When it comes to clinician burnout, one of the most significant challenges for CIOs has been understanding the crux of the issue.
“I don’t think we get it, because we’re not in that world,” said Chuck Podesta, who currently serves as interim CIO at UConn Health, but has amassed more than 25 years of experience in the role. “I work with physicians and round with them, but I’m not doing that job.”
And even if CIOs and other leaders recognize the substantial burden facing clinicians and can empathize with them, it doesn’t necessarily translate into the ability to affect meaningful change. During a recent panel discussion, Podesta addressed this critical topic, along with Brett Oliver, MD (CMIO at Baptist Health System), Daniel Nigrin, MD (CIO at Boston Children’s Hospital) and Christopher Kunney (Chief of Strategy and Business Development with DSS).
The panelists agreed that burnout is a multifactorial problem, and therefore doesn’t have a simple solution. And while technology is often cited as the key culprit in clinicians’ mounting frustrations, it certainly isn’t the only factor. It has, however, played an increasingly larger role, and as a result, is becoming “an add-on to their day, as opposed to being complimentary,” noted Podesta.
The good news is that there is an opportunity to optimize IT systems and leverage other technologies “to help reduce the cognitive load and enable physicians to focus on patient care,” said Kunney, who spent several years on the provider side earlier his career.
Breaking down the ‘why’
As in many cases, the best place to start is by getting to the root of the issue — or, in this case, the roots. One of those, according to Nigrin, comes down to the simple fact that many clinicians feel like aren’t working at the top of their licenses. “They’re not being doctors or nurses, they’re being scribes and administrators,” he said. “When the time you have with each patient is so limited already, and then you layer on what many view as administrative work, it really irritates clinicians.” Throw in the added pressures of increasing volumes and throughput, and it makes for a dangerous combination.
Kunney concurred, adding that DSS has learned through multiple surveys and interviews that manually inputting data takes away from the ability to focus on the patient. “That’s where the satisfaction comes in — from taking the training that they spent years gaining and using it to provide care and not having to focus on a piece of technology.”
That piece of technology, in many cases, comes with an interface that isn’t intuitive enough to provide the seamless experience that users need. Not only that, but it doesn’t match clinicians’ workflow, which is a “big issue,” according to Podesta. “I don’t think enough time is taken to either develop a better workflow, or match the technology to it,” he noted. “A lot of times, it’s matching technology to the current workflow, which may or may not be optimized. So now you’re just adding technology to that. To me, that’s one of the biggest areas that I hear that’s frustrating for physicians.”
As a result, eight-hour days become 10- or 12-hour days, which can lead to stress and sleep deprivation. For CIOs, it ratchets up the pressure to optimize workflows and provide information in a seamless fashion to help reduce the cognitive load.
The big question is, how?
During the discussion, the panelists provided several best practices that can help get organizations move forward in reducing burnout.
- Involve clinicians. It may seem obvious, but involving physicians, nurses, and other caregivers in the discussion is critical, said Nigrin. “This is not something that the IT team can go think of in the back room. This needs to be a collaborative process.”
- Avoid broad brush strokes. Because different clinicians have different challenges, burnout can’t necessarily be addressed at a macro level, said Oliver. “I don’t know what an ER doc who works the second shift needs versus a pediatrician who’s working in a clinic. Their burnout needs, even from a technology standpoint, are going to be different.”
- Use surveys intelligently. Surveys can be used to obtain objective measures on things like time spent charting or extra time logged, noted Oliver, but it’s important to avoid overdoing it. He suggested limiting it to four or five questions, following up regularly, and making sure data are being tracked. “That’s the best way to know whether you’re moving the needle.”
- Mine the data. Podesta recommended leveraging signal data within EHRs to mine the data and identify trends in usage. “You can look at it from an analytics standpoint to get an idea of which physicians are being efficient in what they do, and which aren’t.” At his previous organization, UC Irvine Health, a program was launched in conjunction with UC San Diego to enable more physicians to be ‘Home for Dinner.’ Based on signal data, physicians who scored low in terms of efficiency were paired with those who scored high so that they could learn from each other. “It gave us the ability to bring the data forward and have conversations,” he noted. “It was a big success.” According to Kunney, DSS offers training and support program in which a team of experts rounds with physicians and watches them interact with the computer to try to identify areas of improvement.
- Embrace voice recognition. By itself, voice recognition (VR) can be a powerful tool in reducing the transcription burden. But with artificial intelligence behind it, “you can envision a future state where the bulk, if not the entire, documentation effort is taken away from the clinician. That’s huge,” said Nigrin, who has dipped his toes into VR at Boston Children’s, and plans to do the same when he takes on the CIO post at MaineHealth in January. “We’re very curious to see what’s going to happen with the various products that are emerging now.” Baptist Health is kicking off a small pilot, according to Oliver, who believes VR could play a key role in facilitating tasks like finding chest X-rays, something that is often reported as a pain point. “If we can use voice to do that by pushing just one button, that’s a game-changer,” he said.
- Advise vendors. By providing input and insight to vendors, IT and clinical leaders can help them “develop better solutions, enhance workflows, and address some of the challenges that are leading to increased burnout,” noted Kunney. “When you invest in an EHR, you’re partnering with that organization for an extended period of time, and so it’s in everyone’s best interest to make sure those tools are meeting the needs of the organization, and not creating additional stress.”
By adopting these measures, organizations can make great strides in reducing burnout, and continue the progress that’s already been made. “I think we are closing the gap,” said Podesta, who recalled the huge amount of resistance leaders faced when tools like CPOE were first introduced. “We’ve come a long way,” both in terms of the technology itself, and the adoption rates. “We’ve gotten to a point where the pace is picking up with things like voice recognition and AI. I’m hopeful that these technologies will come forward and allow us to have an Amazon experience.”
To view the archive of this webinar — Optimizing IT to Reduce Physician Burnout (Sponsored by DSS) — please click here.