Authored by: Dinesh Rai, MD
Burnout and the Electronic Medical Record
It’s common knowledge that electronic medical record (EMR) systems have considerable healthcare implications. The old days of going to a records room to learn about a patient’s medical history are no longer. The common trope of a doctor’s bad handwriting has become a historical relic with electronic documentation. And although not yet perfect, sharing medical records has become more accessible thanks to electronic medical systems. Disparate providers can now base their decisions on a common source of truth. The health information congregation improves communication and reduces patient harm. Despite all these benefits, they have become one of the leading causes of burnout.
The rapid implementation of EMRs after the HITECH Act was passed has led to essentially every hospital maintaining records digitally. The speed of adoption was faster than smartphone use. However, that speed has also led to poorly designed user interfaces, integration issues, and excessive documentation requirements.
Unseen Impacts of Digitization
Healthcare providers are expected to spend hours each day documenting patient interactions for both billing requirements and medicolegal protection. Physicians spend more than half their day in the EMR system, leaving the rest of the time for patient interaction. In addition, they still spend time after-hours documenting the clinical session. One survey showed physicians who spent less than 5 hours a week in after-hours charting were twice as likely to have lower burnout scores than physicians who spent greater than 6 hours. Another interesting study showed that increased amounts of EMR functions were associated with higher levels of stress and time pressures, suggesting EMR functionality does not necessarily correspond to the clinical workflow.
Measure First
A massive hurdle in addressing any aspect of burnout is having methods of data collection on workload. Most healthcare institutions do not have accurate ways of measuring workloads, one of which is time spent documenting. Broad brushstroke approaches to improve EMR use will not work among providers with various levels of comfort with technology. A quantitative approach to measuring time spent in the EMR system can provide insight into which providers are at risk of burnout. An institution can create policies regarding those providers to improve operational health scores.
With the thoughtful implementation of tools and technologies, institutions can help providers spend less time on paperwork and more time engaging with their patients. A healthcare system monitoring EMR time could provide insight into which providers need additional training. Granular data such as dot phrase implementation, keyboard shortcut usage, and typing speed could provide targeted interventions that will improve provider satisfaction, organization efficiency, and patient outcomes. Permanent EMR superusers can be implemented to assist those who may not know a dot phrase and can introduce variables like most recent lab work, imaging results, and vital signs. Employing a team of scribes to assist those with excessive documentation burdens could improve provider satisfaction and efficiency. Scribes can sometimes reduce documentation by up to 36% and increase revenue-generating units per hour by 5.5%.
Data is the Key
In a world where data is becoming increasingly prevalent, healthcare systems need to implement methods to collect clinical burdens, documentation workload, and various factors that could impact burnout and staff retention. That’s where CalmWave comes in. With an artificial intelligence-based model that aggregates information on clinical workloads, CalmWave presents the data necessary to understand exactly how burnt out a hospital’s clinicians are from an overabundance of tasks like EMR entry. As early warning systems continuously monitor patients’ vitals and trigger alerts and recommendations, EMR burden scores like those produced by CalmWave’s model will trigger alerts for providers at risk of burnout and offer targeted interventions. Implementing procedures, software, and data pipelines that measure organizational health scores is the key to reducing provider burnout, improving patient outcomes, and increasing hospital efficiency. Schedule a demo for more information on how your hospital can gain insight into the workload burden of your clinicians.
Sources:
Arndt, Brian G., et al. “Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.” The Annals of Family Medicine, vol. 15, no. 5, 2017, pp. 419–426.
Babbott, Stewart, et al. “Electronic Medical Records and Physician Stress in Primary Care: Results from the Memo Study.” Journal of the American Medical Informatics Association, vol. 21, no. e1, 2014.
Eschenroeder, H. C, et al. “Associations of Physician Burnout with Organizational Electronic Health Record Support and after-Hours Charting.” Journal of the American Medical Informatics Association, vol. 28, no. 5, 2021, pp. 960–966.
Hess, Jeremy, et al. “Scribe Impacts on Provider Experience, Operations, and Teaching in an Academic Emergency Medicine Practice.” Western Journal of Emergency Medicine, vol. 16, no. 5, 2015, pp. 602–610.
Jedwab, Rebecca M., et al. “Measuring Nursing Benefits of an Electronic Medical Record System: A Scoping Review.” Collegian, vol. 26, no. 5, 2019, pp. 562–582.