Transcription
Provider BurnoutandThe ElectronicHealth RecordZachary Ward, Ed.D.Assistant Professor of Health AdministrationUniversity of Southern Indiana
OverviewLearning Objectives1. Define what burnout is and how it’s measured.2. Understand the significance of provider burnout on the US healthcaresystem.3. Identify the role EHRs may have on provider burnout and methods tomitigate EHR-related burnout.
What is Burnout?Burnout DefinedMaslach’s Three Dimensions of Burnout Emotional Exhaustion Depersonalization (detachment from job) Lack of Personal AccomplishmentWorld Health Organization (ICD-11) Syndrome conceptualized as resulting from chronic workplace stress that has not beensuccessfully managedHow is Burnout Different Than Stress? Stress may come and go (episodic) Feelings associated with burnout don’t feel as if they end
How Do We Measure Burnout?But wait.there’s more!Maslach Burnout Inventory “Gold Standard” of measurement1981Measures Three Domains22 QuestionsCopenhagen Burnout Inventory 2005 Measures Three Domains Personal Work Client 19 QuestionsMini Z 1981 “Overall, based on your definitionof burnout, how would you rateyour level of burnout?”Oldenburg Burnout Inventory 2002 Measures Two Domains Disengagement Exhaustion 16 Questions
Burnout: Issues Measuring & DefiningJournal of Graduate Medical Education: You can’t call “burnout” burnout unless you’ve used the MBI asyour assessment. Burnout is defined in multiple ways. Burnout is measured in multiple ways.
Burnout: What Does it Look Like?Symptoms of Burnout Cynical about work Lack of energy/enthusiasm about work Negative attitudes around work bleed over to personal life.frequently Work exhaustion bleeds over to Personal exhaustion Negative feelings affect work productivity Negative feelings affect work team cohesion
2019Provider Burnout Timeline:“A Public Health Crisis”-World Health Organization deems burnout an “occupationalphenomenon” in the 11th revision of the InternationalClassification of Diseases (ICD-11).-Physician burnout is labeled a “Public Health Crisis” by fourleading healthcare organizations.-First known model published that explored financial impactof physician burnout20051974Minimizing Error, Maximizing Outcome (MEMO)Study explored stress/burnout effects on patientoutcomesHerbert Freudenberger, psychologist,coins to term “Burnout.”2020COVID-19 changed everything1970198019901981Christine Maslach & Susan Jackson devise thethree “domains” of burnout and the MaslachBurnout Inventory.20002010202020302014The “Triple Aim” of Healthcare (reducing costs, improving population health& enhancing patient experience) became the “Quadruple Aim of Healthcare”by adding “improving the work life of health care providers.”
Burnout Awareness: On the RiseBurnout Publications Indexed in PubMed by 1020202030
Consequences of Physician BurnoutThe Three DomainsPatient CareMedical ErrorsLower Patient SatisfactionDiminished Quality of CareHealth SystemGreater Physician TurnoverReduced Physician ProductivityIncreased CostsPhysician’s Personal HealthSubstance AbusePoor Self-CareHigher Self-Harm IdeationWest, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences and solutions. Journal of internal medicine, 283(6),516–529. https://doi.org/10.1111/joim.12752
The “costs” of physician burnout Medical Errors Costs 20 Billion annually 1 Health System Costs 4.6 Billion Annually 2 Recruitment of new provider, missed referrals, catch up-to pace Patient Satisfaction Costs Personal costs Tend to retire/leave profession earlier 3 Effects personal quality of life (friends/family) 31.2.3.Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. [Updated 2021 Jan 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/Han, S., Shanafelt, T. D., Sinsky, C. A., Awad, K. M., Dyrbye, L. N., Fiscus, L. C., Trockel, M., & Goh, J. (2019). Estimating the Attributable Cost of Physician BurnoutWilliams, E. S., Rathert, C., & Buttigieg, S. C. (2020). The Personal and Professional Consequences of Physician Burnout: A Systematic Review of the Literature. Medical careresearch and review : MCRR, 77(5), 371–386. https://doi.org/10.1177/1077558719856787
We’ve Got a Problem
EHR’s Impact on MedicineHow has the Electronic Health Record Changed the Delivery of Care?Positives Electronic Order EntryClinical Decision AbilitiesHealth Information ExchangeConcise DocumentationEnhanced QualityNegatives Very ExpensiveMaintenance IntensiveDisruption of WorkflowsData OverloadAbility to work from anywhere
What are we hearing?Clerical BurdenLess Patient InteractionPajama TimeTime ConsumingClick FatigueInefficientCumbersome
What’s the literature saying?1. EHR-related stress is very common, predominantly effecting primary care physicians.12. Physicians spend an average of 16 minutes, per patient, in the electronic health record(outpatient setting). 23. One specialty, Family Medicine, physicians spend an average 86 minutes documenting afterhours.4. After-hours charting was associated with HIGHER physician burnout. 41.Gardner, R. L., Cooper, E., Haskell, J., Harris, D. A., Poplau, S., Kroth, P. J., & Linzer, M. (2019). Physician stress and burnout: the impact of health information technology. Journal of the American Medical Informatics Association :JAMIA, 26(2), 106–114. https://doi.org/10.1093/jamia/ocy1452.Overhage, J. M., & McCallie, D., Jr (2020). Physician Time Spent Using the Electronic Health Record During Outpatient Encounters: A Descriptive Study. Annals of internal medicine, 172 (3), 169–174. https://doi.org/10.7326/M18-36843. Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W. J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event LogData and Time-Motion Observations. Annals of family medicine, 15(5), 419–426.4.Eschenroeder, H. C., Manzione, L. C., Adler-Milstein, J., Bice, C., Cash, R., Duda, C., Joseph, C., Lee, J. S., Maneker, A., Poterack, K. A., Rahman, S. B., Jeppson, J., & Longhurst, C. (2021). Associations of physician burnout withorganizational electronic health record support and after-hours charting. Journal of the American Medical Informatics Association : JAMIA , 28(5), 960–966. https://doi.org/10.1093/jamia/ocab053
Pathways to ReducePhysician Burnout with the EHR
Scribes Have an Impact on BurnoutReduction (From 2017) First known study on scribes: Scribes significantly improved physiciansatisfaction, improved documentation accuracy and improved patient satisfaction.Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., Sattler, A., Mahoney, M., & Lin, S. (2017). Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A RandomizedControlled Trial. Annals of family medicine, 15(5), 427–433. (From 2020) Study of Oncologists using Scribes: 90% who used scribes reportedincreased time with patients and decreased “computer” time. 100% of Oncologistsreported scribes improved their quality of life.Gao, R. W., Dugala, A., Maxwell, J., Falconer, P., Birkeland, A. C., Divi, V., & Rosenthal, E. L. (2020). Effect of Medical Scribes on Outpatient Oncology Visits at a Multidisciplinary Cancer Center. JCOoncology practice, 16(2), e139–e147. https://doi.org/10.1200/JOP.19.00307
Utilizing a Team Approach to Care Delegating documentation duties can alleviate documentation burden.Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W. J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. Annals of familymedicine, 15(5), 419–426. Comprehensive information technology support teams are instrumental in reducingphysician burnout.Nguyen, O. T., Jenkins, N. J., Khanna, N., Shah, S., Gartland, A. J., Turner, K., & Merlo, L. J. (2021). A systematic review of contributing factors of and solutions to electronic health record-related impacts on physician well-being. Journal ofthe American Medical Informatics Association : JAMIA , 28(5), 974–984. https://doi.org/10.1093/jamia/ocaa339 Reduce the clerical burden of documentation.
Thank you!Questions/Comments?Zdward@usi.edu
1. EHR-related stress is very common, predominantly effecting primary care physicians.1 2. Physicians spend an average of 16 minutes, per patient, in the electronic health record (outpatient setting). 2 3. One specialty, Family Medicine, physicians spend an average 86 minutes documenting after hours. 4.
