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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

cliexa is now available in the athenaHealth Marketplace

Today, cliexa Inc., a thriving producer of mobile health care management services, revealed a partnership with athenahealth, Inc.® through athenahealth’s “More Disruption Please” (MDP) Marketplace program. As an MDP partner, our cross-communication platform developed for chronic pain patients and providers, cliexa-EASE, is now immediately available to athenahealth’s network of 100,000+ providers and countless prospective clients. EASE enables patients and clinicians to make intelligent correlations between medication dosage, frequency and heightened or reduced symptoms by leveraging an application that functions as a pain assessment model for chronic pain management with seamless scalable EMR integration via API and global HL7 connectivity.

cliexa provides the ideal pain management application to leverage patient-reported outcomes to improve treatment decisions and patient experience, while also maximizing compliance and reimbursement. cliexa-EASE is designed for chronic pain management, podiatry, and general patient wellness. cliexa-EASE allows providers to gather digitized intake data and customize assessments to correlate data that best adheres to their patient population.

In order to provide physicians with high accuracy metrics, cliexa-EASE uses patient reporting methods on visual body maps, and pain expression in voice, face, and body movements. This allows physicians to view the physical attributes of pain beyond self-reported descriptions which can often be difficult to translate into clinical diagnostics terms. Tracking these markers allows physicians to use patient-reported outcomes to treat the “whole patient.”  One of cliexa’s existing clients, Anderson Podiatry Center, is already seeing the benefits of using the cliexa platform with a custom digital patient intake and screening process, also digital consent forms, integrated to their athenahealth electronic medical record (EMR).

The athenahealth Marketplace partnership opens up a hyperconnected, national network of healthcare professionals providing chronic pain management. With this partnership, the two companies align to provide measurable financial and clinical results for providers. cliexa is a real-time data provider for future medicine and will continue to build on our vision to increase patient-provider engagement and compliance through mobile health solutions.

“We are excited to partner both with athenahealth and Anderson Podiatry Center to deploy cliexa platform into the marketplace as this is the first of many subspecialties we currently have in our portfolio. We are looking forward to implementing other subspecialty applications to the athenahealth marketplace which will strengthen our partnership in healthcare space,” says Mehmet Kazgan, Founder and CEO of cliexa.

Eric Seyler, CEO of Anderson Podiatry Center, says, “The transition to a digital patient intake has given us more opportunities to help our patients than we had envisioned. Our patients have spent less time in the waiting room with more time delegated to their doctor’s visit. The integration is done in real-time which supports our goal to be more efficient with clinic resources while helping to provide the best possible patient experience.”

cliexa enables patients to track their chronic disease activity by quantifying symptoms using scientifically-proven and clinically-validated scoring models. cliexa delivers quantified disease activity and documentation through real-time integration to athenahealth electronic medical record, which streamlines processes and increases efficiency in population health management.

View our listing here: //marketplace.athenahealth.com/product/cliexa

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/

Image of the "Best Rheumatoid Arthritis Apps 2019" from Healthline Media
Image of the "Best Rheumatoid Arthritis Apps 2019" from Healthline Media

In a late May article by Healthline, cliexa-RA was named one of the “Best Rheumatoid Arthritis Apps of 2019.” For the second straight year, cliexa-RA has been nominated for this selection, receiving a perfect five stars on the iOS App Store and the highest average score among all apps named. With the extensive features, assessments, accuracy, and patient-physician efficiency included with the application, it is one of the most thorough rheumatoid arthritis apps on the market.

cliexa-RA is a specially designed app for tracking patient progress, medication adherence, and complications from the patient’s smartphone. It includes several medically validated and custom assessments for keeping tabs on patients and providing physicians with accurate and up-to-date information. The app can also use a patient’s medical history and statistical data to more clearly assess patients\’ rheumatoid arthritis progress and therefore help physicians accurately provide treatment plans. The outpatient data helps create efficiency of communication between patient and physician, cutting down on time spent at the clinic and providing more accurate care solutions.

cliexa’s platform implements effective Remote Patient Monitoring to optimize clinical workflow, medical billing compliance, and reimbursements. Accurate outpatient data is essential to the cliexa platform, with cliexa-RA being recognized for its capability to utilize Remote Patient Monitoring effectively.

Read More: The Best Rheumatoid Arthritis Apps of 2019

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