Reducing Physician Burnout due to EHRs

Technology is aimed at making our lives easier and simple – however, the transition stages seem to make life more difficult and tough.  A typical example is the Electronic Health Record (EHR) system.  While EHR use has definite benefits for patient safety and quality of care, it is also causing frustration amongst physicians and other medical professionals.

EHR use has found acceptance across the country with 97% of hospitals and 75% of physicians already using it.  Even though EHRs are here to stay, its use seems to be contributing to physician burnout and interfering with patient care.  According to surveys, primary care physicians and emergency physicians feel that their facilities are not effectively addressing physician burnout, with EHR use and time pressures identified as the biggest causes for frustration.

A recently published survey result from The Annals of Internal Medicine, reports that nearly 50% of the office time for physicians is spent working on EHR inputs.  Compare this to a mere 27% that is spent with patients directly.  And this does not end at the office – doctors spend an average of one to two hours at home completing and updating EHRs.  A similar finding by a Medscape survey, reports that 57% of physicians stated that EHR use reduced face-to-face patient interaction while 50% said that EHRs limited the number of patients they could see.

Exacerbating physician burnout; the mounting pressure from frustrated clinicians and management, in turn, is impacting health IT workers’ stress and job satisfaction.  A recent HealthITJobs.com survey found that 55% of health IT workers are stressed with 38% citing high or extremely high stress.  However, healthcare organizations can prevent provider burn out; improve clinical workflow efficiency and job satisfaction by optimizing their EHR and other clinical IT systems.  Organizations can identify and quantify the daily challenges their providers are facing and then through a careful assessment of IT systems and processes, design strategic solutions for high-quality patient care.

Negative repercussions of EHR burnout will likely influence the future of healthcare industry. Some examples of these repercussions could be:

Declining physician pool: According to a survey by Physicians Foundation, almost 50% of physicians plan to cut back on their working hours, retire or opt for non-clinical jobs due to burnout.  This is likely to cause a shortage of physicians and with the aging US population, seems to be heading for a disaster.

New or future physicians: Burned-out medical students are more likely to engage in patient care misconduct and endorse unprofessional behaviour, states a study by the American Medical Association.  Burnt-out medical students, who typically practiced with physician mentors, were also found to hold less altruistic views of their role as physicians in society.

Care quality: Physician burnout may also lead to lower care quality, increasing medical error, risks of malpractice and patient dissatisfaction, which can end up reducing payment under value-based care reimbursement models.

Pessimism: Most medical professionals are pessimistic about the future of their profession, according to the survey, with one-third indicating they wish they had chosen a different career and nearly 50% recommending different career paths to their children.

However, providers are not completely opposed to EHR use and agree that some features do increase satisfaction to combat burnout.  According to a survey of more than 15,000 physicians across 25 care specialties, nearly 62% of physicians deemed e-prescribing as the most useful EHR feature, while 57% ranked easy review of patient information as the second highest,. Standing third at 49% were the ability to share patient records and lab results, conduct drug/allergy checks and incorporate clinical lab test results. The survey also found that 56% of physicians believed that EHR use effectively improved the documentation at their practices with 81% planning on keeping their current EHR system.

EHR usability is one of the main stressors for both health IT staff and end users.  Organizations can implement vendor scorecard metrics on patient-provider interaction time and after-hours documentation and then analyze data to identify excessive EHR-related usage time to improve patient care and physician/patient experience.

More intuitive user interfaces and templates to support efficient clinical workflows and physicians’ natural thought patterns will improve EHR navigation.  Aligning processes with industry best practices for structured-form workflows, and working with vendors for task sequence customizations to fit work habits, will go a long way in helping EHR use.  Documentation requirements and actual end-user entry need to align, focusing on standardization and simplification of only the most meaningful data.

Health IT staff must properly train and transition end users to be comfortable with and invested in the EHR system.  All stakeholders need to feel they are within a culture where they are inspired, valued and vital to the overall organizational goals and enterprise-wide patient care experience.

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References

1. 2016 SURVEY OF AMERICA’S PHYSICIANS. (2016). Retrieved October 24, 2016, from http://www.physiciansfoundation.org: http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf
2. Kyle Murphy, P. (2016, March 28). Ensuring Physician EHR Use Doesn’t Lead to Physician Burnout. Retrieved October 24, 2016, from http://www.ehrintelligence.com: https://ehrintelligence.com/news/ensuring-physician-ehr-use-doesnt-lead-to-physician-burnout
3. Liselotte N. Dyrbye, M. M., F. Stanford Massie, M., & Anne Eacker, M. (2010, September 15). Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. Retrieved October 24, 2016, from http://www.jamanetwork.com: http://jamanetwork.com/journals/jama/fullarticle/186582
4. Medscape EHR Report 2016. (2016). Retrieved October 24, 2016, from http://www.medscape.com: http://www.medscape.com/features/slideshow/public/ehr2016
5. Stoltenberg, S. (2016, October 07). Tips for Reversing Physician Burnout Caused by EHR Use. Retrieved October 24, 2016, from http://www.ehrintelligence.com: https://ehrintelligence.com/news/tips-for-reversing-physician-burnout-caused-by-ehr-use

 

 

Causes of EHR-related Pediatric Malpractice Claims

The days of squinting while trying to read the physician’s prescription are long gone along with the bulky files which stored all our medical records.  The electronic health record (EHR) has replaced the pen and paper documents, resulting in better legibility and documentation of our medical records.  A powerful tool that is helping physicians achieve better care, lower costs per capita and better population health.  But, like all good things, the EHR is also prone to causing errors – errors that can be a source of medical liability.  Let us look at some of the factors that can be the cause for EHR related malpractice claims at a pediatric setting.

Interoperability Issues

Office based pediatricians use of EHR rose from 58% in 2009 to 79% in 2012.  However, interoperability issues caused due to multiple EHR systems and platforms coupled with limited pediatric functionality still prevail.

There is a need for pediatricians to realize that due to these interoperability issues, they do not have access to complete data on hospital admissions, emergency department visits, lab results, subspecialist reports and care provided outside the medical facility.  Serious errors in medical management could result due to these fragmented EHRs, resulting in harm to patients and exposing pediatricians to professional liability through malpractice claims.

Electronic Prescribing

While nearly 50% of pediatric practices are transmitting prescriptions directly to the pharmacies through the electronic prescription programs, the lack of pediatric functionalities in many EHRs can pose significant safety risks to children.  There is a need to verify if the EHR uses pediatric-specific drugs, calculates the correct pediatric dosages, and alerts the provider of dosing errors and potential contraindications.  Another problem area is that the majority of e-prescribing programs do not keep information from providers using a different e-prescription program. This can lead to serious consequences for both the patient and the pediatrician.

Cloning

While copying and pasting information from previous medical records does reduce time and effort to duplicate records – it can also cause tragic results.  Also known as cloning, duplication more often than not, results in over-documentation of the actual findings – for example, when the document cites items that have changed or were not examined in subsequent visits.  This can lead to damaging the credibility of the record in a liability action for the pediatrician.  For the patient, incorrect information from a past visit can lead to incorrect care.

Validating Reports

It is important that electronic reports from labs and consultation are examined by a provider before being incorporated in the EHR.  Incorrect reports or posting the wrong one can lead t serious medical errors and pose a significant malpractice risk.

Transition, Retention, Contracts

While it is good to move with the times, care should be taken when transitioning from paper to electronic charts. Before getting rid of the old paper records, pediatricians need to be sure that they have complied with all federal and state record retention laws.

Before finalizing the provider, all EHR vendor and service contracts should be scrutinized and legal review secured.  Pediatricians need to be aware of where protected health information is stored and the relevant risk of loss of this data.

Coding Issues

Some EHRs may be prone to coding pediatric services at a higher level than warranted due to a feature that automatically calculates CPT codes based on the services documented in the EHR.  Incorrect coding can lead to receiving overpayments, which may lead to liabilities due to fraud and system abuse.

The majority of pediatricians using EHR find the advantages outweigh the disadvantages.  Although, adverse EHR events are rare, they do exist. Becoming aware of and preventing potential and real risks of EHR errors is the best policy.

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Reference

1. Anunta Virapongse, M. M., David W. Bates, M. M., & Ping Shi, M. (2008, November 24). Electronic Health Records and Malpractice Claims in Office Practice. Retrieved from The JAMA Network: http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/414653
2. Graber ML, S. D. (2015, November 6). Electronic health record–related events in medical malpractice claims. Retrieved from PSNet: Patient Safety Network: https://psnet.ahrq.gov/resources/resource/29582/electronic-health-record-related-events-in-medical-malpractice-claims
3. Richard L. Oken, M. F. (2016, August 8). Lessons learned from EHR-related medical malpractice cases. Retrieved from American Academy of Pediatrics: http://www.aappublications.org/news/2016/08/08/Law080816
4. Spooner, S. A. (2007, March). Special Requirements of Electronic Health Record Systems in Pediatrics. Retrieved from American Academy of Pediatrics: http://pediatrics.aappublications.org/content/119/3/631

Time Management Tips for Physicians

The world is a busy place and is going to keep getting busier.  Everybody seems to be running against the clock and physicians are no different.  Already swamped, physicians find themselves even busier with the addition of approximately 22.4 million new patients – courtesy the Affordable Care Act.  Treating patients, administrative work, departmental and team meetings, conferences, keeping up with the latest developments in healthcare – all these coupled with taking out time for the family and other social commitments, is definitely taking its toll on our healthcare professionals.  The result – stress builds up, energy levels drop and very often, mistakes occur.  While this is true for nearly all professionals in most fields, the problem with healthcare professionals is that their mistakes can often end up being life threatening.

The reason why most people end up in such stressful situations is because they are not trained to manage their time.  Professional courses (other than corporate management training programs) very rarely offer any training on time management.  The result – most people end up juggling multiple activities with knowing how to streamline and manage them.  Given below are some well tested time management tips that should help you – the healthcare professional to balance your time between the various activities throughout your day.

Prioritize your activities

One of the primary tasks in time management is to prioritize your activities of the day.  Make a list of all that you need to do on that day and the time required for each one of them.  Keep checking that list to see if you are falling behind schedule.  However, remember that the list is not sacrosanct – adjust the activity and time if required.  You will find yourself completing more tasks this way.

Evaluate yourself

To effectively manage your time, you need to know what type of a person you are.  Conduct a SWOT analysis to understand your strengths and weaknesses, the opportunities and threats that you face.  Are you energetic in the mornings or the evening?  Do you dash headlong into activities or are you prone to procrastination?  Understanding yourself and then allocating time to your activity based on your strengths will help you manage them better.

Use technology to the fullest

Technology is a two way sword – while the internet has made it faster to send and receive messages; it is also the reason for a larger number of not so important messages interrupting you throughout the day.  Use technology judiciously.  There are software’s available that allow you to streamline your healthcare practice and reduce paperwork.  Use mobile applications that allow your patients to review their medical records, book appointments and even get prescriptions without having to visit your facility, save time for both you and the patient.

Optimize your EHR

As in the tip on technology – your EHR can be productive or a time consuming part of technology.  This depends totally on how user-friendly your system is, how functional it is for your practice and how well your staff and physicians are trained to work with it.  Although it requires time and effort to optimize your system, it pays huge dividends in the long run saving your time and energy by cutting down on paperwork and allowing access to information on your fingertips.

Learn to delegate

You may be a ‘hands on person’, but remember you just have two hands.  There is no shame or loss of control in delegating some part of your work to others around you.  After all, your administration staff, medical assistants, interns and volunteers are there for this purpose – to take on responsibilities and work and leave you with time to manage your patient’s well being.

You are allowed to say ‘No’

People look up to you and ask for your help frequently – be realistic about your workload.  Can you accommodate the request without compromising on your priorities? If yes, then go ahead but if the answer is no, then do yourself and the other person a favor by saying no.  Saying yes when you should be saying no will only increase your stress levels, exhaust you mentally and physically and decrease your productivity – none of which will benefit either of you.  Attending every conference, speaking at seminars is definitely good for your career – but only if you can continue your career without suffering a burnout from over-exhausting yourself.

Learn to relax

The brain rejuvenates itself when you relax – it could be a power nap, listening to music, taking a walk or just sitting with your eyes closed.  A rejuvenated brain works faster and better, allowing you work more efficiently and thus save on the time taken.  Schedule small relaxing breaks into your day and follow them as rigorously as you would follow your other activities.

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References

1. Casey, J. (2016). 6 Tips for Better Time Management. Retrieved May 28, 2016, from http://www.webmd.com: http://www.webmd.com/add-adhd/features/time-management-tips
2. Kersley, S. E. (2016). Time Management – The five mistakes doctors make. Retrieved May 28, 2016, from http://www.support4doctors.org: http://www.support4doctors.org/detail.php/46/time-management-the-five-mistakes-doctors-make?category_id=15
3. Reese, S. (2016, April 27). 12 Smart Time Management Tips for Doctors. Retrieved May 28, 2016, from http://www.medscape.com: http://www.medscape.com/viewarticle/860328_2
4. Taylor, J. (2013, October 15). 6 TIME MANAGEMENT TIPS FOR HEALTHCARE PROFESSIONALS. Retrieved May 28, 2016, from http://www.carecloud.com: http://www.carecloud.com/blog/6-time-management-tips-for-healthcare-professionals/