As a hospitalist, I see the workforce challenges that fuel burnout every day. Over the past year, emergency department visits and the inpatient census at the hospital where I work have reached all-time highs. Some staff have chosen to leave the field entirely, others have left full-time roles for higher-paying traveling contracts. Meanwhile, Covid infections among the clinical teams are reducing the number of staff members available on any given day.
Beyond these situational stressors, however, is one constant source of burnout: studies confirm that physicians across specialties spend more time on documentation and admin work than they spend face-to-face with patients, the very reason why we went to medical school.
The challenge is not just related to documentation and menial tasks, but extends to patient communication. Healthcare’s clinical workforce is not growing in parallel with the expanding “digital front door” that makes healthcare services and communication with providers much more accessible. With that increase in access comes increased burden on providers to respond to patient messages quickly – and those messages can come in at any hour. These pressures correlate directly with burnout symptoms.
The response across the industry has been varied. Some practices have cut back on the number of hours physicians work, and others have shifted to concierge practice models where they have fewer total patients and, therefore, fewer notes to write at the end of each day. Both approaches result in greater burdens placed on the delivery system and less access to care for patients. Just as unfortunate is the growing cohort of health systems that have implemented a “charge per message” strategy, billing patients for asking for advice through online patient portals.
Any approach that punishes patients for engaging with their care team is the wrong approach. So, what’s the right approach? Ultimately, the question is whether technology can provide a positive path forward. The answer will not rest in the capabilities of the modern EHR.
The future of the EHR
Many physicians remain skeptical of technology as a tool to increase efficiency, and wax poetic about the good old days when notes were only scribbles on paper charts. We spend so much time staring into computer screens today that we blame technology for the mess we are in.
The truth is more complex: we face pressure to increase throughput and maximize productivity, we are more aware of the penalties to be met for inadequate documentation, and we know that in our increasingly fragmented healthcare system, colleagues who share patients with us rely on our notes to glean insights and ensure smooth transitions of care.
The EHR as it exists today is a burden we accept begrudgingly, knowing our paychecks depend on the functionality behind our computer screens and wondering when the promised efficiencies of technology will be made manifest.
Clinicians need technology that anticipates our needs and unshackles us from the many administrative tasks we face in our practice. We need a new generation of EHR, one that involves an ecosystem of interconnected applications and solutions working in harmony to support both providers and our patients. It is not unfathomable.
Every day, physicians across the country are inundated with messages from other providers, messages from patients, and patient test result alerts. Managing the flurry of communications is not only tedious, but unnecessary. There are dozens of tools available to declutter our email inboxes. Clinicians want tools that help them manage their EHR inboxes by effectively filtering messages and automating triage processes.
Similarly, clinicians and their staff spend significant time calling patients, often to collect information or relay very simple messages like confirming upcoming appointments. Every other industry has managed to automate these simple tasks. Healthcare has an opportunity to leverage automation to a much greater extent across organizations. Not only can automation help solve for the current workforce labor shortages, but it can also free up office staff to focus on more top-of-license activities. A recent example comes from two academic primary care practices in Philadelphia where a cohort of patients discharged from the hospital received automated transitions of care text message support. They saw 41% fewer ED visits or rehospitalizations in the following 30 days compared with a cohort of patients receiving usual care.
The first generation of EHRs were designed to serve the administrative needs of providers, but the next generation must be patient-centric. Health systems are
beginning to recognize the need to empower patients to self-schedule their own appointments and engage with disease-specific education and guidance. By bridging the gap between provider tech systems and patients, and by using technology to support patients in achieving more self-management of their conditions, providers will feel the burden lift and can focus more attention on the meaningful patient interactions that brought them to choose careers in medicine in the first place.
As a workforce, we must accept that we can’t do it all. Instead, we should learn how to achieve the vision of an EHR 2.0, where we finally put technology to work for us – to offload many of our administrative and repetitive tasks, to help us achieve greater efficiency, and to help patients find the support and guidance they are craving. Patients will be better cared for as healthcare workers feel the empowerment to again find fulfillment in our jobs.