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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

Mobile Health Applications - Value Based Care

In today’s healthcare system, there is a focus on creating a value-based care system to foster a standard of effectiveness, and efficiency when it comes to patient health outcomes, and reduced costs. Through this model, healthcare providers are incentivized to deliver high quality care and this value is derived from measuring health outcomes over time. There is significant pressure that many providers face to be able to quantify their patient’s health outcomes in order to show they are in fact delivering “value-based care.” A value-based model creates a need for a fruitful cross-communication system that extends to patients, providers, payers, and all involved in the healthcare system in order to quantify and qualify health measures.

In a effort to utilize patient-reported health status to improve care, cliexa is collaborating with the American College of Cardiology to develop technical modules targeting cardiology-specific diseases using remote patient monitoring. The first module, cliexa-PULSE, has been developed is for Atrial Fibrillation and includes patient-reported symptom tracking, medication reconciliation functions, connections to wearable data and claims data connection. This information will fulfill reporting needs for patients through visual tracking graphics in the application and to physicians in a summarized, customized manner. Moving forward we are looking to commercialize this product through the ACC’s 2,500 members and beyond.

Improved communication and reduced costs can be achieved by improving patient engagement, streamlining clinical workflow, and implementing a customizable technology that will automate clinical processes, analyze and simplify patient data, which can lead to improved care and health outcomes. By the incorporation of patients’ health status and value via patient-reported outcomes (PROs), providers can monitor the quality of health care delivery.

PROs can be used as absolute terms, or as a change from a previous result as well as a measurement in clinical trials. Physicians can better determine baseline status, clinical trial endpoints, monitor therapy effectiveness, assess change in stats and prognosis predictor, while the patient experiences positive impacts on daily activities, emotional wellbeing, psychological health, and social function. In addition, PROs can aid clinics to improve patient outcomes, quality of life and satisfaction by using the PROs to better inform their care. PROs prioritize the important details in a clinical encounter and aid a better understanding of the motivation behind patient behavioral change. With this information, the clinic can analyze the evidence, design clinical trials and change their practice and policy. In addition, PROs can aid clinics to improve patient outcomes, quality of life and satisfaction by using the data to better inform their care. PROs prioritize the important details in a clinical encounter and aid a better understanding of the motivation behind patient behavioral change. With this information, the clinic can analyze the evidence, design clinical trials and change their practice and policy.

Patient-centered data collection outside of a traditional clinical is the next frontier of modern healthcare. By digitizing and automating PROs, both patients and physicians benefit financially and through effective time management. PROs tackle the challenge of long surveys, care integration, multimorbid patients, and improving the relationship between patient and provider. Clinicians need instruments (surveys) to capture patient-reported measures of symptom status, functional status and health-related quality of life. PROs help quantify the disease from patients’ perspectives, makes disease- specific measures more sensitive and relevant, help meet all the requirements of performance measures and can improve the process of delivering clinical care while bringing the patients’ voices into care. Physicians have found that PROs, in the right setting with the right workflow, are a helpful mechanism for shared decision making and help tackle the treatment goals of patient survival, free of hospitalization, and increased quality of life.

Read more from ACC: //www.acc.org/latest-in-cardiology/articles/2019/04/14/12/42/innovation-at-acc-collaboration-using-patient-reported-health-status-to-improve-care

 

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.

Digital health benefits

2018 has seen a significant boom in the application of technology in digital health innovation, which are poised to disrupt the healthcare industry. Innovations have included advances in mobile health (mHealth), health information technology (IT), as well as wearable and Internet-of-Things (IoT) devices.

cliexa has identified six specific areas of medicine already reaping the benefits of digital health innovation:

1. Rheumatology

Disease Activity Scoring (DAS) metrics remotely collected by cliexa from patients are used by physicians in their offices when assessing the severity of rheumatoid arthritis through a Q & A approach. cliexa empowers patients with the ability to communicate their patient-reported outcomes to their physicians at the touch of a finger, on their own mobile devices, providing physicians with instantly-scored clinically-validated assessments. The application of cliexa innovations in rheumatology drastically increases the efficiency and quality-of-care for both patients and their providers.

Check out the cliexa mobile platform for Rheumatoid Arthritis, cliexa-RA: //www.cliexa.com/cliexamobile/rheumatoid-arthritis/

2. Pain Management, Primary Care, & Integrative Medicine

Chronic pain, affecting over 10% of American adults, is a leading cause of opiate abuse. Managing and overcoming chronic pain is a complex obstacle for many healthcare providers. With the increased shift away from the prescribing of opioids in the treatment of chronic pain, cliexa enables providers to remotely monitors opioid-prescribed patients while empowering them to relay their patient-reported outcomes and track their mental health conditions in association with their chronic pain, while catering specifically towards the individual needs of each patient-provider relationship.

Check out the cliexa mobile platform for Pain Management, cliexa-EASE: //www.cliexa.com/cliexamobile/pain-management/

3. Behavioral Health & Addiction Treatment

Though struggles with addiction are becoming increasingly more prevalent in society, the present methods of addiction treatment are limited. Through innovations in health technologies, patients and providers are shifting towards new ways of treating addiction. The monitoring of patients in real-time is essential for positive treatment outcomes for both patients and their providers. By leveraging patient-reported data, patients adhere to their treatment plans and overcome addiction as a disease, rather than as a fault.

Check out the cliexa mobile platform for Behavioral Health, cliexa-SENSE: //www.cliexa.com/cliexamobile/behavioral-health/

4. Digestive Health

Through cliexa innovations, providers better manage chronic gastrointestinal diseases, such as inflammatory bowel disease or ulcerative colitis, using specifically-designed, highly-structured treatment plans that leverage disease activity scoring models taken from qualitative patient responses to assessments which quantify and track symptoms over long periods of time.

Check out the cliexa mobile platform for Digestive Health, cliexa-IBD: //www.cliexa.com/cliexamobile/inflammatory-bowel-disease/

5. Respiratory Care

cliexa enables providers to qualitatively track chronic diseases of the respiratory system, like chronic obstructive pulmonary disease (COPD), through remote patient-reported outcomes. The ability to structure individualized and specialized care leads to improved patient-provider experiences.

Check out the cliexa mobile platform for Respiratory Care, cliexa-COPD: //www.cliexa.com/cliexamobile/chronic-obstructive-pulmonary-disease/

6. Pediatric Care

cliexa health technology drives innovations in mental health resiliency in adolescents, a hot topic in today’s health community. cliexa’s clinically validated medical assessment applications, coupled with its mHealth prevention services, help providers identify and reduce risk behaviors in adolescents and young adults. cliexa’s mobile patient-engagement applications equip providers with the tools adolescents use to overcome anxiety and depression, increasing the overall quality-of-care for both patients and providers.

Check out the cliexa mobile platform for Pediatric Care, cliexa-OPTIONS: //www.cliexa.com/cliexamobile/adolescent-resiliency/

Electronic Medical Record (EMR)

At some point in all of our lives, each of us has been a patient. Each of us has faced the benefits, trials, and tribulations of getting care, but very few of us have stood in the shoes of our physician. So, let’s take a look at what it can look like to be a doctor using an EMR system…

First, let’s talk about change. Most of us have undergone frustrating change at work. A change of leadership, new regulations or a new kind of copy paper. But how many of us have undergone a full up-end in our workflow process?

Widespread adoption of the Electronic Medical Record (EMR) system as the new way to organize and store patient data began in 2014 (//bit.ly/2NNghtd), prior to this time processes were largely paper and pen and manually filed.

As of 2015,

This process changed the way medical staff stored and communicated data and while there has been shown to benefit from the shift, the process was long and arduous. Remember that time you had to use Excel for the first time, yeah like that, times 100. Additionally, this change came along with a slew of new regulatory guidelines and reporting rules.

So how has life, post-EMR implementation? One study found that:

  • Physicians spend 49.2% of their time doing paperwork and EHR work
  • Physicians spend 27% of their time with patients.

With so much time being dedicated to working, physicians are on a tight schedule to maintain their patient load and their desk work.

So how often does this schedule not work out as planned? One study found that:

  • 75% of physicians fall behind in their appointment schedule at least once a week.

Of this 75%:

  • 79% said that the reason for falling behind was that they spent more time than a single visit time allotment with patients.
  • 66% said the reason was that patients were late or didn’t have time to fill out the paperwork.
  • 49% spent time between appointments recording notes.
  • 78% said that appointments are booked too tightly together or were overbooked.

When asked, physicians listed things that they believed would improve their efficiency:

  • 43% said better technology
  • 38% said more non-clinical staff
  • 29% said fewer patients scheduled
  • 19% said more administrative staff (//wb.md/2Ni7joa)

The healthcare system as we know it has numerous opportunities for improvement across the board, but it is important to understand the challenges facing each participant. A collective understanding moves us closer to being able to stand in each others’ shoes and work together to improve the healthcare experience at every level. 

To learn more about how cliexa is solving these problems, download our FREE PDF on Chronic Care Management, and how to streamline clinical workflow.