Current systems, requirements and workloads burn out clinicians

Provider leadership needs to prioritize workforce preservation and take a hard look at unnecessary requirements, say presenters in new HDM KLASroom series.

Have clinical information systems solved the wrong problem?

Current electronic health records systems are good for the purpose of recording care diagnoses and providing a sequence of what’s been done for the patient, but the technology “stack” upon which these systems have been built hasn’t advanced much in the last 20 years. Meanwhile, clinicians are facing growing challenges to sift through troves of data to answer clinical questions – all within workflow and 20-minute patient encounters.

"The tech stack (of EHRs) is handcuffed, and it’s hard to change them. We need a bit of a revolution.”

These challenges were underscored during presentations on Wednesday, April 6, on the topic of Improving the clinician and care team experience, the first in a series of four educational events produced by Health Data Management and KLAS Research.

The series, focusing on how best to reduce clinician overload and enable better results with health technology, took a close look at the disconnect between current technology and reasons why clinicians are struggling to meet current patient care demands.

It’s still volume, not value

Despite the growing focus on value-based care, “healthcare is a volume business, and that’s contributing to a lot of issues,” says Shane Danaher, chief operating officer of Divurgent, a consultancy. That burden falls in different ways on clinicians in healthcare, he adds, noting a recent study by athenahealth that found a disproportionate amount of documentation burden falling on female clinicians.

Current EHRs “are stuck in the 20-year ago model,” notes Subha Airan-Javia, MD, founder and CEO of CareAlign and a former associate CMIO at Penn Medicine. Public-facing websites have evolved over that period of time to be reactive and responsive to users, and that needs to be done to help clinicians now. “There’s a ton that we can do to make it easier for clinicians to find the information they need. Right now, the tech stack (of EHRs) is handcuffed, and it’s hard to change them. We need a bit of a revolution.”

Dr Subha Airan-Javia, founder and CEO, CareAlign - with Dr Eve Bloomgarden, CEO, Women in Medicine and Shane Danaher, COO, Divurgent

EHRs are repositories of too much information, she notes, citing data that a chart with five years of documentation contains an average of 15,800 words – that compares with Shakespeare’s longest written work, which contains 30,000 words.

“The fact is, we’re supposed to be digesting half of Hamlet every 20 minutes (for the typical patient encounter, and then documenting on top of that,” says Eve Bloomgarden, MD, director of thyroid care and director of endocrine innovation and education in the division of endocrinology at NorthShore University Health Systems.

Amidst the heavy load that EHRs place on clinicians, they wind up far away from the practice of medicine that attracted them to care in the first place, says Bloomgarden, who also is co-founder of IMPACT and is chief development officer of Women in Medicine. “I’m the mom of two children – when they play doctor, they think that means sitting in front of a computer and typing. If I had been told that being a doctor means sitting at a computer and typing, I would not have gone into medical school. You see people just deciding there are better opportunities out there, so it’s no wonder we’re just seeing people exit the workforce.”

Dr Eve Bloomgarden, CEO, Women in Medicine - with Dr Subha Airan-Javia, founder and CEO, CareAlign and Shane Danaher, COO, Divurgent

Burnout crisis

The industry must pivot quickly to address physician challenges leading to burnout, says Brian Patty, MD, currently chief medical informatics officer at Medix Technology and former vice president and CMIO at Rush University Medical Center. “Burnout is a systems issue,” he contends. Interventions to improve systems of work are known to be more effective than efforts aimed directly at physicians. “Workflow is king; if you do anything, change the technology and not the workflow. Give end users the ability to change the system.”

Healthcare organizations need to take a hard look at the systems they’re using and what they’re asking of clinicians, contends John Lee, MD, senior vice president and CMIO at Allegheny Health Network. “We have the wrong information driving us to the wrong goals,” he contends. “It’s an asymmetrical problem – it prevents us from achieving the quadruple aim (of value-based care).”

Dr John Lee, Allegheny Health Network - with Dale Sanders, IMO, and Mitchell Josephson, HDM

Several industries have undergone digital innovation to redesign how they operate, Lee says, underscoring changes in fields ranging from travel to retail. They’ve done so by delivering information more effectively to end users. The same opportunity now exists within healthcare.

Drowning in data

“Rethinking the healthcare system is what we need to do, and the keystone of that is information deliver,” Lee concludes. “Now, we’re overwhelmed with knowledge, and our limitation is being able to pick and choose what we need to apply to a particular situation. We’re locked in because of payment mechanisms and regulatory frameworks. There are plenty of opportunities to disrupt.”

Dale Sanders, IMO - with Dr John Lee, Allegheny Health Network and Mitchell Josephson, HDM

“What’s lacking is leadership, the genuine passion to be data driven,” says Dale Sanders, chief strategy officer for Intelligent Medical Objects. Documenting for reimbursement and to meet quality measures “is doing nothing but burning clinicians out.”

Watch the HDM KLASroom series on-demand here (registration is required).

Register for future sessions here.

Research Referenced During Session

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