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Doctors Work 2 Hours on EHR Tasks For Every 1 Hour of Time With Patients – Are You OK With That?

Posted on December 10, 2018 I Written By

The following is a guest blog post by Wayne Crandall, President & CEO of NoteSwift.

At NoteSwift, we’re passionate about providing clinicians with the tools and workflow support they need so they can focus on delivering great care to their patients. It’s become increasingly clear over the past few years that EHR workflows are a big frustration for many doctors. This leads us to today’s question:

As a healthcare industry, are we satisfied with a system that forces clinicians to spend two hours inputting and completing EHR records for every one hour of actual time with patients? Is this the kind of health care we aspire to provide?

In thinking about this topic, I’m reminded of a blog I read a couple years ago which passionately addressed the issue of EHR time burdens from the perspective of a physician. Hear the passion in the author’s voice, and consider the tips and workflow adjustments he’s been forced to adopt in order to minimize the time they spend in EHR work.

The author calls the amount of time many EHRs require a “national disgrace” because it pulls doctors away from time with patients. We hear this story from nearly every clinician we talk to — it’s painful and frustrating to train for years to care for patients, yet feel forced to spend most of the day typing notes and clicking EHR check boxes.

A recent white paper looking at studies across the industry backs up this frustration with even more data. Doctors today are forced to spend two hours on EHR entry for every one hour of patient care. This EHR time burden is directly connected to the increase in physician burnout being reported across nearly every physician specialty. You can access this white paper here.

I believe it’s our obligation as an industry to continue improving our EHR workflows to better serve clinicians working on the front line of health care and who need more time to build relationships with patients, not EHR workflows.

At NoteSwift, we believe there is no reason for a clinician to spend 2 hours manually completing an EHR record, and we are working on exciting A.I. solutions to reduce the time doctors spend in their EHRs. Our solution, Samantha, the real-time EHR transcriptionist, allows clinicians to dictate the patient narrative one time; from there, powerful A.I. parses the narrative, creates structured data elements, adds those elements across the entire EHR, and offers the clinician a review screen to finalize the note. The entire process is automated, accurate, and efficient.

The author ends his blog with the following sentence: “Every day on my way into work I make a conscious decision to do everything possible to spend face-to-face time with patients.” I think this is a great mantra for doctors to adopt, and it’s the responsibility of all of us in health care to continue improving our EHR workflows to make better patient care a reality.

To receive your complimentary copy of this white paper, “Physician Burnout By The Numbers,” click here. You’ll receive instant access to the paper as a resource for you and your team.

About Wayne Crandall
Wayne Crandall’s career in technology spans sales, marketing, product management, strategic development and operations. Wayne was a co-founder, executive officer, and senior vice president of sales, marketing and business development at Nuance Communications and was responsible for growing the company to over $120M following the acquisition of Dragon and SpeechWorks.

Prior to joining the NoteSwift team, Wayne was President and CEO of CYA Technologies and then took over as President of enChoice, which specialized in ECM systems and services, when they purchased CYA.

Wayne joined NoteSwift, Inc. at its inception, working with founder Dr. Chris Russell to build the team from the ground up. Wayne has continued to guide the company’s growth and evolution, resulting in the development of the industry’s first AI-powered EHR Virtual Assistant, Samantha(TM).

NoteSwift is the leading provider of EHR Virtual Assistants and a proud sponsor of Healthcare Scene.

Is EHR Use Causing Physician Burnout?

Posted on November 12, 2018 I Written By

The following is a guest blog post by Wayne Crandall, President & CEO of NoteSwift.

Over the past decade, numerous studies have been published with the same concerning conclusion – physicians are increasingly expressing feelings of burnout, frustration, and a lack of support from their employers and technology solutions. There is no single cause for this burnout, but there are plenty of signals pointing to a primary cause:

EHR use, requirements, and regulations are leading to incredibly high levels of physician burnout.

The data is increasingly clear on this issue. Consider this statistic: according to a 2015 survey, almost 90% of doctors feel moderately to severely stressed and burned out on an average workday.

And this one: A new study by the University of Wisconsin and the American Medical Association (AMA) found primary care physicians spend almost six hours (5.9) on EHR data entry during a typical 11.4 hour workday.

Because of this rapid rise in physician burnout and clear connection to EHR use and management, we decided to look more deeply into the causes, symptoms, and possible solutions to the physician burnout crisis. The result of this research is a newly published white paper we’ve created in partnership with Dr. Robert Van Demark, Jr., a leading voice on the issue of physician burnout.

In this paper, you’ll find the following:

  • Compilation of recent data and studies on the symptoms and causes or physician burnout.
  • Researching connecting physician burnout to employee retention
  • Examination of how EHR use contributes to the burnout crisis
  • A look ahead to emerging solutions to this crisis

There are many compelling examples for why this research is more timely and important than ever. In a time where many physicians are questioning whether the burnout, stress, and anxiety are worth it, health care systems are reporting massive costs for recruiting and replacing doctors who leave due to burnout and overwork. The stakes could not be higher for health systems, doctors, and patients who need access to expert care.

The paper also takes a closer look at the innovative world of artificial intelligence and how it holds much promise for improving health care and EHR entry through automation and understanding. At a time where physicians are looking for more ways to control their workflow and create better, more efficient care for patients, the world of artificial intelligence is leading the way toward better solutions and better care.

I was recently reading a helpful LinkedIn article on the topic of physician burnout, and the author noted how many practices and health care systems focus on treating the symptoms of physician burnout instead of treating the actual cause of this burnout. More meetings, more committees, more work for doctors, while the underlying causes go untreated. EHRs are a primary cause of this burnout, and we believe that finding a better way to handle our EHR work is major way we can improve workflows and reduce physician burnout. Hopefully this white paper can lead the conversation in that direction.

To receive your complimentary copy of this white paper, “Physician Burnout By The Numbers,” click here. You’ll receive instant access to the paper as a resource for you and your team.

About Wayne Crandall
Wayne Crandall’s career in technology spans sales, marketing, product management, strategic development and operations. Wayne was a co-founder, executive officer, and senior vice president of sales, marketing and business development at Nuance Communications and was responsible for growing the company to over $120M following the acquisition of Dragon and SpeechWorks.

Prior to joining the NoteSwift team, Wayne was President and CEO of CYA Technologies and then took over as President of enChoice, which specialized in ECM systems and services, when they purchased CYA.

Wayne joined NoteSwift, Inc. at its inception, working with founder Dr. Chris Russell to build the team from the ground up. Wayne has continued to guide the company’s growth and evolution, resulting in the development of the industry’s first AI-powered EHR Virtual Assistant, Samantha(TM).

NoteSwift is the leading provider of EHR Virtual Assistants and a proud sponsor of Healthcare Scene.

EMR and EHR Angst

Posted on March 21, 2018 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 thought it was time to do another Twitter roundup and as I started searching for interesting tweets I came up with a theme: EMR and EHR angst. I’m sure if you use an EHR in your practice, then you’re familiar with this subject. The following tweets illustrated some of the angst that exists out there.


I love the term algorithm monster that we get from John. I wonder if he’d feel different if the algorithm monster was able to improve patient care and not just maximize reimbursement.


Jeremy offers a more rosy view of EMR. Although he still has angst that many people are treating the EHR as the end game as opposed to a foundational piece that’s required to get to the benefits that so many desire. I think many are just tired of the promises that never materialized.


Leave it to the Gomer blog to add some humor to the situtation. Unless you’re the one that far behind on your charts. Then, it’s not quite so funny.

Two Medical Practices’ Reactions to MACRA Ruining Healthcare

Posted on January 31, 2018 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.

Last week I wrote a post that discussed whether MACRA was ruining Healthcare. It’s an important discussion to have as we look at where healthcare IT legislation should go in the future.

In response to the article I got some pretty heated responses from medical practices that I thought were worth sharing with the wider audience who doesn’t get a chance to read the comments (yeah, I know that’s most of you).

The first comment is from Billy who said the following:

I wouldn’t say MACRA is ruining healthcare, but it’s starting to drive the decision train, which may be the first step.

From my corner of healthcare in America, our practice is forcing adherence to MACRA to set the tone for an ever growing portion of the workflow. The benefit from such is viewed as non-existent aside from protecting revenues. We have compliant doctors (with plenty of grumblings), but no happy ones that are doing this in the belief it’s good for medicine.

Taking two parts of your post I think I can speak towards in view of that…

“All of this leaves doctors I know upset with MACRA and MIPS. They wish it would go away and that the government would stop being so involved in their practice.”

They’re upset at the government because MACRA is seen as an intrusion with no benefit. At best, it’s a threat to their income (both to the business and their end of year salary), and at worst, they don’t trust the government entering the realm of “quality” which traditionally was limited to clinical relevancy. We’ve had plenty of internal discussions of how MACRA quality measures are worlds away from what the physicians view as truly important quality measures for their profession.

“Let’s imagine for a minute that Congress was functional enough to pass a law that would get rid of all of MACRA. Then what? Would doctor’s problems be solved?”

This doesn’t account for the primary reason MACRA was passed in the first place- controlling the costs of Medicare. They can talk about quality all they want, the government needed to eliminate the near automatic 2.5% (or thereabouts) increase in Medicare fee reimbursements. They do that with the freeze in rate increases, and making the physicians battle each other for what remains with the reward/penalty system.

Congress will never get rid of MACRA, it’s their plan to keep Medicare costs from blowing up until 2025 as the boomer generation keeps adding to the rolls.

So, MACRA is seen as having no benefit but a lot of downside in income and daily operations. About the only other thing that could have brought these emotions about would come from the IRS, but this is worse in some ways, as it’s forcing changes in clinical operations for the purpose of checking a box to protect income.

Welcome to the new normal.

It’s hard to think that Billy is right that this is the new normal. Should it be? Could we do something to make it so it’s not?

The next comment was from a long time reader who’s been commenting against MACRA and meaningful use before that (ie. a long time). Here’s meltoots’ take on the question of if MACRA is ruining healthcare:

Yep.
Count me as another mid career MD that sees the futility in any hope for the future of medicine. We are doomed. I do everything I can to talk everyone out of becoming an MD. Including my children.

We have 100% of the accountability and zero authority. Worse I am penalized by our government because I refuse to play stupid counting and clicking games. I was just discussing again (seems daily) my plans to exit this career. Too bad as I am one of only 4 orthopaedic surgeons left at our hospital. 20 years ago we had 35 on staff.

Every single person on earth seems to be saying all this data entry by MDs is silly, inefficient, useless, complex and frankly a huge costly waste of time. Everyone is speaking to burdens and the ridiculous nature of all this forced mindless data entry, super complex reporting, terrible auditing and penalizing for no good reason. When we look back a decade from now and wonder how we made medicine like the postal service, I know I can say I did try to point out better ways. But no one listened. At all.

If all these programs are so wonderful, tell me all the great things that have come out of MU, PQRS, VBM, QPP? So you got MDs to buy EHRs. Great. Everyone hates them. Great work.

HITECH set back real IT innovation in medicine at least a decade.

CMS touts patents over paperwork with absolutely no action, even worse, they made the MACRA program even more burdensome this year. AAPM, you want me to take even MORE risk, and hire more admins to run it? For 5%? Come on.

I have finally come to realization, that medicine has been destroyed by administrators, CMS /ONC, regulators, bean counters and the dozens of people I support just trying to stay ahead of the complexity. Its like the movie Office Space when I forget to click something in the 1000 clicks I have to do a day, I get 10 admins telling me about my TPS reports on what I did wrong.

What is really the worst part, is that I am pretty darned good at what I do, I am super busy and loaded with patients, too many. So I will be yet another MD, that has just had enough, that left the game in his prime. We should all be ashamed at what we did to our physicians.

Burnout is Overused and Under Defined

Posted on December 8, 2017 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

Recently, John hosted a #HITsm chat on using technology to fight physician burnout (Read the full transcript from the chat here). The topic’s certainly timely, and it got me to wondering just what is physician burnout. Now, the simple answer is fatigue. However, when I started to look around for studies and insights, I realized that burnout is neither easily defined nor understood.

The Mayo Clinic, among others, defines it this way:

Job burnout is a special type of job stress — a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work. 

So, it is fatigue plus self doubt. Well, that’s for starters. Burnout has its own literature niche and psychologists have taken several different cracks at a more definitive definition without any consensus other than it’s a form of depression, which doesn’t have to be work related.

Unsurprisingly, burnout is not in the DSM-5. It’s this lack of a clinical definition, which makes it easy to use burnout like catsup to cover a host of issues. I think this is exactly why we have so many references to physician or EHR burnout. You can use burnout to cover whatever you want.

It’s easy to find articles citing EHRs and burnout. For example, a year ago April, The Hospitalist headlined, “Research Shows Link Between EHR and Physician Burnout.” The article then flatly says, “The EHR has been identified as a major contributor to physician burnout.” However, it never cites a study to back this up.

If you track back through its references, you’ll wind up at a 2013 AMA study, “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.” Developed by the Rand Corporation, it’s an extensive study of physician job satisfaction. Unfortunately, for those who cite it for EHR and burnout, it never links the two. In fact, the article never discusses the two together.

Not surprisingly, burnout has found its way into marketing. For example, DataMatrix says:

Physician burnout can be described as a public health crisis especially with the substantial increase over the last couple of years. The consequences are significant and affect the healthcare system by affecting the quality of care, health care costs and patient safety.

Their solution, of course, is to buy their transcription services.

What’s happened here is that physician work life dissatisfaction has been smushed together with burnout, which does a disservice to both. For example, Medscape recently published a study on burnout, which asked physicians about their experience. Interestingly, the choices it gave, such as low income, too many difficult patients – difficult being undefined — are all over the place.

That’s not to say that all physician burnout studies are useless. A recent study, Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative, used a simple, five item scale to ask physicians how they viewed their work life. See Figure 1.

Figure 1 Single-Item Burnout Scale.

Their findings were far more nuanced than many others. EHRs played a role, but so did long hours. They found:

EHR proficiency training has been associated with improved job satisfaction and work-life balance.14 While increasing EHR proficiency may help, there are many potential reasons for physicians to spend after-hours on the EHR, including time management issues, inadequate clinic staffing, patient complexity, lack of scribes, challenges in mastering automatic dictation systems, cosigning resident notes, messaging, and preparing records for the next day. All of these issues and their impact on burnout and work-life balance are potential areas for future research.

There’s a need to back off the burnout rhetoric. Burnout’s overused and under defined. It’s a label for what may be any number of underlying issues. Subsuming these into one general, glitzy term, which lacks clinical definition trivializes serious problems. The next time you see something defined as physician or EHR burnout, you might just ask yourself, what is that again?

The Whole Healthcare System is Burnt Out

Posted on November 2, 2017 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.


We’ve all seen charts and graphs like the one above. Physician burnout has become a real problem. The EHR has largely become the scapegoat for the physician burnout, but I believe it’s much more complex than that. There are a lot of pressures on doctors that are causing burnout and even physician suicide (a topic which many don’t like to talk about).

Physician burnout is indeed an important topic and one that needs to be addressed. However, I recently saw someone tweeting about physician burnout and in response, someone suggested that we should be talking about Patient Burnout as well. The idea really resonated with me. Especially because I’d never heard anyone talk about patient burnout despite it being a real problem. To better understand the effort, I asked Erin Gilmer to host this week’s #HITsm chat on Patient Burnout. I think we’ll learn a lot about this topic during the chat.

This week I’m at the CHIME Fall Forum with a wide variety of healthcare CIOs. During one of the keynotes, the speaker mentioned physician burnout and it prompted the following tweet:


Indeed. Many healthcare CIOs are burnt out as well. They have so many regulations, so many intiatives, cybersecurity issues, and much much more that’s hitting them from every angle. it’s no wonder that they’re burnt out.

This all made me realize, the whole healthcare system is burnt out. Is there anyone in healthcare that isn’t a little burnt out? Some deal with it better than others, but there’s a lot of burnout all around in healthcare.

This tweet captured the issue of burnout nicely.


How then do we fix all this burnout? I wish I knew the answer. Acknowledging it is the first step, but that still leaves us a long way from a solution. Hopefully we can work towards it for everyone involved.

Physician Burnout Cartoon – Fun Friday

Posted on September 29, 2017 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.

If you haven’t noticed, I love irony. That’s why this cartoon from Pediatrician and Cartoonist Dr. Maypole was perfect for a Fun Friday entry.

The sad part of this Fun Friday is that this is far too true for far too many doctors. The one good thing is that people are now recognizing it and working to address it in their workforce as Dr. Maypole suggests we do.

Quadruple Aim of Healthcare Infographic

Posted on May 25, 2017 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.

There’s been a lot of talk about the triple aim of healthcare and the need to refocus many of the EHR and healthcare IT solutions on the triple aim. Many of the concepts are really good, but the triple aim is certainly not all encompassing.

This was highlighted really well by this infographic (see below) by Caradigm which suggests a 4th aim that should be added: Improving the work life of health care providers, including clinicans and staff.

The most ironic part of the infographic is the final section which talks about how technology solutions can be used to make providers’ lives better and decrease physician burnout. While I agree that technology solutions could and should help with this problem, the reality is that many of them have just made this problem worse. We could talk about whether the EHR is the whipping boy for regulations, but the EHR definitely is getting the blame for a lot of physician burnout. Will we turn the corner and start seeing technology as an enabler of this 4th aim? Or maybe I should say when will we see this?

Physician EHR Burnout Infographic

Posted on February 9, 2017 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.

Physician burnout is a hot topic and one that’s not likely to go away anytime soon. There are a lot of elements to physician burnout and I was impressed with how well eMedApps captured the issue of physician burnout in the infographic below.

I think the question of the next decade is going to be, “How do we decrease the administrative tasks the doctors perform?” If we don’t find a satisfactory answer, our healthcare system will be permanently damaged. What’s even scarier is that this seems to be trending worse and not better.

What would you propose to help solve the problem of physician burnout?

Physician EHR Burnout and Administration Tasks - eMedApps

Has the MD Profession Been Irreparably Harmed?

Posted on January 13, 2017 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.

Physician burnout has been a hot topic lately. You see it anywhere you find a physician. Doctors are tired, worn out, and feel like they’re overworked. Many feel like they’ve become data entry clerks and not doctors. Many doctors feel like all these regulation and reimbursement requirements have gotten between them and the patient. Many are pressured by their employer to hit numbers as opposed to caring for patients.

I could keep going, but you get the point. If you’re a doctor, then you’re living many of these challenges. If you’re not, I’d love to hear from you.

Lately when I’ve heard people talking about the damage the meaningful use, EHR, and now MACRA have caused, I hear those people proclaim that the medical profession has been damaged. Many go on to suggest that irreparable harm has been caused to the medical profession. Is that true?

When I ask these people what the solution is, they say that government should get out of the exam room. While that principle is interesting, it’s not very practical. Most of these doctors that want government out of the exam room still want Medicare to cut them a check for seeing Medicare patients. There’s a big disconnect there and it’s not likely to change.

All of this sidesteps the real issue we have in healthcare. Whenever we talk about lowering the cost of healthcare, that means someone is going to get paid less. Who should that be? Yes, there is the pretty rare scenario that you can lower costs while improving care. I’ve seen examples of this, but it’s an extremely challenging thing to make happen.

Going back to the main question. Is the medical profession irreparably harmed by the implementation of EHR software and other regulations? Certainly, it’s had a significant impact, but I don’t think the harm is impossible to repair. We do need to simplify the hoop jumping that we require from physicians. We do need to improve our EHR software so that it makes the physician workflow more efficient and not less. We do need to find better incentives that provide for health data sharing and deeper engagement with patients. All of these things will help repair the medical profession. Doing so will create a whole generation of doctors who can’t imagine what it was like to practice medicine without an EHR.