Compared to paper files, electronic health records (EHRs) have facilitated quicker and more accurate communication among healthcare providers, but they are nonetheless often cited as a leading cause of physician burnout. After analyzing several studies on medical record-caused fatigue, a group of researchers came up with four key recommendations that they believe healthcare organizations could implement to curb burnout.
Lisa Merlo, Ph.D., an associate professor of psychiatry and director of wellness programs at the University of Florida College of Medicine, teamed up with Oliver Nguyen, a research coordinator and IT specialist in the College of Medicine, to evaluate 35 studies of records-related burnout, looking for common threads. Their study, published in the Journal of the American Medical Informatics Association, is part of a special issue on physician burnout.
“Having them do so much clerical work doesn’t make sense,” said Merlo. "In order to improve the healthcare experience for everyone, we need to help them focus more on the actual practice of medicine." Nguyen added, “The longer clinicians spend on records, especially after hours or on weekends, the more it’s associated with burnout.”
In 2019, leading healthcare researchers issued a “call to action” report, which stated that physician burnout is a public health crisis and addressing the problem requires improving EHR standards with a strong focus on usability and open application programming interfaces (APIs). “The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout,” report author Ashish K. Jha, M.D., the K.T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health, and director of the Harvard Global Health Institute, said in a press release statement accompanying that report.
Now, as the pandemic stretches healthcare workers ever thinner, “we’re beyond the straw that broke the camel’s back,” Merlo opined. “The system has survived for so long because physicians step up and get the work done out of a sense of altruism and dedication to their patients. But there’s only so long you can sustain that.”
Physician wellness initiatives have increased during the pandemic, often focusing exclusively on self-care. But “adding more yoga classes is not going to address a clinician working on electronic health records at home at 11 p.m.," Merlo said.
As such, Nguyen and Merlo teamed up with colleagues at the University of Alabama at Birmingham, the U.S. Navy, Moffitt Cancer Center, the University of South Florida and the University of Central Florida, and uncovered several potential solutions that could help physicians. Their recommendations included:
- Share the load
Overflowing inboxes contribute to burnout, the researchers stated. As the pandemic shifts some office visits to videoconference, email and phone communication, “inboxes are blowing up,” Nguyen said. A shared inbox that allows office staff to triage messages that don’t require a doctor’s input, such as insurance questions, can help.
- Revisit policy
The Centers for Medicare and Medicaid Services (CMS) launched its Patients over Paperwork initiative in part to reduce the documentation requirements. If it shows promising results for reducing records burden, Nguyen and Merlo said, it could serve as a model for private insurers to emulate.
- Create power users
Even when they’re familiar with an EHR interface, doctors might not know about time-saving features like templates and bookmarks. An optimization team that offers proactive support can streamline time spent in the system.
- Collaborate on design
“Usability continues to be a struggle for physicians,” Nguyen said. More input from users can help when it comes to designing EHRs, as well as selecting and implementing them.
“The good news is, a lot of the issues can be fixed,” Merlo said. “If we invest in these resources, we can make this better for patients, for health care providers, for everybody.”