AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
AMA Update
How ambient clinical intelligence and AI tools for medical charting can reduce physician burnout
Aug 26, 2024
Featured topic and speakers
Featured topic and speakers
What is the best part of being a doctor? How does AI connect people? Do doctors work outside of work? What is ambient listening technology in health care?
Our guest is Ah Rim Shin, MD, a family medicine physician and physician lead of the wellness committee at The Southeast Permanente Medical Group. AMA Chief Experience Officer Todd Unger hosts.
Speaker
- Ah Rim Shin, MD, family medicine physician and physician lead of the wellness committee, The Southeast Permanente Medical Group
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about the being efforts at the Southeast Permanente Medical Group that led to its recognition in the AMA Joy in Medicine™ Health System Recognition Program, and we'll discuss ways to get feedback from physicians and partner with IT to drive change.
Our guest today is Dr. Ah Rim Shin, a family medicine physician and physician lead of the Wellness Committee at the Southeast Permanente Medical Group in Tucker, Georgia. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Shin, it's a pleasure to have you today.
Dr. Shin: Thank you for having me.
Unger: Well, first off, I want to say congratulations on being recognized by the AMA Joy in Medicine™ Program in 2023. That was the first time that you applied to the program, but you've been working on physician well-being for years. What motivated you to finally apply for recognition.
Dr. Shin: Well, one of the benefits of working at TSPMG is that we get to collaborate with other PMG's across the nation, across different aspects of our organization, including our wellness initiatives. And we were inspired to apply by our colleagues at Southern California who are currently recognized by the AMA Joy in Medicine™ application program at the gold level.
And upon reviewing the application criteria and seeing the key metrics that are measured and the initiatives outlined in the roadmap, we realized that some of those things were things that we had been trying to tackle ourselves in the last several years, and this motivated us to take a stab at applying last year. We still have a long way to go, and we've definitely appreciated the AMA's roadmap in helping us tackle our burnout across our organization.
Unger: That's excellent. And you're doing so much now on physician well-being. I really want to ask for a little bit more information about two specific things. The first one is this issue around physician feedback. What role does it play in shaping your well-being efforts, and how do you actually go about getting feedback from physicians?
Dr. Shin: So we really try. We take physician burnout seriously. And it's important to me because I've been a victim of burnout in the past myself. And in 2021, we changed our engagement survey questions to include very specific questions regarding physician burnout so that we can begin to actively measure burnout across our medical group.
And in 2022, we implemented a campaign called Pebbles in the Shoe by using a crowdsourcing platform that garnered feedback from our clinicians and admin staff regarding inefficiencies throughout their workday or IT related burdens. And we recognize these inefficiencies as pebbles in our admin staff and physicians shoes that prevented their ability to have joy at work.
And in the first year of the campaign, we had 163 pebbles submitted, which was eye opening for us to see how many pebbles were frustrating our clinicians and admin staff day to day, and those pebbles we used to shape our well-being efforts that year as we composed a cross-departmental team comprised of clinicians and admin staff to tackle those pebbles submitted.
Unger: That's funny. I love the imagery of the pebbles in the shoe. Sounds like it's small but really painful when you step on one. And you put 163 in there, and that's a lot of pebbles to deal with. I'm curious, when you look at all the pebbles and the pieces of feedback that you've gotten from physicians, what's the one piece of feedback that surprised you the most.
Dr. Shin: One piece of feedback that surprised me the most over the years was how much our physicians generally enjoyed spending time with their patients. And I know this shouldn't surprise me, but it does. Because colleagues will go on and on about what frustrates them throughout their work day, and then say, "Ah Rim, the best part of my day is when I'm in the room with a patient. And the worst part of my day is everything that comes before and after that time, whether it's support staff shortages that lead to inefficiencies in rooming the patients in a timely manner or the charting or the in-basket that comes afterwards."
And one of the foundational aspects of quality care comes from that basic interaction between the patient and their physician. And patients don't come to the doctor just to have labs done or tests ordered. They come to the doctor to be listened to, to be treated as a unique individual and to have a relationship with their physician. And so feedback like this really motivates us to do our best to remove the pebbles surrounding the sacred time so that we can allow our physicians to do simply what they love to do, which is to take care of their patients.
Unger: That's so true. We hear that consistently from physicians at that time with patients is what they got into medicine for. And it's all these other things that stand in the way and minimize the amount of time they get to spend face to face with physicians that really form the root of these burnout problems.
One of those issues—and you mentioned it a little bit in that—is just around technology and all of the things that are a part of that. And I want to dig a little further into how you've made progress, and that is partnering with your IT group to really resolve some of these problems in the technology space that contribute to burnout. Can you tell us more about that collaboration?
Dr. Shin: Sure so out of the 211 pebbles we've had since the launch of the campaign, over 35% of them were related to IT issues. And so we recognized we needed to add someone from the IT department to our wellness committee. And this individual has partnered with our committee to go over pebbles related to IT issues and give suggestions on next steps for resolution if possible.
We also have someone on our wellness committee from the acceleration and care transformation department, and this department is tasked with keeping our organization at the forefront of health care transformation. So they have access to HR metrics and data analytics to drive some of our initiatives and changing workflows and gathering feedback and tweaking improvements.
Unger: Do you have an example of one of those technology pebbles that you partner with it on to resolve?
Dr. Shin: So one recent project TSPMG has worked on with IT that had an impact on physician burnout was an AI-driven ambient listening tool that helped reduce charting time for our clinicians. And we were inspired by our Northern California PMG colleagues regarding this technology. And then we partnered with national leadership to ultimately choose the vendor we use now.
Implementing this tool was spearheaded by our physician leaders of it related innovation and admin staff, and we as a wellness committee partnered with them to gather feedback from the clinicians before and after implementation of this tool to see how it impacted our physicians. And what we saw were improvements of our clinicians ability to juggle their workload. We also saw improvements in their ability to successfully balance work and personal life, and we also saw a reduction in our physicians who felt burned out on a daily basis.
One surprising finding that we saw was this tool's ability to impact human connection. Many of the clinicians actually said that the tool helped them to focus more on the patients in front of them rather than on the computer screen. And so they stated that it helped increase enjoyment of their patient encounters.
Unger: Now, those are some really great outcomes, and it sounds like you've had now experience with a wide variety of these types of pebbles and changes, and you probably are really well aware that the ones that are going to really have an impact require a lot of time, attention, collaboration. If I gave you magic powers and you could kind of snap your fingers and instantly make one of these changes a reality, what would it be?
Dr. Shin: If I could snap my fingers and instantly make one change into a reality, it would be to eliminate WOW time or work outside of work time. And I know this is a multi-layered, complex issue, and there's multiple factors to consider.
Whether it's improved in-basket support or reduction in charting time or decreasing inefficient workflows throughout the work day so that we have less wasted time and then less work goes home with our clinicians, we're actively embracing innovative solutions to help our clinicians reduce charting time, like we discussed with the ambient listening tool earlier. We're also exploring new care models like team-based care to address the support staff shortage.
We also utilize AI and nurse practitioners to help with in-basket support so that many redundant emails or normal labs are appropriately handled before even reaching our physicians. So we have a long way to go. But if there is one change I can make instantly into reality, it would be to eliminate that work outside of work time. I think this is our greatest area of opportunity, and I'm excited to see all the possibilities that are available with the new technology we have in the market right now.
Unger: I love that. We talk at the AMA a lot about pajama time, which is the work after dinner, after the kids are in bed, and you're working on charts and stuff like that. But WOW time is just, kind of, that bigger picture of just always being on. I was at a brunch over the weekend on a Sunday and a pediatrician happened to be there. And I saw her have to go away in a corner and spend 15 minutes working on a day off.
I know exactly what that looks like. And I'm sure eliminating WOW time would be very, very meaningful to the physicians there. So thank you so much for being with us today and telling us more about the great work that's happening at the Southeast Permanente Medical Group.
If you're a health system leader out there, you should learn more about the AMA Joy in Medicine™ Program and how it can help you improve physician well-being at your health system. Visit ama-assn.org/joy and join the more than 70 health systems that we recognized last year alone for their well-being efforts.
That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
Subscribe to AMA Update
Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.
