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Combating Burnout with Technology

TechnologyTechnology is slowly infiltrating every aspect of our lives, including physicians’ everyday practice. Health information technology, and specifically the electronic health record (EHR), is directly correlated to physician burnout.1,2 In a Rhode Island study of over 1,700 physicians, 70% reported health information technology stress1. The reasons EHRs are related to physician burnout are multiple, including increased time spent charting, and remote availability making it difficult to establish boundaries of work and home environments, among others.1-9 A recent Journal of the American Medical Association (JAMA) study of internal medicine residents demonstrated that 66% of medicine residents’ time was spent in indirect patient care predominantly with the medical record.10

Combating physician burnout is of utmost importance to the entire medical community.11-14 Interventions to combat burnout are being tested and implemented across the country in an effort to reduce the negative consequences that physician burnout causes. A systematic review of such interventions to reduce burnout published in Lancet in 2016 showed many promising interventions that focus on individual and organizational changes to help reduce burnout symptoms and improve emotional satisfaction at work. Many of these interventions focus on limiting hours, stress management and other individual strategies, but did not focus on technology interventions.14-15

Technology is unavoidable and ways to reduce burnout by leveraging technology are necessary. Focusing efforts to combat burnout on reducing technology and psychosocial interventions are not sufficient alone. Such efforts are beginning to be studied with success.16-17 Use of bioinformatics tool to optimize specialty-specific EHR tools are central to these processes.

Some areas in which you can make a change now include:
1)    Dictation software has come a long way. Clinical documentation that is integrated within the EHR has sharpened their capacity to understand the complexity of individual language characteristics as well as specialty-specific dictionaries to improve quality. Phone apps that can help ease access through EHRs are now readily available. Here are two examples of programs that may be utilized for this purpose:
    a.    M Modal
    b.    Dragon

2)    Specialty-specific templates and smart phrases. If you always do the same thing, make it a smart phrase or template. Don’t keep spending time typing the exact same thing every time. A small amount of time upfront saves hours spent in EHRs over time.

3)    Scribes have been shown to reduce burnout. If you can afford them, use them.

4)    EHR superusers or experts in bioinformatics can help streamline everyday operations to lessen clicks, free text, improve template utilization or create a more usable daily EHR approach that can be individually tailored. Extra training to help you figure this out may be well worth your time.

5)    Closing your eyes to improve your tear production, eye strain and mind strain from physically being glued to a computer screen all day are key to success in long, technology filled days.

6)    Portable computers and tablets allow you the ease of moving around the office instead of having to log-on freshly in each room’s desktop computer and also allow you to be more efficient with space utilization in your office. This can also be used in the waiting rooms to help patients fill out their own review of systems and other historical data that you may have otherwise had to self-impute into the EHR.

7)    Merge multiple software requirements for your office into one platform. Having one scheduling software, another EHR software, and perhaps a third for another operation is cumbersome and makes staff unhappy. Whenever possible, reduce extra log-ins and reduce errors by choosing software that can run all operations from one single log-in.

8)    Expand to include telehealth. Are you sick of all the endless lab follow-up phone calls and sick over the phone consults? Switching to telehealth is now becoming an insurance-covered feature that may help reduce one burden and allow for improved reimbursement for services you used to do for free.

9)    Remote messaging can reduce lab follow-up burden. Playing phone tag with patients trying to get lab results or phone calls after hours to discuss blood results can be reduced by embracing this feature. It seems like a lot of work up front, but typing out your interpretation of labs literally next to the lab value can be extremely valuable to patients and reduce phone/wait times for you and your staff.

10)    Re-evaluate the purpose of the physician note in the EHR and be willing to abandon perfection in order to regain time. Allergists are trained to include detailed histories, assessments, and plans; and reimbursement hinges on proper documentation. However, the amount of information contained in notes is often excessive and can reasonably be abbreviated.

11)    Readjust expectations for time spent on the EHR. Institutions should set clear expectations that emails and EHRs should not be accessed between 7:00 pm to 7:00 am nor on weekends, and provide adequate administrative time during the workday for physicians to complete all patient care work.

12)    Many EHRs support patient questionnaires that can import data directly from the patient. New patient questionnaires, standardized questionnaires such as the Asthma Therapy Assessment Questionnaire, medication reconciliation, and other data can be entered directly into the EHR by the patient.

13)    Widescreen views of the EHR can facilitate multi-tasking by allowing multiple parts of the chart to be visible to the user at the same time, for instance, the current note, the previous note, and the labs.

14)    Smart watches can be used to set silent alarms to keep track of time in a patient’s room, or glance quickly at messages to determine which might be urgent.

15)    Videos can be used for patient education. There are many available through the AAAAI website, or you can make your own on YouTube and share with patients on a tablet in the room, or on a public TV in the waiting room.

16)    UpToDate, Epocrates, and other websites and apps can make it easy to find clinical information quickly.

1.    Gardner RL, Cooper E, Haskel J, Harris DA, Poplau S, Kroth PJ, Linzer M.  Physician stress and burnout: the impact of health information technology. Journal of American Medical Informatics Association. Feb 2019: 26(2): 106-114.

2.    Shanafelt TD, Dyrbye LN, Sinsky C, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfication. Mayo Clin Proc. 2016;91 7:836-48.

3.    Kroth PJ, Morioka-Douglas N, Veres S, et al. The electronic elephant in the room: physicians and the electronic health record. JAMIA Open. 2018; 1 1:49-56.

4.    Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: results from the MEMO study. J AM Med Inform Assoc. 2014;21(e1):e100-6.

5.    Poissant L, Pereira J, Tamblyn R, et al. The impact of the electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inofrm Associ. 2005; 12 5:505-16.

6.    Feblowitz JC, Wright A, Singh H, et al. Summarization of clinical information: a conceptual model. J Biomed Inform. 2011;44 (4):688-99.

7.    Martin SK, Tulla K, Meltzer DO, et al.  Attending physician remote access of the electronic health record and implications for resident supervision: a mixed methods study. J Grad Med Educ. 2017;9 (6):706-13.

8.    Pelland KD, Baier RR, Gardner RL. “It’s like texting at the dinner table”: a qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals. J Innov Health Inform. 2017; 24(2): 894.

9.    Toll E. A piece of my mind. The cost of technology. JAMA. 2012; 307 (23);2497-8.

10.    Chaiyachati KH, Shea JA, Asch DA. Assessment of inpatient time allocation among first-year internal medicine residents using time-motion observations. JAMA Internal Medicine. April 2019. Doi:10.1001/jamainternmed.2019.0095.

11.    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009; 374:1714-1721.

12.    Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014:12:573-576.

13.    Sikka R, Morath JM, Leap L. The Quadruple aim: care, health, cost and meaning in work. BMJ Qual Saf, 2015: 24: 608-610.

14.    West CP, Liselotte LN, Erwin PJ, Shanafetl TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Nov 2016; 388 (10057):2272-2281.

15.    Clough BA, March S, Chan RJ, Casey LM, Phillips R, Ireland MJ. Psychosocial interventions for managing occupational stress and burnout among medical doctors: a systematic review. Syst Rev. July 2017;6(1):144.

16.    Bohman B, Drybye L, Sinsky, et al. NEJM Catalyst. Physician well-being: the reciprocity of practice efficiency, culture of wellness, and personal resilience

17.    Sieja, A, Markely K, Pell J, Gonzalez C, Redig B, Kneeland P. Optimazation Sprints: Improving Clinician Satisification and Teamwork by rapidly reducing electronic health record burden. Mayo Clin Proc. 2019: 94(5):793-802.