Finding ways to alleviate clinician burnout continues to be a priority for many health systems nationwide, and much of the attention is specifically turning to informatics leaders who are tasked with ensuring that technology doesn’t get in the way of providing patient care.
One survey last year from healthcare communications company Spok of 470 clinical staff found that 90 percent respondents agreed that increased or ineffective technology contributes to the risk of clinician burnout. Then, of course, there’s also the widely-cited Annals of Internal Medicine study from 2016, which found that for every hour of direct clinical face time with patients, there’s nearly two additional hours spent on electronic health record (EHR) and administrative work.
To address these burdens professionals in the field of medical informatics are applying new user-centered design methods. Specifically, chief medical informatics officers (CMIOs) and their teams are optimizing applications of artificial intelligence, telehealth, EHRs and other technologies so providers can access the right information at the right time to support real-time decisions and enable better patient care.
In a recent interview with Healthcare Innovation, Tammy Kwiatkoski, director of clinical informatics at the Chicago-based Healthcare Information and Management Systems Society (HIMSS), explains why informatics professionals are growing in importance, and becoming key leaders for health systems as they work on getting clinicians back to focusing on providing the care they trained for by eliminating unnecessary burdens. Kwiatkoski also discusses the broader environment around IT-caused burnout and the evolving nursing informatics field. Below are excerpts of that discussion.
What are the core IT-related elements that are contributing to clinician burnout today? What has changed over the last few years?
When we talk about clinician burnout and burden, we certainly hear and know that EHRs tend to be at the top of the list. We want to try to find a way to improve the functionality and usability of the EHR so that clinicians could spend less time recording health information and more time working with their patients and providing patient care. At HIMSS, I work with informaticians to learn from them and [observe] how they're positively impacting patient care through the work of clinicians, specifically, and addressing the interactions they have with the EHR.
Breaking down the IT elements, the [amount] of documentation really needs to be reduced. There are lots of studies and surveys out there trying to understand how much time the clinician spends in the EHR, and when they're seeing is that 50 percent of their time is being spent on administrative and billing documentation. That's significant. You want to optimize the system so that you can minimize that work inside the EHR, as we're all faced with data overload. So our [HIMSS-member] clinicians are trying to optimize their systems and work with their informatics teams to decide what information is needed on the patient, and in what order. How do we get through these tabs, or sub-tabs, to search through and find the information on our patients that is important for us to know right now?
Another piece I hear a lot about is the need to be more mobile-enabled. There are new security features and opportunities within healthcare organizations to allow clinicians to be more mobile and to take the EHR on their mobile device, iPad, or even on their own phone, so that they can move around and ask us information when and where needed. This way, they’re less tethered to the PC in their office, where they have the big screens around them and these large EHR systems that they have to get into.
When you have frustrated end-users reporting low satisfaction levels with health IT, who is most accountable for these issues and how can they be remedied?
I think it’s a mix; you have [EHR system] developers and designers who have this great idea and want to create a fabulous product. But this is where clinicians who actually use the product have very little control, unless that vendor is going to enter some user-centered design and really get the input of clinicians at the bedside to see how it can be usable. But if they're just developing products without taking in the ability for the solution to have a lasting impact, be adaptable, or be interoperable, then this is not a good solution. So we really have to take it back to the vendors and their design philosophy, to think about how this product will work in the real world. As hospitals and health systems use these products, they're giving feedback to the vendors, but what is being done with that information? Can they continue to evolve, and create products and put out that training and support that will help future users?
Also, who else is using the product? You have your clinicians as the users, and their proficiency, knowledge, and dedication to learning it and trusting it—while communicating any issues—will [determine] their best possible usage with it. But they really need to learn [the product]. And then you have your system CIO [and others] who are deciding what they're ultimately going to purchase, how much they’re going to invest in training, and how much time they want their staff to attend to customizations. So having their guidance and involvement to ensure that all these intended goals are met is also very important.
Finally, there’s the regulatory reporting side; the government is involved here, and they have a hand in how we're going to [be able to] reduce that level of burden by reducing some of the duplication when it comes to regulatory reporting requirements, and how much information is [needed] for billing and quality measures.
What trends are you seeing as it relates to the evolving nursing informatics workforce?
We [conducted our own survey] on this area, which we do every three years. We collected a lot of data from over 1,300 respondents [this year]. I would say there are four key notable findings. First, graduate degrees in the field are increasing. We're also seeing that as the nursing informatics field itself has evolved, the number of years of clinical experience is decreasing. More and more nurses are leaving the clinical field sooner and going into the informatics side of the business. As far as the reporting structure, most informatics nurses still report to IT, but we’re seeing a shift of now reporting to nursing [leadership] more. I think that speaks to how the informatics field has evolved; now that we've purchased and implemented these systems, we need to optimize them with less of an IT focus and more of a clinical one. Also, there are now more chief nursing informatics officers; so those who are achieving higher levels of being notable within their own organization are getting the titles to follow.