What to do about clinician burnout?

Recent research has shown that the cost of clinician burnout appears to be significant:

“Clinician burnout is prevalent across health care settings and may impair clinicians' ability to maintain safe practices and detect emerging safety threats.”^[i]

 “Using a hypothetical organization that employed 450 physicians, the researchers showed a $1 million investment could save the organization $1.125 million per year in replacement costs associated with physician turnover—a 12.5 percent ROI.”^[ii]

As noted above, burnout negatively impacts patient safety, patient satisfaction, and---due to the cost of replacing clinical staff---the bottom line of health care delivery systems.

One of the oft-cited reasons for burnout is the frustrating nature of EHR workflow, as illustrated in these quotes from doctor/rapper ZDoggMD:

“[T]he Tower of Babel of existing EHRs may not ever talk to one another, but they do share one thing: they come between us and our patients.”

“Notes used to be our story, narrative, but yo
Replaced with copy paste, now a bloated ransom note
Me, I’m at that bedside, focused like a laser beam
On the patient, naw come on, I’m treatin’ the computer screen”

The good news is the increasing body of science that can help us understand causes and test interventions. Adverse work flow, low work control and unfavorable organizational culture are correlated with increased burnout.^[iii]

One study examined multiple interventions aimed at improving work conditions for primary care physicians. Approximately 22 percent of intervention physicians showed improvements in burnout, compared to only 7 percent of those in the control group.^[iv]

Interventions in the aforementioned study included scheduling regular meetings to address stressful issues, shifting work to medical assistants and clerks and working on quality improvement activities. As one reads the details of the interventions (e.g. “data entry,” “medical assistants enter data into EMR,” and clerks moving information) it seems obvious (to me at least) that a good amount of burnout stems from how hard it is to get data into electronic records.

I suspect that this is in part due to quality measurement and billing requirements that cause EMR vendors to force structured data entry (a.k.a. check-boxes, pull-down menus, etc).  ZDoggMD raps that notes used to be a story or narrative, but this relatively easier form of documentation creates text notes that are unreadable to machines. He says:

“Tech should bind us, connect, not blind us, to the reason why we care”

Given the advancements in natural language processing and information technology ecosystems including sophisticated, semantic-level translation across data nomenclatures, technology companies can develop user interfaces that re-connect clinicians and patients with low-friction data entry, extracting meaning and details with technology and not by bludgeoning clinicians with click-boxes and pull-down menus.

L. Gordon Moore, MD, is senior medical director for Populations and Payment Solutions at 3M Health Information Systems.

[i] Audrey Lyndon PhD. “Burnout Among Health Professionals and Its Effect on Patient Safety | AHRQ Patient Safety Network.” Patient Safety Network, AHRQ. Accessed November 9, 2017..

[ii] Daniel Allar. “Investing in Physician Well-Being Pays off, Reduces Burnout by 20%.” Cardiovascular Business, September 27, 2017..

[iii] Linzer, Mark, Linda Baier Manwell, Eric S. Williams, James A. Bobula, Roger L. Brown, Anita B. Varkey, Bernice Man, et al. “Working Conditions in Primary Care: Physician Reactions and Care Quality.” Annals of Internal Medicine 151, no. 1 (July 7, 2009): 28–36, W6-9.

[iv] Linzer, Mark, Sara Poplau, Ellie Grossman, Anita Varkey, Steven Yale, Eric Williams, Lanis Hicks, et al. “A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study.” Journal of General Internal Medicine 30, no. 8 (August 1, 2015): 1105–11.