What Can Healthcare IT Leaders Do To Flip the Script on Physician Burnout?

June 3, 2019
Leaders from Nemours Children’s Health System discuss the challenges involved in improving the well-being of their health system’s nearly 850 physicians, in the context of EHR-related challenges

On Monday, June 3, leaders from the Wilmington, Delaware-based Nemours Children’s Health System engaged in a broad panel discussion around physician well-being, at the Mid-Atlantic Health IT Summit, being held at the Hilton City Avenue Hotel in Philadelphia, and sponsored by Healthcare Innovation. The executives’ panel session was entitled “How Physician Informatics Can Increase Engagement and Address Burnout.”

Immediately after their presentation, the panelists sat down for an interview Healthcare Innovation Editor-in-Chief Mark Hagland. The Nemours executives were Gina Altieri, senior vice president and chief of strategy integration; David West, MD., medical director, health informatics; Matt Di Guglielmo, M.D., chief, Division of General Pediatrics, Department of Pediatrics; and Sara Slovin, M.D., a primary care physician in the Department of Pediatrics. Below are excerpts from that interview.

What are the key elements in what you discussed just now that CIOs, CMIOs, and other senior healthcare IT executives in patient care organizations should be thinking about right now?

Gina Altieri: As Matt said during the panel discussion, I think they need to appreciate that there’s an issue here. And the more technology we throw on people, the more they need to learn. And sometimes, it’s too much. And I remember when we built our Orlando hospital, it turned out to be too much for the doctors. And I think sometimes the tech people don’t understand that.

David West, M.D.: People’s personal experience with technology is, what works, is what I can achieve on my own. It is complex. And healthcare has a different type of data set, with different, and multiple currencies. Many other industries work in a single currency, money—such as the financial services industry; that’s simply not true in healthcare.

Are patient care organizations asking physicians to do so much on electronic health records? Not only asking that they document clinically, but also supply data for outcomes measures for quality regimens, and many elements related to billing and reimbursement, etc.?

Matt Di Guglielmo, M.D.: When you think about paper charts, which I trained on, things were very different. I would open a patient’s chart, and there were three things I had to look at, and I could tell you everything about that kid and that kid’s family. And things are different now. How do we bring the advantages that we had from working on paper, together with the electronic capabilities that have transformed how we work?

West: When I talk to residents who work on these templates for progress notes, whether ambulatory or inpatient, they’re trying to learn how to use a tool, and the most valuable thing is, not your ability to use technology, but what you think [and which is translated into clinical documentation in the EHR]. I want them to write what they think. That’s the most valuable commodity, and if we add too much on there with documentation and billing requirements.

Sara Slovin, M.D.: Note bloat is a real problem, and there’s a lot contributing to making notes lengthy and convoluted. Some of the graphical representations, trying to get to where you can digest a lot of information quickly. We struggle with that so many elements have to be present in a note for billing purposes, but it gets too complex. So there’s an education piece to all of this as well.

Altieri: I don’t think the industry recognizes what you were saying, Dr. West, per value. When value comes into play, it’s more than just a change in reimbursement and taking care of populations, having this data. Then it does become a tool for population health.

Slovin: And we’re lucky working in a health system in which there are other people generating data that goes to insurance companies, that we employed physicians don’t have to do, but the fact that we’re provided with dashboards helps us think about how we might want to change some of the things we might do differently in our practice, about thinking.

West: We need to think about who the data managers will be in all of this. One of the departments that has undergone a huge revolution has been the HIM [health information management] department. And HIM’s whole mission has changed with the advent of EHRs. I think a new paradigm for healthcare organizations is, how do we focus those resources (HIM) into being effective managers for physicians, so that when they come to the chart, it’s recognized cognitively? We have a big clinical logistics center, where we process things. And we staff that center with EMTs. They’re used to making quick decisions on a fixed set of data, are good at protocols, etc. So we’re thinking about how to make this HIM department into something else, something that helps physicians. We have all this interoperability and HIE, but nobody has solved how you incorporate vaccination list data, medication list data, allergy list data, into the EHR, in a coordinated way. Right way, this is falling on the physicians, and most are balking.

Di Guglielmo: With regard to our discussion about CIOs and CMIOs, if the organization is having a meeting and all the C folks are sitting around and talking about burnout, they’re missing the discussion—it’s how we change the organization and the system. And one piece of that is the information technology piece. So have to take a holistic viewpoint. And the CIOs and CMIOs can help facilitate that conversation.

Slovin: And it’s also working to engage your team members to work at the top of their licensure. So how do we have a team-based approach to managing all the data. Informatics is a piece of it all, a very valuable piece; but it’s not the whole piece. It’s really the documentation that bothers people. How can we transform the requirements facing all the clinicians?

Di Guglielmo: Whenever anyone is thinking of reforming processes, they need to understand that if a process involves the physicians, then problem-solving with the doctors should happen first.

Slovin: We’re exploring reforming discharge summaries right now, and we’re actively talking with the physicians.

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