Issue link: https://beckershealthcare.uberflip.com/i/1439541
36 CIO / HEALTH IT How to alleviate clinicians' EHR burnout, per 12 CIOs By Katie Adams C linicians are experiencing a burnout crisis that stems from several factors — one of them being EHR burden. Here, executives from 12 hospitals and health sys- tems across the country share their thoughts on how to best address EHR burnout. Editor's note: Responses have been lightly edit- ed for clarity and style. Michael Restuccia. Senior Vice President and CIO for Corporate Information Ser- vices at Penn Medicine (Philadelphia): A first step is to recognize that EHR burnout is real and must be addressed, particularly in today's environment where front-line caregiv- ers are oen stretched to meet the ever-grow- ing clinical demands of the population. A key contributor to EHR burnout focuses on the need for superfluous amounts of clinical documentation to ensure appropriate reim- bursement as well as clinical care support. e combination of organization and govern- ment requests to gather this data has resulted in the unintended consequence of burden- ing clinicians to respond to and document a never-ending set of inquiries. We are not yet perfect at this, but with the guidance of our clinical committees, our ap- proach to reduce this burden is multifaceted. Our efforts include validating the purpose of additional clinician documentation prior to building it within the EHR, eliminating ex- traneous documentation requirements, lever- aging/pulling preexisting patient data to pop- ulate required documentation and providing patients with the ability to enter data via the patient portal that can be validated by the cli- nician have been introduced. Simply put, the need for less documentation will result in less EHR burnout. B.J. Moore. Executive Vice President and CIO at Providence (Renton, Wash.): In close collaboration with clinical leadership, and in addition to ongoing targeted optimization work, we have made investments and estab- lished partnerships that enable us to make improvements that ease our caregivers' bur- den with speed in a sustainable way. In the spring of 2022, we will have completed our EHR standardization, one of the largest Epic implementations in the world. is will enable us to optimize workflows for the en- tire system and respond with greater agility to feedback and evolving needs. In addition, our strategic partnership with Nuance plays an important role through their ambient sensing technology including DAX (Dragon Ambient eXperience), which enables doctors and nurs- es to focus on the patient encounter instead of taking notes. Zafar Chaudry, MD. Senior Vice President and CIO at Seattle Children's: Helping to ease clinician burnout requires a multipronged approach. Providing quality training and "at- the-elbow" support is essential. Look at inter- ventions designed to optimize technologies and workflows. Maintain constant communi- cation directly with clinical leaders about EHR usability issues. Consider live or virtual scribes for certain high-volume medical specialties, and make voice recognition available for all clinicians. Ensure that the EHR team has both clinical and technical competencies. Jon Manis. Senior Vice President and CIO of Christus Health (Irving, Texas): EHR blame for physician burnout is likely masking bigger, more complex issues. e real chal- lenge is the requirement to use a new digital tool within an old analog care model. It's like being required to go to a video store to stream a movie or visit a banking branch to upload a check. e problem is exacerbated by the physician compensation model. Most physi- cians are compensated for seeing individual patients face-to-face, historically in-person. ough virtual visits have helped, traditional care and compensation models need to evolve into the digital age. Physicians should be fairly compensated for leveraging digital connections to keep healthy individuals well, and compliant, well-managed patients from utilizing costly, in-person clinic, hospital and emergency department services. To- day, physician mental health and job satisfaction are threatened by the requirement to use a digital tool within an analog care model while main- taining the one-to-too-many relationships ne- cessitated by large patient panels and the closely monitored productivity metrics that drive most physician compensation models. To alleviate stress and reduce physician burn- out, a modern digital care model should in- corporate a data and communication triage capability, an EHR, and a care team capable of remotely managing and coordinating care for individuals and patients by leveraging wear- able, implantable, and ingestible sensors; con- nected monitors and self-service diagnostic tests; automated, from-home check-ins and check-ups; automated health status, trends and alerts; compliance and progress reports; and the provision of in-person care by a phy- sician only as required by exception. Adopting modern care and compensation models that utilize available technology tools and digital channels will increase access, im- prove satisfaction and reduce costs. It should also help to reduce physician burnout and im- prove job satisfaction. How would physicians feel about their profession if they were able to work regular hours and maintain both their status and standard of living by spending more high-quality time with fewer patients — the clinical exceptions — that actually need to be seen in-person? R. Hal Baker, MD. Senior Vice President and Chief Digital and Information Officer at WellSpan Health (York, Pa.): We believe that the key to reducing EHR-related burnout for clinicians is to focus on the time and attention of caregivers as precious resources. Since our major EHR implementation in 2017, we have concentrated on caregiver time as a measurable resource and sought to reduce the amount of time EHRs demand of our care team. By recognizing that every nine to 15 seconds is 1 percent of the time for an office visit, we emphasized reducing the time spent with the computer to allow more time to focus on the patient. We also identified administrative tasks that could be removed from the workflow of our providers so that the physician can focus more attention on the needs of the patient. Perhaps the most exciting tool we have im- plemented is ambient voice technology in the office setting. By letting ambient technology document the conversation in the exam room, our providers can focus on engaging with their patient. A note follows a few hours later in the EHR and requires only a minute or two of edits, dramatically reducing the amount of a provid- er's time taken for documentation. Since adding ambient technology, our physicians are sharing that they enjoy their work much more and feel more connected to their patients during visits. Tom Barnett. Chief Information and Digi- tal Officer at Baptist Memorial Health Care (Memphis, Tenn.): I had a physician relay to me once that each irritation in the EHR or workflow is like a tiny stone in your shoe — it doesn't hurt that much at first (you might not even notice it) but aer a full day you literally could be limping from the pain! e EHR is consistently cited as one of the main drivers of physician burnout. It's a complex issue — is it the EHR that's burdensome or the tedious regulations behind it that are simply being expressed through the EHR? Perhaps a sub- optimal workflow could be to blame? I think one area that can add dramatic improve- ments to the provider experience is optimiza- tion. By that I mean every organization should