Taking Action Against Clinician Burnout A Systems Approach to Professional Well-Being (2019) / Chapter Skim
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7 Health Information Technology
7 Health Information Technology
Pages 199-234
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From page 199... ...
As the committee described in Chapter 4, poorly designed and deployed 1 Excerpted from the National Academy of Medicine's Expressions of Clinician Well Being: An Art Exhibition. To see the complete work by Diana Farid, visit https://nam.edu/ expressclinicianwellbeing/#/artwork/132 (accessed January 30, 2019)
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From page 200... ...
. Although all types of technologies affect the clinical work environment and the experiences of clinicians and patients, much of the current literature on technology in the context of clinician burnout -- and thus this chapter as well -- focuses on health IT and, more specifically, the electronic health record (EHR)
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ELECTRONIC HEALTH RECORDS Health IT -- including, but not limited to, EHRs -- that is well-designed to meet clinicians' and patients' needs and that is integrated seamlessly into care processes will improve both clinicians' and patients' experiences with health care delivery and the quality of that care (IOM, 2012)
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. However, for a variety of reasons, the EHRs are not as usable or well aligned with clinical workflow as most clinicians would desire and are associated with clinician burnout and decreased professional satisfaction (Ehrenfeld and Wanderer, 2018; Gardner et al., 2018)
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. Installation of new systems is often difficult, and there has often been a steep learning curve associated with the introduction of digital health records.
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. As was mentioned in Chapter 4, numerous studies have reported that greater use of the EHR is associated with more clinician burnout (Babbott et al., 2014; Robertson et al., 2017; Shanafelt et al., 2016)
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Nurses also reported difficulty accessing the information they needed to make patient care decisions ( ephart et al., 2015)
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. While there is some evidence that EHR use is associated with improvements in clinical note quality (compared with paper records)
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allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and (c) does not constitute information blocking.3 While the Cures Act encourages interoperability and prohibits any sort of blocking of information that may interfere with the exchange of health information (Lye et al., 2018)
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on April 19, 2019, which outlines a common set of principles, terms, and conditions to facilitate inter perability o and information exchange across disparate health information exchange platforms and help enable the nationwide exchange of electronic health information (ONC, 2019b)
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. Especially in the first year post-implementation, clinicians spend more time interacting with current EHR systems than they had spent documenting in paper health records (Baumann et al., 2018; Carayon et al., 2015; Joukes et al., 2018)
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. This burden is compounded by multiple logins and other screens, especially when multiple non-communicating systems must be accessed concurrently during patient care delivery.
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. Patient portals allow patients easier access to their health information, including laboratory results, clinical summaries, and health histories as well as to clinical appointments and billing information.
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SHARED RESPONSIBILITY FOR IMPROVING HEALTH INFORMATION TECHNOLOGY To advance health IT and improve its usability and interoperability and to reduce its administrative burden, it will be critical that participants at all three levels of the systems model -- actors in the external environment (including health IT vendors, payors, regulators, and national societies) , HCOs, and frontline care delivery -- work together to find solutions.
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The draft acknowledges many of the problems asso iated with health IT use as delineated in this chapter and includes three c goals to reduce clinician burden: 1. Reduce the time and effort clinicians spend recording record health information; 2.
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. The draft outlines a common set of principles, terms, and conditions for facilitating interoperability and information exchange across disparate health information exchange platforms to help enable the nationwide exchange of electronic health information.
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A 2015 position paper from the EHR-2020 Task Force of the American Medical Informatics Association suggests that federal agencies should more fully quantify the burden of requirements before they implement them. They recommended federal support of research into the unit-time cost of documentation requirements and how they differ across different collection mechanisms, such as typing, dropdown selections, voice recognition, natural language processing, and handwriting recognition (Payne et al., 2015)
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HHS identified these areas as problem areas for EHR usage, and many of the same areas appear in existing literature on factors that lead to frustration and burnout. To provide greater transparency in the certification process, in 2016 ONC launched the enhanced Certified Health IT Product List, which allows end users to compare product functionality, performance, and certification status (ONC, 2016)
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Doing so will also help organizations reduce the clinician burnout that is a result of frustration and the excessive time that clinicians spend using technology that does not meet usability or interoperability standards (see Chapter 4)
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Non-physicians are taking greater, more proactive roles in patient care, which potentially could make all clinicians' work more meaningful. Clinicians will need to adapt to these changing roles and to changes in the environment of practice, the flow of information, the structure of teams, and consumer expectations.
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. Frontline care delivery clinicians too must be part of the solution, given that HCOs include clinicians in their processes.
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History has shown that technological advances are not sole determinant of the future; the method of deployment, people, and surrounding processes will drive the ultimate outcome. This next section describes some of the most important technological trends and examines their potential to address the clinician burnout epidemic.
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. While emerging technologies hold promise in helping to reduce clinician burden and are not currently part of the immediate pressures relating to clinician burnout, it is possible that they will become a factor within the next several years as the technologies mature and their adoption becomes more widespread.
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. Further research into acceptability and adoption, particularly at the care team level, is warranted to ensure that the innovations are effectively integrated into the care delivery process.
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and tele-assistive specialty care, where either human experts or AI systems provide remote guidance during in-person clinician–patient encounters. Little published research has examined the relationship between the use of telehealth by clinicians and clinician burnout.
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2018. The impact of electronic health record sys tems on clinical documentation times: A systematic review.
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2015. Electronic health records improve clinical note quality.
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2018. Physician burnout in the elec tronic health record era: Are we ignoring the real cause?
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2018. Physician stress and burnout: The impact of health information technology.
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2018. Letter to National Coordinator Don Rucker re: Request for information regarding the 21st Century Cures Act electronic health record reporting program.
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2018. The 21st Century Cures Act and electronic health records one year later: Will patients see the benefits?
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ONC (The Office of the National Coordinator for Health Information Technology)
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2018. Scalable and accurate deep learning with electronic health records.
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2018. Improving the safety of health information technology requires shared responsibility: It is time we all step up.
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2017. Comparison of accuracy of physical examination findings in initial progress notes between paper charts and a newly implemented electronic health record.
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