EHRs Play a Role in Physician Burnout

A 2015 study found that U.S. physician burnout, satisfaction and work–life balance all suffered over the four-year study period from 2011–2014. Additionally, more than half of U.S. physicians reported professional burnout.¹ N. Lance Downing, MD, clinical assistant professor of medicine at Stanford University, Calif., and colleagues recently published an editorial on physician burnout in Annals of Internal Medicine. They explain that physician burnout has become a crisis in the U.S. and describe the well-documented association between physician burnout and electronic health records (EHRs).²

The authors note the average physician spends 44% of the clinical visit facing the computer. Medical scribes may be able to reduce this documentation burden, but for every hour physicians provide direct clinical face time to patients, they spend an additional two hours  on EHR and deskwork within the clinic day. The problem is exacerbated by the fact that the typical physician also spends an additional one to two hours of personal time performing computer and clerical work each night.³

These findings have led some in the healthcare community to call for staffing and scheduling changes that reflect the shift in physician time. Billing should reflect that physicians now seem to equally allocate their time between face-to-face ambulatory care visits and desktop medicine work. Unfortunately, the current payment policy reimburses office visits, laboratory work and procedures, but largely overlooks the desktop medicine work that appears to be taking a toll on physicians. One possible solution is to use EHR access logs to identify discrete, time-stamped activities and use the information to better understand the time necessary for various processes of care and make suggestions for payment reform.

The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 may make it possible to move away from payment for visits only and allow for reimbursement of critical aspects of patient care that occur outside the visit. A growing body of research suggests that such a change in physician payment policy is warranted and perhaps the EHR access logs could serve as a simple and unobtrusive way for healthcare delivery systems to quantify how clinicians spend a significant portion of their day.

The movement toward a value-based payment system may both ameliorate the negative effect of documentation on physician workflow and provide compensation for the remaining EHR burden. However, Dr. Downing and colleagues worry that this concept misses a critical piece of the puzzle. They note EHR vendors have responded to federal stimulus by creating robust financial and compliance features while simultaneously compromising usability features. This approach has created an undue burden on physicians and contributed to their burnout. They suggest what is needed is a revision of regulatory requirements, as well as EHR platforms that focus on the needs of physicians.

“We believe that platform improvements are essential, but will be insufficient to address a key cause of physician burnout: our outdated regulatory requirements,” write the authors in their editorial. “Value-based reimbursement programs hold the most promise for controlling spiraling costs, but they must avoid overburdening physicians with administrative responsibilities. Regulatory reform (including changes to billing requirements) allowing clinicians to strip documentation to bare essentials would improve accuracy, enable better use for research and reduce the tedious work that occupies so much of our time.”

Lara C. Pullen, PhD, is a medical writer based in the Chicago area.

References

1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work–life balance in physicians and the general U.S. working population between 2011 and 2014. Mayo Clin Proc. 2015 Dec;90(12):1600–1613.
2. Downing NL, Bates DW, Longhurst CA. Physician burnout in the electronic health record era: Are we ignoring the real cause? Ann Intern Med. 2018 May 8.
3. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: A time and motion study in four specialties. Ann Intern Med. 2016 Dec 6;165(11):753–760.