When Jane F. Fogg, MD, MPH, first became a doctor, patient charts were on paper. She looked forward to the rise of the EHR, believing electronic charting could help modernize the care she provided while also empowering herself and her patients.
Funny how things turn out.
“EHRs are a source of burnout—we have lots and lots of great evidence that has helped us understand the low usability and the high work burden that it adds to physicians,” Dr. Fogg, senior physician adviser at the AMA, said during a boot camp held at the Association’s Chicago headquarters. “Why that happened is that we didn’t spend the time and the care to design the EHR as we would design everything we do—our team-based care, our clinical practice, evidence-based medicine.”
“We tried to translate paper processes into the computer, and we didn’t know that many years ago that this would be something that doesn’t work well,” said Margaret Lozovatsky, MD, vice president of digital health strategy at the AMA. “Today we have the unique opportunity to look at what exists and work together to improve it, to enable our physicians to be able to care for patients.”
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Here are just a few ways that health systems and organizations can improve EHR workflows to reduce physician burden.
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Identify the pain points
- When Dr. Fogg met with her team and her health system’s technology partners, the goal was to identify how they could optimize the EHR for primary care physicians. For them, it was that the average full time primary care physician was receiving 500 messages in the inbox per week. “People were drowning. We wanted to reduce that work burden. We examined the current state carefully to identify the pain points and potential solutions,” Dr. Fogg said.
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Ask the “why” of the current state
- “When you’re thinking about opportunities for improvement … you really need to take a step back and understand why things are the way they are today,” Dr. Lozovatsky said. “Asking the ‘why’ question to understand the reasons—such as regulatory requirements or quality goals—that led to the current state is the first step to understanding the best approach to optimization.”
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Prioritize the work
- “There’s only so much work that can be done. There are large projects and small pebbles in the sand,” Dr. Lozovatsky said, noting that “some organizations have very complex prioritization teams. We chose to move away from that to make it very simple and to assign a one to three priority to things to make it move through the system faster” to improve EHR use and offer some quick wins to share.
- “What it created is transparency across our institution for when your work will be completed. And that let our clinicians have an expectation of how their needs will be met and when,” she said.
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Change the EHR inbox workflow
- Going one by one over all suggestions physicians provide is not a good use of time because “sometimes there were things that were not causing pain points for everyone or required a high lift for a low impact. So, we sat down, and we figured a way to do prioritization of suggestions based on impact, feasibility and clinical care needs,” Dr. Fogg said. For example, “we wanted to reengineer the inbox to reflect our existing team-based care—where the team triages incoming clinical needs and engages the physician when appropriate.”
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Eliminate, automate, delegate and collaborate
- One approach that really made a difference was asking, “What can we eliminate? Where are we going to automate, delegate and collaborate?” Dr. Fogg said. “Automation is where we’re going to embed the protocol into Epic so that whatever process it is, is completely resolved without me doing it.
- “We used automation strategies with both prescription renewals—which reduced inbox messages by 50%—and we did it with normal labs, which reduced the labs in general by 30%,” she added.
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Remove items that don’t add value
- “Elimination was a key tactic as there was so much waste in the EHR. It was an opportunity to do this work behind the scenes without anyone having to have a new workflow,” Dr. Fogg said, noting that her team looked at all items and determined what really needed to go to the doctor’s inbox and what could be filed into the chart without a doctor’s review. “For scanned documents found in the ‘media manager folder,’ we were able to eliminate 98% of the messages as they were mostly administrative or misfiled. This led to a remarkable 98% reduction in this folder.
“Making sure that your physicians at your organizations are engaged in the conversation and plugged in, in the most efficient and effective way is going to allow us to move the needle, to turn the narrative from technology being a burden to technology being an enabler, which is where we all want to go,” said Dr. Lozovatsky.
AMA STEPS Forward® open-access toolkits offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency.
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