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Poorly Designed EHR Systems Are Major Cause of Physician Burnout

Poorly designed EHR systems are a significant factor in physician burnout, which is becoming a crisis in healthcare, new paper argues.

ehr systems

Source: Getty Images

By Fred Donovan

- Poorly designed EHR systems are a significant factor in physician burnout, which is becoming a crisis in healthcare, according to Ashish Jha, director of the Harvard Global Health Institute, physician, and Harvard faculty member.

“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,” observed Jha.

According to a survey published last year in the New England Journal of Medicine Catalyst, 83 percent of 703 clinicians, clinical leaders, and healthcare executives surveyed said that physician burnout was a significant problem at their organization.

Physician burnout, in which physicians lose satisfaction and a sense of efficacy in their work, has become a public health crisis, warned a paper, A Crisis in Health Care: A Call to Action on Physician Burnout, jointly prepared by the Harvard Global Health Institute, Harvard T.H. Chan School of Public Health, the Massachusetts Medical Society, and the Massachusetts Health and Hospital Association.

The paper called for significant improvements in the usability of EHR systems, including:

  • Reform of certification standards by the federal government
  • Improved interoperability
  • Greater use of application programming interfaces (APIs) by vendors
  • Increased physician engagement in the design and implementation of EHRs
  • Reduced documentation and quality measurement requirements payers and healthcare organizations place on physicians

The paper also recommended that organizations improve access to and expand health services for physicians, including mental health services, and appoint executive-level chief wellness officers to assess physician burnout and work with physicians on interventions to reduce burnout.

“The issue of burnout is something we take incredibly seriously because physician wellbeing is linked to providing quality care and favorable outcomes for our patients,” said Alain Chaoui, a practicing family physician and president of the Massachusetts Medical Society.

“We need our health care institutions to recognize burnout at the highest level, and to take active steps to survey physicians for burnout and then identify and implement solutions,” Chaoui added.

Other authors of the paper include Andrew Iliff, program manager at the Harvard Global Health Institute; Steven Defossez, vice president of clinical integration at the Massachusetts Health and Hospital Association; Maryanne Bombaugh, president-elect of the Massachusetts Medical Society; and Yael Miller, director of practice solutions and medical economics at the Massachusetts Medical Society.

The study found that physician’s meetings with patients are dominated by the demands of the EHR, which can impose a frustrating workflow that often detracts from good patient care.

The paper said that physicians typically spend two hours doing computer work for every hour spent with a patient, including completing online administrative tasks that do little to advance patient care.

Physicians cited poor workflow, distracting and unhelpful alerts, and burdensome documentation processes as the biggest problems with EHR systems.

The paper encouraged the development of APIs that could enable physicians, clinics, and hospitals to customize their workflow and interfaces according to their needs and preferences.

The paper related that artificial intelligence (AI) could be used to speed clinical documentation and quality measurements. AI could be used to automatically review documents and extract information for quality report and/or populate missing data fields.

“No matter what tools are brought to bear, a major course correction to reduce physicians’ burden of documentation is now overdue. Further, physicians must be deeply involved in the process of improving EHR usability,” it stressed.

The 2018 Survey of America’s Physicians by the Physicians Foundation found that EHRs were the most important “pain point” facing physicians in their practice. Close to 40 percent of physicians identified EHR design and interoperability as the one factors they find least satisfying about medicine.

“Physicians are increasingly obliged to document patient encounters through EHRs as the healthcare system moves toward quality-based payments and their attendant ‘paperwork’ requirements,” the survey observed.

A majority of respondents said that poorly designed EHRs have a negative effect on them in terms of efficiency and patient interaction.

The survey of 8,774 physicians found that close to 78 percent of respondents said they feel burned out at least sometimes.

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