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Yet Another Study Says EMRs Contribute to Physician Burnout

Posted on September 21, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A Mayo Clinic study recently concluded that – surprise, surprise – that physicians who used EMRs were less likely to be satisfied with the amount of time spent on clerical tasks. But from where I sit, while the story certainly deserves attention, it’s also worth considering how this fits into the problem of physician burnout on the whole.

First, let’s review the study itself. To conduct the study, which appeared in the Mayo Clinic Proceedings, researchers connected with 6,375 physicians in active practice, 5,389 of which (84.5%) reported using EMRs. Meanwhile, of 5,892 physicians who said that CPOE was relevant to their practice specialty, 4,858 (82.5%) said they used CPOE technology.

Researchers concluded that physicians who use EMRs and CPOE had lower satisfaction with time spent in clerical tasks and higher rates of burnout, including when the data was adjusted for age, sex, specialty, practice setting and hours worked per week. The bottom line, researchers said, was that this large national study demonstrated that satisfaction with EMRs and CPOE was generally low.

Now let’s take a look at the big picture on physician burnout. One comprehensive take comes from the American Academy of Family Physicians, whose position paper on the subject includes the following definition of burnout: “A syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feeling of cynicism (depersonalization), and a low sense of personal accomplishment.”

The AAFP paper, which points out that the phenomenon has been studied for decades, notes that 45.8% physicians are considered to be experiencing at least one symptom of burnout. According to a recent broad-based study, that there is currently a 35.2% overall burnout rate among U.S. physicians.

According to research cited by the AAFP, there’s still no definitive data on what causes physician burnout, but notes that common drivers of family physician burnout include paperwork, feeling undervalued, frustration referral networks, difficult patients, medicolegal issues, and challenges in finding work-life balance.

While I don’t want to minimize the impact that a badly-designed EMR can have a negative impact on a physician’s practice, or underplay the findings of the Mayo study cited above, I think it’s worth noting that the group doesn’t cite EMRs as a specific cause of burnout.

Clearly, physicians don’t like using EMRs for administrative work — and it even appears that they would rather use paper to handle such chores. However, let’s not kid ourselves into thinking that doctors loved documenting on paper either. Complaints about not wanting to finish their charts were common in the paper world too.

And the truth is, as EMRs have gradually shifted from being vehicles to support billing to richer clinical documentation and support tools, it may very well have become harder to use them for routine administrative tasks. Vendors probably need to reconsider yet again the balance between clinical and administrative features, and how effective both are.

That being said, I think it’s important not to forget that physicians are facing many, many challenges, most of which began grinding away at their independence and self-respect well before EMRs became an established part of the picture.

Unfortunately, it’s likely that for some physicians, feeling forced to adopt an EMR has proven to be the straw that broke the camel’s back. And they certainly deserve a hearing. But if in the process, we allow ourselves to lose sight of the countless other problems physicians are struggling with, we are doing them a disservice. Addressing physicians’ EMR issues won’t fix everything that’s broken here.

Generation Who Doesn’t Know Paper Chart World – EHR Natives

Posted on November 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I loved this insight from a doctor at EMA Nation, Modernizing Medicine’s EHR user conference. When making the comment, he was talking about how many MAs in his office don’t know how to keep the clinic going in a non-EHR world (ie. the EHR is down). Obviously, that’s an example of where dependence on EHR goes too far. However, I’ve found that a great leader in a practice can easily quell and comfort these MAs (and other clinical staff) when the EHR is down or otherwise unavailable. It’s never a fun experience, but it can be managed.

While dependence on EHR has its challenges, it also illustrates where the industry is headed. Very quickly not just the MAs, but the RNs, doctors and all of your staff will be EHR natives. What’s an EHR native? It’s someone who has only practiced medicine or worked in a clinic where an EHR was present.

The number of EHR natives is still rather small, but it’s starting to grow very quickly. Soon, we won’t even be having a discussion of going back to paper charts, because a large majority of users won’t even know what it was like to practice on a paper chart. In fact, they’ll likely not even understand how someone could practice medicine on a paper chart.

This is a dramatic cultural shift that is happening right before our eyes. However, the shift is slow and gradual, so many people don’t even realize that it’s happening. While it currently is important to talk about EHR acceptance, this will be gone forever with EHR natives. Many of the paper chart culture will just disappear from healthcare.

I personally look forward to this day. That’s not to say that many of the paper chart natives can’t learn EHR as well. They can and do. Although, I know the cost of learning something new and it’s high. Trust me. I just added snapchat to my cell phone. All I longed for was to go back to SMS, Facebook, and Twitter. It’s definitely hard to teach an old dog new tricks. It’s possible, but possible doesn’t mean it’s easy.

An Image Worth 1000 Words Offers a Great Healthcare Perspective

Posted on August 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I have no idea where this picture comes from, but it’s a pretty interesting look into some of the history of medicine. As @notasmedicina points out, it’s pretty disturbing to see them working on someone without gloves. Take a look below to see what I mean.

As I saw this, I thought about how far we’ve come with EHR software. I wonder if 20-30 years from now we’ll look at a picture of a paper chart and feel disturbed. I imagine my children will look at it and wonder how a doctor could practice medicine with a paper chart.

Dealing with Old Paper Charts in an EHR World

Posted on January 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

To preview this post, start by enjoying this quick 1 minute video preview:

Such a well done video by ChartCapture. Plus, it intrigued me enough to get me interested in what they had to offer. I think I’d actually met them at the Canon booth at HIMSS before, but somehow I did’t capture the full simplicity of their chart scanning solution until I saw this video demonstrating how their solution works:

I love really simple and straightforward appliances and chart capture is the perfect solution for an appliance like this. It’s beautiful to have a plug and play appliance with no server, no setup, and just ready to go without having to get IT to make it a priority.

As I talked to Scott Ferguson from ChartCapture, I asked him when most customers chose to start using their product during an EHR go live. He responded, “Most customers typically drop us in 90 days prior to go live (or as soon as the have the “realization moment”).”

I love the concept of the realization moment and anyone who’s worked on an EHR implementation knows what I’m talking about. It’s that moment during the EHR implementation that the users ask the question “what about the paper charts?” For some reason many people just think that the EHR vendor will somehow magically just deal with the paper charts. The realization moment is when they realize that they’re going to figure out what to do with the paper charts.

I’ve long been a proponent of scanning in your old paper charts. I still love the outsourcing option because some of the quality they can provide in the scanning process. However, that option is cost prohibitive to many. So, an appliance like ChartCapture is a nice alternative solution for scanning your paper charts at a lower cost. Just be sure if you choose to scan in house that you make sure you hire detail oriented people for the job. It’s a monotonous job and requires detailed effort to do it right.

Putting Paper Charts into Perpsective

Posted on June 6, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

It was with a sigh of relief that the nurse at my daughters’ new pediatrician’s office handed me my youngest’s immunization records just minutes after I requested them. This was her first well visit at the new doctor’s office, and I wasn’t sure how easily everything would transfer over from her previous doctor. Thankfully, the nurse was able to pull them up within seconds via their EMR, and I was happy to see they were in a format I could easily understand. The fact that my youngest had previously seen a pediatrician within the same health system certainly helped record retrieval.

I had to jump through quite a few hoops to make sure my oldest’s were faxed from the old provider to the new provider. Consent and release forms had to be filled out and faxed. Multiple phone calls had to be made to each provider. It was just so time consuming! Oh, how I look forward to the days when health information exchange can make this process a little easier.

For all the complaining and nit picking I might do when it comes to the absence, delayed use  or misuse of electronic medical records, I (and pretty much everyone else in a first-world country) really have no reason to bellyache. This realization was driven home when I came across a recent Bill & Melinda Gates Foundation blog by Orin Levine. The title, “Records for Life: Saving Lives by Design,” made me think I was about to read an opinion piece of the importance of user experience in EMRs. The subject turned out to be much simpler, and so much more important, than my initial impression.

Levine, who provided aid in refugee camps while working for the CDC some years ago, was astounded that more than 60% of parents in the camps had their children’s paper health record with them. “What struck me was that these mothers and fathers,” he writes, “who were able to bring so little with them when they fled their homes, chose the child health record as one of the few possessions to take.”

His observation certainly puts things into perspective. How many of us would grab the folder filled with our children’s medical history, rather than the scrapbooks gathering dust in some rarely opened chest? Many of us, I’m sure, would assume these records are resting safe somewhere in the cloud, waiting to be accessed at our convenience.

Things aren’t so simple in other parts of the world, and it comes as no surprise that developing countries still rely on paper charts.

“These cards are particularly important in the developing world,” Levine explains, “where electronic health record systems are almost non-existent. Historically, these cards have been developed for national immunization programs by health care providers who have little, if any, design experience to maximize the cards’ utility.”

Perhaps the next time we watch our providers suffer through an extra mouse click, or toggle back and forth between screens, we can remind ourselves – and them – how fortunate we are to be receiving care with a roof over our heads and records at our fingertips.

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The Bill & Melinda Gates Foundation is launching an international contest to redesign the child health record. Guidelines for the contest are available here.

Things EMR Doctors Never Say

Posted on September 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Here’s a quick look at Things EMR Doctors Never say (maybe I’ve been watching too many late night shows):

“I’m so glad to be doing meaningful use!”

“I can’t wait until ICD-10 makes my life easier.”

“I wonder when that ACO model is finally going to kick in. I can’t wait.”

“I miss trying to read Dr. Smith’s handwriting.”

“I wish I could go and ask HIM for a chart pull.”

“I miss hiding behind the pile of paper charts on my desk.”

“I love this fax machine.”

“I miss the coffee stains on the paper charts.”

“I love the mix of EHR, EMR, HIE, ACO, ONC-ATCB, ICD-10, 5010, BI, with the RCM cherry on top.”

I’m sure I missed some. Please add more in the comments and I’ll add them to the list.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 26-30

Posted on October 28, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I met someone at a conference who commented that they liked this series of posts. I hope you’re all enjoying the series as well.

30. Remember that the EMR is only part of the safety problem
Remember that the EMR is just a tool. How you use that tool still matters. How you manage that tool matters. How you implement that tool matters. Safety is a result of great processes and that doesn’t change when you implement an EMR. In fact, I’d say it’s even more important. The same applies to bad clinical workflows. EMR won’t solve those bad workflows either. You can try to do a redesign of the workflows with the EMR implementation, but that often doesn’t go over well.

29. Errors should be easily reportable
To be honest, I’m not sure exactly which errors Shawn is talking about. I think I’ll take a different spin on it than what he intended and talk about the errors or issues that someone has using an EMR. This is particularly important when you first implement an EMR. You should want to know the errors that are occurring regularly so you can fix them. Make it easy for them to report them and provide proper encouragement and/or rewards for reporting errors they have with the system. Ignorance is not bliss…it always catches up to you eventually.

28. Use data to show both individual and system safety metrics
The key component that Shawn is describing here is the ability to report on various cross sections of data (individual vs system). If you can’t chop up your data to really know what’s going on in your system, then you’re not going to be able to really pinpoint the issues that users are having. Maybe it’s only one person who’s bringing down the average for the entire hospital. You don’t want to make sweeping changes to the system that annoy the majority of users when all you really needed to do was address the issues of an individual or small group of individuals.

27. Record management in the EMR is just as important as in paper
You thought HIM was done when you got the EMR. Wrong! Their role is still very important. Granted, it changes pretty dramatically, but in the clinics I’ve worked in the records management people were able to do a much more effective job improving the patient record in the EMR. Many of the things they did they never had time to do cause they were too busy pulling and filing paper charts.

26. Evaluate decision support tools for a fit to your needs
I believe that the clinical decision support tools are going to be the thing that changes the most over the next 5-10 years. You should definitely see how the clinical decision support tools they have available fit into your environment, but also spend as much time seeing what they’ve implemented and what their road map and method of implementing new clinical decision support tools is so you know where they’re going to be with their tools and product in five years.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.

EMRs and Paper Records: Natural Enemies

Posted on March 5, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

How useful is an EMR when large volumes of data don’t get entered into the system?   It seems we’ll have plenty of chances to find out.

As the following story illustrates, clinical staffers will often revert to using paper documentation at their first opportunity, even if a perfectly nice EMR is available for use.

Apparently, U.S. Army mental health personnel working in Afganistan and Iraq aren’t entering patient data into the DoD’s AHLTA EMR system. The Army is now swamped with paper behavioral health records and has no system in place to scan and code the records for use within AHLTA, according to iHealth Beat.

Admittedly, entering data on the battlefield may pose some unique problems. Still, I doubt the DoD is the only organization facing this problem. After all, if you’re a clinician who’s been using paper records for decades, and somebody suddenly tells you to stand your work habits on their head, resistance is only natural.

Now, I’m well aware that even if the DoD hasn’t purchased one, there are systems available which can transform paper records into data usable by an EMR.

However, I’m fairly such systems are designed primarily to import data from  existing paper archives.  I doubt they could transform an ongoing stream of paper records into data quickly — much less in real time.

The truth is, paper and EMRs are natural enemies. You either chart it or you enter it, but the two are based on substantially different work flows.  If your health organization’s staff slips back into using  paper documentation, it’s not just an inconvenience, it’s a huge problem.

After all, just imagine the potential for patient harm if half the critical data lives on the EMR platform and half in paper.  When they need live patient data, what do clinicians do with a message from IT that says: “We’re two weeks behind on scanning — figure it out for yourself”?