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Overview of the Physician Burnout Problem

The demanding work pace, time constraints, and emotional fatigue are the aspects that make physicians vulnerable to burnout. Symptoms caused by long-term stress such as depersonalization, low sense of accomplishment and emotional disparity due to work-life imbalance make the doctor prone to exhaustion leading to a feeling of quitting.

The WHO terms burnout as an ‘occupational phenomenon’ which, in its latest update of the definition, is referred to as a ‘syndrome’ that occurs due to chronic work stress that is not effectively managed.  The physician burnout is metaphorically referred to as the bank account of energy.

There are three main types of energy; physical, emotional and spiritual energy that keeps on adding up and depleting with time and circumstances. The highly demanding doctors’ profession and the workplace norms generally have a downward trend towards energy levels that puts clinicians at a high risk of burnout. 

According to a study published in the Annals of Internal Medicine in 2019, Physician burnout costs around $ 4.6 billion to the United States. Dr. Lotte Dyrbye of Mayoclinic opines that whoever enrolls in medicine is aware of the fact that it is a demanding and stressful profession.

Over the past years, the sprouting cases of physician burnout have led to cynicism about its repercussive effects on patient access to care, care quality as well as patient safety. Burning out inflicts the doctors to quit their jobs making access to care, less likely. Lack of attention and focus, as well as memory constraints, hamper patient safety and quality of care.

According to several studies, 1 out of every 3 physicians is suffering from burnout at a time. Thus, every physician precisely is at risk of burnout and it rightly needs to be dealt with as a crisis. Although the physicians can take the necessary steps themselves to improve the work-life conditions and keep the burnout symptoms at bay, big changes are needed at the institutional level to bring forth evident outcomes.

A recent report from Harvard states that physician burnout is a public health catastrophe that urgently needs a solution. Among the recommendations stated by the report, changes to the practice of Electronic Medical Record (EMR) or Electronic Health Record (EHR) are declared to be a significant measure to provide a medium-term solution for physician burnout.

Problems that are focused on EMR-related issues

The patient record used to be written on paper for ages and has consumed an ever-increasing space and remarkably deferred access to proficient medical care. As of today, EMRs collect individual patient data and clinical information electronically, facilitating immediate accessibility of this information to all healthcare providers. It is thus said to assist the provision of coherent and regular care.

Electronic Medical Records (EMRs) are automated medical information systems that assemble, store and present patient information. They are a way to produce reliable and structured recordings to access clinical data about patients. Hence, EMRs have replaced paper-based medical records which most practitioners have been long familiar with.

There are a number of potential advantages EMR is known for. These include

  • Optimizing the records of the patients
  • Improving communication of patient data to clinicians
  • Improving access to patients’ healthcare information
  • A substantial decline in errors
  • Optimizing payments and advancement in reimbursement for services
  • Formation of a data storage area for research and quality enhancement
  • Reduction of the use of paper

EMRs are envisioned to have great potential for enhancing quality, stability, protection, and efficacy in healthcare. These are the reasons why they are being implemented throughout the world.

In spite of the high expectations and focus on the technology worldwide, there are several EMR-related issues associated with them that have kept their overall implementation rate relatively low. They are viewed to oppose a physician’s customary working style and also entail the following barriers to acceptance by physicians.

  1. Financial Barriers

    EMRs necessitate a greater competence in dealing with computers. Further, installing a system entails significant financial resources; high startup expenditure, high maintenance cost as well as uncertainty about Return on Investment (ROI).

  2. Technical barriers

    Lack of computer skills of the clinicians and the other staff, deficiency of technical training and support, complexity and limitation of the system, etc. are the factors considered as technical barriers to EMRs.

  3. Time constraints

    The physicians find it too time-consuming to select, purchase and implement the system, to learn the system, to enter data, to convert the records and requiring more time per patient. 

  4. Psychological barriers

    Based on their personal reservations, understanding, and perceptions, clinicians have concerns about using EMRS. Their observation of the uncertain quality improvement associated with EMRs and doubts about the loss of specialized autonomy lead to a lack of belief in the EMR.

  5. Social barriers

    The social barriers include uncertainty about the vendor, lack of support from external parties, from other colleagues and from the management. Also, the physicians find EMR to be a system that interferes with the doctor-patient relationship.

  6. Legal barriers

    Clinicians think that keeping the patient records and medical information safe is vital to avoid legal issues. Nonetheless, there is a lack of clarity about the security standards to keep the patient records safe and confidential. 

  7. Organizational size and type

    A small practice is estimated to face greater difficulties in working out the financial issues than a large practice.

  8. Change process

    Implementation of EMRs in the medical practices demands a major change for clinicians who have their own working styles developed over the years. This renders them unwilling to adapt to variations in their methodology of work. Therefore, the change process is a challenge as well as a problem at the same time. Problems that occur during the change process include a lack of suitable organizational culture, lack of incentives, lack of leadership and reluctance in participation from physicians, nurses and other staff members.

According to a study, the slow rate of EMRs adoption implies the fact that resistance amongst medical doctors is strong. This is because the clinicians are the frontline users of EMRs and whether or not the other user-groups like nurses and administrative staff support and use EMRs, largely depends on EMR’s acceptability by the clinicians. Consequently, doctors have a great influence on the adoption level of EMRs. 

Additionally, a study found that most of the physicians who are stressed out are due to the work conditions and time pressures. The family responsibilities, time demands, chaotic environment at workplace, lack of control of the pace, unfavorable institutional culture; all are attributes associated with dissatisfied and stressed out doctors who inculcate a feeling of switching fields. However, these factors, not necessarily translate into poor patient care by the doctors. However, when a drop in the patient care quality was seen, it was rather due to burnout caused by the organization than by the doctors themselves.

The study also found that the implementation of the EMR contributed to burnout instead of reducing the stress levels as it was hoped. It was claimed that practices that implemented EMR caused an increase in stress to the doctors, the levels of which then reduced as the use of EMR matured. However, the stress level was never found to drop to the lowest. Furthermore, it was found that the fully established EMR systems, particularly coupled with shorter visits caused burnout, stress and an intention to leave the practice.

Causes of the EMR-Related Issues

Like all other technologies, EMRs can be used in a variety of ways for a variety of purposes. In regards to our current healthcare structure, one important performance requirement of EMRs is to generate clinical revenues. This means that it should support physicians’ billing and documentation to produce as much revenue as possible for each medical service. Moreover, EMRs should also help clinicians meet regulatory necessities that may have monetary or endorsement implications.

This implies that existing EMRs are not designed in a way so as to support many of the matters that clinicians, patients, and policy-makers value including improved care experiences, decreased cost, improved care quality, and inhabitants’ health management. Current EMRs have not been created to facilitate the physicians to improve in their diagnoses or become more cost-effective prescribers. This is because the present-day health care system generally does not compensate for these actions.

Having said so, EMRs have very minimum capacity pertaining to clinical decision making (which increases the quality of care), for the data collection on duplicate and needless tests, or on the collective health of the patients.

Simply put, the advancement of the EMRs will necessitate the changing of prime considerations regulating their design. This includes moving towards risk-sharing by clinicians and eventually, some form of potential reimbursement rather than the current fee-for-service culture. Till then, optimizing the usability and worth of EMRs will be an ascending effort.

READ NEXT: cliexa Partners with the athenahealth Marketplace Program

Researchers Receive $1 Million Grant to Study Digital Screening Intervention Tool for Adolescents and Young Adults

cliexa is excited to partner with the University of Northern Colorado (UNC) with a grant from the Department of Health and Human Services’ Office of Adolescent Health that provides nearly one million dollars over the next two years for the implementation of cliexa-OPTIONS, a digital screening intervention tool that fosters earlier identification of high-risk adolescents in a clinical setting. The funding supports independent evaluation including, cost-benefit analysis and randomized controlled trial of the cliexa-OPTIONS risk screening tool and MyPLAN mobile health follow-up. The Principal Investigator for the project at UNC is Dr. William Merchant. He is the evaluation professor in the Applied Statistics and Research Methods program in the College of Education and Behavioral Sciences. 

The cost-benefit analysis assesses cost savings between the cliexa-OPTIONS risk screening against current paper pencil and verbal screenings. Also, the cliexa-OPTIONS risk screening identifies 30- 50% more risk in adolescent populations fostering early identification of adolescents at highest risk for acquiring an STI or experiencing an unplanned pregnancy. Improving quality in clinical workflows for adolescent and young adult populations is timely, given that sexually transmitted infections for young people ages 15 -24 are at epidemic proportions.

Saving time and keeping providers satisfied with new technology in clinical workflows is no simple task. The cost-benefit analysis will also assess the benefits of early identification of adolescents at highest risk for adverse reproductive health outcomes, substance use, mental health, and wellness.

Read the full article at: //www.unco.edu/news/newsroom/releases/million-dollar-grant-digital-screening-intervention-tool.aspx

Image of the White House Lawn

cliexa’s hard work and commitment to improving our country’s healthcare systems has been recognized by the Office of American Innovation (OAI) for our advancements within the industry. The OAI, appointed by President Donald J. Trump, and led by Jared Kushner, has invited cliexa to attend the 2019 White House Blue Button Developers Conference in Washington, D.C. on Tuesday, July 30th at the Eisenhower Executive Office Building. We are humbled and honored to receive this invitation. We are looking forward to connecting and potentially collaborating with policymakers, technologists, and medical experts to advance the sharing of medical information through mobile technology.

We are one of the few technology vendors who have successfully enabled the Center for Medicare and Medicaid’s (CMS) Blue Button 2.0 API into our software platforms. According to CMS’s website, the Blue Button 2.0 API is a “developer-friendly, standards-based API that enables Medicare beneficiaries to connect their claims data to the applications, services and research programs they trust.” This API enables patients to sync their Medicare accounts to our applications and bi-directionally share the information, specifically claims data, to their providers, and care teams.

With this information, there are a variety of potential outcomes from leveraging this data, including streamlined documentation and the secure exchange of patient information which can lead to uncovering new insights about patients’ health status and increasing time for face-to-face interactions between patient and provider.

Image of cliexa-EASE with CMS' Blue Button 2.0 API enabled

Our first use case for this API was in our application, cliexa-EASE, designed for the Department of Health and Human ServicesAgency for Healthcare Research and Quality‘s Step-Up App Challenge. With this build, we were selected as one of the three winners of this challenge. The goal of the challenge was to develop an application that simplifies the process of collecting, interpreting, aggregating and sharing patient-reported outcomes (PRO) data related to physical function outcomes. Using the Blue Button 2.0 API, patients could connect Medicare accounts to our platform and share their claims data directly to the health systems’ electronic medical record system. Other functionalities including the connection and aggregation of data from IoT and wearable devices, electronic medical record systems paired with custom, mobile clinical assessments.

To learn more about the Blue Button 2.0 API, and the Blue Button Developers Conference, visit //bluebutton.cms.gov/

 

Last week, over 12,000 public health professionals flocked to San Diego for the 75-degree weather, ocean views, and the most significant public health conference in the U.S, the American Public Health Association’s Annual Meeting and Expo. Two large buildings downtown were dedicated to housing deep dive conversations about, among other things, tobacco use, obesity, women’s health, racial inequity in health and the most cutting-edge research in the field. In reflection, I had three takeaways from the conference about the role and use of digital health in public health.

#1. Health technology and its benefits are not largely understood in its application to the public health community.

Many times, throughout the conference I found myself reiterating the value of a health platform for clinical, research or evaluation processes. Many people I spoke to had a genuine interest but weren’t sure how technology could optimize their work. In reality, many public health programs and projects are researched and evaluated using patient-reported data. Imagine digitizing that process so patients can participate through an application on their phone; imagine the impact that would have on response rates and loss-to-follow-up. Imagine the benefits of pushing routine surveys to patient’s phone instead of having to call to do scheduled evaluations. Not to mention the equitable distribution of programs and interventions across diverse populations, rural populations and those who have transportation barriers that technology can help address. In public health we operate in a world of outcomes, without being able to show outcomes we don’t see funding renewals, patient participation fades away, and programs fail. Health technology provides a way for researchers and evaluators to track outcomes in real time.

#2. UX/UI can be a major make-or-break when looking at making a tool that applies to diverse or vulnerable populations.

My first event was a meeting in a small room with other health technology professionals discussing the process that they’ve undergone to get health technology recognized as a section at APHA. In this room, we considered the impacts on research, evaluation, follow up, data visualization and overall patient experience. One of the most impactful conversations that I had was with a social worker who embraced technology as a tool for diverse or vulnerable populations. She emphasized how user interface and user experience can shape program success in diverse and vulnerable populations. She encouraged me to reach out to individuals who interact directly with the specific population when designing products to be used in public health settings. Only if the patient or client is engaged with the tool, can we see the successes or obtain accurate information for physicians, for researchers, or health program evaluators. A crucial point when considering Take Away #1, and the importance of highlighting tangible outcomes over time.

#3. There is “data overload” in public health.

This conference had some of the country’s top experts in health, with rows of poster projects, all with their own calculated data sets backing the findings that they were at APHA to present. Some will likely be published while others will remain in the researcher’s computer with little other exposure. I spoke to individuals who were collecting health data, payor data, and policy data, and all were positioning their data sets in different areas independent of each other despite their overwhelming connectivity. With the rate that new studies are conducted, data changes so quickly so even systematic reviews and meta-analyses become outdated far too quickly. There is an opportunity to leverage technology to collect a real-time outcomes database to ensure the hard work that researchers do to make correlations and identify patterns is not lost in the data black hole. Entities such as the CDC, NIH and WHO do an excellent job of collecting and displaying related data sets for public use, however the time that it takes to gather data often puts the data sets months to years behind the times. There is a significant opportunity for technology to lend to this real-time collection process.

Overall, the themes of APHA for me centered around how much opportunity there is to impact the way public health programs are research, delivered and evaluated through the use of digital health. These conversations were inspiring and exciting but also demonstrated how much we still have to do to fully optimize the work that we do in the public health field.

cliexa is a semifinalist in the AHRQ's Step-Up Challenge

cliexa is a semifinalist in the AHRQ's Step-Up Challenge

cliexa is one of 10 companies out of 50+ advancing to Phase 2 of the Agency for Healthcare Research and Quality (AHRQ)‘s Step-Up App Challenge with the “goal of developing an app that integrates standardized patient-reported outcomes (PRO) data into clinical care and research.”

For Phase 2 of the Step Up App Challenge, cliexa will design, develop, and demo our application using the FHIR technical specifications and PROMIS® resources for patient-reported outcomes with the hope to be selected as one of the three winners, who will get the opportunity to test their product in nine practice settings affiliated with MedStar Health in Washington, DC.

Read the blog announcing the 10 semifinalists from Director of the AHRQ, Gopal Khanna, M.B.A: https://www.ahrq.gov/news/blog/ahrqviews/stepup-challenge-finalists.html

Check out our portfolio of patient-reported outcomes applications: cliexa Mobile