The Healthcare IT News article “Fighting Physician Burnout: How Tech Can Undo the Damage Done by EHRs” is enticing; it promises that healthcare information technology and EHRs can solve the burnout problem.
I have a different take on it. The physician burnout problem is not caused by technology per se; it’s about workflow and how technology is used.
As I read the article, standard concerns about healthcare information technology stood out:
- Software should not go down.
- Service should not be interrupted.
- EHR should be integrated with critical systems.
- Better document management is important.
- Information should be readily available and easily searchable.
- The information must be reportable.
- Communication within the practice is important.
There are many very good systems I’m aware of that do all of the above quite well. Many tech-savvy physicians have been using these systems, and despite all of this, these tech-savvy physicians complain of burnout — they complain of turning into data entry operators!
What is the real issue?
Efficiency must be measured in terms of the big picture rather than as just software and clicks. Physicians are a practice’s most important — and expensive — resource. Their every moment is valuable and must be spent taking care of patients. All other tasks can, and should, be delegated to staff who can utilize healthcare information technology to accomplish everything a physician needs for critical clinical decision-making.
What this means is using technology to have information at the physician’s fingertips and making the information available when and where he or she needs it; however, the physician doesn’t have to be the primary technology user to enter or pull data.
It’s all about the workflow
I’ve helped many physicians jump the hurdle of the EHR technology barrier. It is possible for the provider to deliver good care without becoming a data entry operator, but still take advantage of everything healthcare information technology has to offer. The provider can do all this with minimal keyboard and screen contact.
Provider walks into the exam room. Past notes, triage notes, vitals, results of orders, and radiology, are all available and displayed on the computer screen for the provider to review immediately. How that happens varies from practice to practice. The important thing is that the provider doesn’t have to spend time clicking or typing.
Provider spends time talking to the patient. It is important to note that the provider’s only task is to talk to the patient while maintaining eye contact.
As the provider talks to the patient, the nurse or medical assistant interacts with the EHR to enter the discussion’s pertinent details.
The provider has minimal interaction with the computer. Their interaction should be limited to selecting diagnostic and CPT codes and e-prescriptions, if necessary.
The provider goes to his or her office and dictates a personalized narrative into the EHR system. This should not take more than 60 seconds. Often, it takes fewer than 30 seconds.
The provider can quickly view the note and sign it.
The provider moves on to the next patient.
Some of you may argue that the provider cannot afford to have additional staff in the exam room. What I fail to understand is when it becomes acceptable to have a provider with a very high hourly rate perform data entry instead of a medical assistant. The above workflow may allow a provider to see one more patient per day, or to go home early, thus achieving a work-life balance.
Efficient medical practices use a combination of great technology and improved workflow. The above scenario allows all the advantages that EHR technology has to offer without converting a provider into a data entry operator.