he says, adding, “It’s a huge project and we’re still in the middle of that.”
Megerian asserts that close collaboration with Allscripts has played a key role in accelerating improvements with EHR usability and physician satisfaction. “About a year and a half ago, the partnership accelerated as we really became cognizant of the fact that we can’t, on our own IT platform, make every improvement without them making improvements on their end.”
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