How conventional EHR’s are contributing to Physician burnout and what can be done. “Almost one third of Irish hospital doctors experienced burn-out, indicating suboptimal work conditions and environment”1 “50% of doctors reported being emotionally exhausted and overwhelmed by work”1 “The annual cost of physicians spending half of their time using EHRs is over $365 billion […]
How conventional EHR’s are contributing to Physician burnout and what can be done.
“Almost one third of Irish hospital doctors experienced burn-out, indicating suboptimal work conditions and environment”1
“50% of doctors reported being emotionally exhausted and overwhelmed by work”1
“The annual cost of physicians spending half of their time using EHRs is over $365 billion (a billion dollars a day) – more than the United States spends treating any major class of diseases and about equal to what the country spends on public primary and secondary education instruction.”2
“54% of physicians rate their morale as between somewhat or very negative”3
Physician burnout is real, and it is getting worse. In a 2019 Health Affairs blog, a group of top healthcare CEOs called physician burnout a “public health crisis”.4
In this blog, I do not want to dwell on the statistics, because all they do is substantiate what we already know. Where I think we need to focus our efforts now is not on the “if” burnout exists, but the “how”. It is worth noting that the first EMR was developed in 1972 by the Regenstreif Institute7 , with burnout among doctors first described just 2 years later, in 19748.
Physician’s needs are simple. Beyond those contained in Maslow’s hierarchy, physicians have the need to provide quality medical care, maintain autonomy, fulfil expectations, and build rapport with their patients. In current health systems, each one of these needs is systematically challenged on a daily basis, both by the EHR and other forces.
Outlined below, are just some of the ways the EHR contributes to physician burnout. This is my take on how change can be brought about for the better.
We know that physicians need to be able to switch off. “Resilience” workshops will tell physicians that their inability to do this is the major contributor to their burnout. At the same time, we are seeing conventional EHR’s evangelising the emergence of “connectivity” and the idea of “doctor in your pocket”. This constant connectivity to a physician means at some point in the day, every day, a physician needs to be contactable by, and as a result responsible for, their patients. While the vast majority of physicians continue to cite a high desire to practice medicine, a higher amount cite constant connectivity as a major contributor to their stress levels.
We need to implement systems that recognise the unique needs of physicians and their medical colleagues. We need to recognise that expecting a physician to use tools built for administrators is like asking your hairdresser to dry your hair with their appointment book! Systems that focus solely on the clinical needs of physicians, will be the ones that truly reduce administrative burden. These systems will empower, rather than oppress physicians, by providing solutions that fit their workflows and practices. Systems need to also recognise that the antiquated view of Physician = Physician = Physician no longer holds true. The IT needs of a cardiologist are going to be vastly different from those of a pathologist, and it is ignorant to suggest that they should both bend to fit a rigid system. There is also a fine line between “connectivity” and 24/7 responsibility. Recognising this, and allowing for it within the fabric of the IT system employed is key.
Taking steps to implement a clinically focused system is not going to end physician burnout. What it can do is show all members of the healthcare team that their needs are recognised, considered, and important. Beyond the needs of Maslow’s hierarchy, physicians just need to be allowed to be physicians. There is no reason healthcare IT systems cannot accommodate this.
Writer – Dr. Sarah O’Reilly