In June 2016, researchers from the Mayo Clinic and AMA surveyed a national sample of 6,560 physicians regarding physician burnout. According to the survey, the majority of respondents pointed to EHR systems as a cause of clerical burden, contributing to feelings of emotional exhaustion, depersonalization and a reduced sense of personal accomplishment, i.e. physician burnout. As the survey suggests, many physicians quickly name their EHR system as a burden, rather than an advantage, and say they spend more time in front of a screen, less time with their patients and additional hours working at the end of the day.
EHR systems in general aren't to blame, but rather poorly developed user design and inefficient workflows related to the technology are the culprit. Certain characteristics of physician-centric and well-developed systems can help reduce the administrative burden, make quality of care reporting easier, help us get paid for the work we do, and as a result help reduce physician burnout.
Doctors went to medical school to help people and to treat patients' health concerns. But increasingly, a physician's time is spent on administrative items such as patient intake forms, prior authorizations, and billing compliance. With the CMS further defining the move towards compensating for quality rather than quantity, documentation for PQRS, Meaningful Use and ICD-10 will now be spent on MACRA and MIPS. In the past, half of my administrative burden occurred during the patient visit, while the other half was outside the visit, and it took valuable time away from my family.
Lately, I've found that the right EHR can help eliminate time-consuming administrative tasks and complete the majority of patient data entry during the actual visit. This allows me to enter patient data only once and leave the office on time. It also helps eliminate the after-hours work of uncompensated time too. Less headache, more time with my family.
Actionable Data, Physician Experience and More
Not all EHRs are created alike and those with structured data and automated reporting measures can be a help rather than a hindrance to documentation and tracking patients' progress. Patient data collected in a touch-based system at the point of care ensures that information is only collected once and can be used for multiple purposes, from populating a superbill to easily reporting for PQRS and/or the quality component of MIPS. Medical coding should be built-in, and all outputs and reports are automated. This accurate data collection saves time in the long run and helps physicians get paid for the work that they do. No under billing or over billing, no seeing the same number of patients yet being paid less.
Quality of care is of growing importance, especially with MACRA going into effect this year. Analytics that track and analyze clinical performance data will help physicians come out on top with MACRA and provide doctors with actionable data to increase their referral base, understand payer mix and ensure they are at or above quality benchmarks to reduce chances of revenue gaps.
EHRs at their core should be physician-centric. We're the users and an intuitive user experience is vital. Yet so few seem to be built with the workflows of specific specialties in mind. Dermatologists don't have the same workflow as ophthalmologists. It shouldn't be the physician's responsibility to take the time to transform a one-size-fits-none design into a system that works for them.
Vendors should ensure that specialty-specific medical knowledge and coding are built in and available out of the box. Physicians should only see what they need to see, not superfluous plans that don't apply to them. Intuitive systems that remember physician preferences and know a specialty's workflow save valuable time. Adaptive learning and predictive algorithms remember the most common diagnoses seen plus their treatments. The plans that physicians utilize most frequently move to the top of the list. In addition, there are systems that help physicians string together a list of diagnoses and interventions across multiple practice locations. Cloud-based and mobile, iPad-based systems not only let doctors access the information they need when and where they need it, but also help maintain the physician and patient interaction during the exam.
Technology increasingly enables patients to access their test results, medical records, images and prescriptions through the convenience of patient portals on their smart device or desktop. This creates more engaged and educated healthcare consumers, and more importantly takes away much of the administrative burden of collecting patient information from the physician and practice. Kiosks in the waiting room can help speed up and streamline the check-in process by letting patients update their personal information and medical history and sign consent forms on an iPad. When the kiosk integrates with the EHR and adds data to the patient's record automatically, it saves time and increases accuracy.
There's no question, physician burnout is a real and major problem contributing to overall physician dissatisfaction, but EHRs as a whole are not to blame. Poorly designed EHR systems can contribute to the complicated physician burnout problem. However, a tailored and intelligent system allows physicians to forget about burdensome administrative tasks.
Dr. Michael Sherling is the co-founder and Chief Medical Officer of Modernizing Medicine. He’s responsible for developing and designing the dermatology-based software, and supervising the the design of Modernizing Medicine’s other EMA specialties. Michael has been a practicing dermatologist since 2006. He is currently practicing in a comprehensive skin care dermatology group in Palm Beach County, Florida. He is an expert in medical, surgical and cosmetic dermatology.
Michael obtained his B.S. in Biology at Brown University with honors in 1996, his MD from Yale School of Medicine with honors in 2002, and his MBA from Yale School of Management in 2002. He received his clinical training at Harvard Medical School, where he served as chief resident in dermatology. He is licensed to practice medicine in Florida.