Article

Enabling healthcare professionals to work smarter, not harder, will combat burnout and promote a sustainable future for medicine

By Dr. Nele Jessel, athenahealth Chief Medical Officer | January 19, 2022

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No physician goes into medical school expecting a 9-to-5 job. But they also don’t anticipate that their after-hours “pajama time” will be spent on basic administrative tasks instead of serving patients.

Clinician burnout — ranked among the top issues in healthcare year after year – certainly hasn’t decreased considering the pandemic. COVID-19, ongoing regulatory changes, and complex payer requirements have only exacerbated the strain on those of us who strive to practice hands-on medicine. The “Great Resignation” and an ongoing shortage of qualified staff across all healthcare settings are further evidence that if we don’t do something to relieve documentation burden, the U.S. healthcare crisis will get even worse.

But as a physician, I know the solution is more nuanced than simply “less documentation.” For instance, more thorough notes from my colleagues about persistent ear infections always helped when I was in the exam room with other doctors' patients. Clinician after clinician featured in athenahealth’s new research on the duration and quality of time spent in an EHR agree: They applaud documentation efforts that contribute to delivering better patient care. The crux of the problem is that legacy EHR technology wasn’t designed to tell a patient story, but to support billing and regulatory requirements. Clinicians often must enter the same information in multiple places. These tasks add to their workload and obscure patient information that should not only be quicker and easier to access but curated so that only the most relevant information is surfaced at the right time. The way healthcare is structured today gives physicians two jobs – one clinical and one administrative – but they are only trained and compensated for the clinical role.

So, what’s the answer? As it turns out, there may be several.

Readjust healthcare’s focus from appointment volume to quality of care. This would not only help improve outcomes for patients, but also alleviate the burden of squeezing 45 minutes of support and documentation into visits that are all too often 10 to 15 minutes long. This transition from fee-for-service models to value-based care requires greater industry standardization of quality metrics and VBC reporting requirements (which seem to change constantly), complemented by intuitive technology. Allowing clinicians to focus on patient care and evolving medical research, instead of on evolving regulations and technology will go a long way toward improving clinician satisfaction and decreasing clinician attrition.

Embrace technology that allows clinicians to work smarter, not harder — and accept that what works for one isn’t preferred by all. One of the things I’ve been most excited about since joining athenahealth is the opportunity to use my experience as a provider to inform our innovation process. I’ve had the pleasure of working with several other clinicians who’ve weighed in on our voice recognition technology. Users of the athenaOne Mobile App can document and navigate patient encounters by using voice commands, which cuts down on documentation that needs to be completed after encounters — and for some clinicians, can even remove the need to have a screen in the exam room. One of our beta users for voice assistant capabilities shared that he fills his “dead time,” like walking to his car or sitting in traffic, by using his voice instead of his hands to complete documentation. If you’re seeing an average of 16-plus patients a day – like Dr. Diana McDermott of Access Health Louisiana, who spoke with us for our documentation research – you know that even the smallest incremental improvement enhances efficiency while reducing burnout. As a pediatrician, I’m admittedly unlikely to use voice recognition to document pediatric exams. (Can you imagine the kids’ reactions to speaking clinical terms aloud?) But I remember what it was like before templates, workflow accelerators, and order sets existed — and those tools I can’t imagine living without. We need to design and invest in technology that automates more of the tasks that don’t contribute to the patient story.

Consider people and process. Innovation is only one component of the progress trifecta. An analysis of athenahealth network data from last year found that pre-encounter workflows that let staff add templates, include screening questions, and queue up order sets minimize provider work during the patient visit. Data from 2021 show an average two-minute reduction in encounter and post- encounter documentation time per patient among physicians who altered their models in this way. The new EHR research shows that clinicians who complete a higher percentage of their own encounter and document work spend more total time in the EHR per patient visit and more EHR time outside patient appointment hours.

Rethink the fundamentals of clinician job design. It’s time to recognize that “alternative” approaches — like team-based care — can facilitate a more rational distribution of tasks. The Physician Sentiment Index conducted by athenahealth in 2020, which surveyed a broad sampling of clinicians using a variety of EHR vendors, found that providers whose clinical and administrative work is shared across nurses, physician assistants, pharmacists, social workers, case managers, multiple providers, and other healthcare professionals were much more likely to be able to focus on patient care. Team-based physicians were one-third more likely to believe their commitment to success was recognized by their organization, as compared to clinicians in traditional care settings. They were almost twice as likely to believe that their organizations are set up to support patients' social needs.

Recognize that clinicians need protected time to capture their notes in charts. At some organizations, dedicated administrative time is considered a competitive advantage in hiring and retaining clinicians. One athenahealth customer allots clinicians 45 minutes a day to catch up on documentation and other administrative work. The approach hasn’t resulted in a loss in productivity and grants the practice built-in flexibility to see more patients during busy times like flu season. Rethinking the status quo so that changes benefit both clinicians and patients is something that other organizations spanning the healthcare continuum can benefit from, too.

Ultimately, stress is bound to come with most careers. But there’s a big difference between stress and burnout that can have long-lasting implications across the healthcare continuum. After two years of serving on the front lines of one of modern medicine’s biggest crises, it’s time to stop tinkering at the margins and get to the root causes of clinician burnout. We must continue to push for innovative technology solutions and automation. We must recognize the importance of shifting away from volume-based reimbursement systems. And we need to spotlight the value of teamwork and other workplace structures. Only then will medicine have a sustainable future.