EHRs hold a powerful lesson in using integrated clinical workflows to address physician burnout. At times, they have been a source of stress for many clinicians. But as interoperability and integration with other digital solutions across hospitals and health systems have increased, they’ve started to deliver on the promise of more efficiency and meaningful use.
As healthcare leaders push the boundaries of digital transformation, physicians around the world have a greater need for integrated, user-empowering technology — the kind that supports fast-changing workflows as the role of clinicians continues to evolve.
But optimal use of this technology requires that hospital and health system leaders are well-versed in the current state of physician burnout and the benefits of integrated workflow technology, and that they understand how to overcome potential barriers to integration and adoption.
The state of physician burnout after years of COVID
Physician burnout has been in the news as provider shortages continue and the long-term effects of the COVID-19 pandemic begin to unfold.
A study in Mayo Clinic Proceedings found that, after a six-year decline, physician burnout rates spiked during the pandemic. Unfortunately, this trend is holding. The study found that the prevalence of burnout has shifted over the last decade — jumping from 45.5% of U.S. physicians in 2011 to 62.8% in 2021 (after an improvement between 2017 and 2020).
The study results reflected a significant increase in providers’ emotional exhaustion and depersonalization scores compared with mid-2020. What’s potentially most striking are the results for certain groups and specialties: The odds ratio for burnout among women physicians was 2.02 relative to 1.27 for men. Providers in emergency medicine, family medicine and general pediatrics were found to be at increased risk for burnout after adjusting for personal and professional characteristics.
Additionally, researchers found that one out of five physicians has intentions of leaving practice within two years. Globally, 6.4 million physicians will be needed to achieve universal health coverage, with the largest gaps in South Asia, Sub-Saharan Africa, Southeast Asia, Oceania, North Africa and the Middle East. The United States now faces a projected shortage of between 37,000 and 124,000 physicians in the next 12 years, including shortages in primary care of between 17,800 and 48,000 and surgical specialties of between 15,800 and 30,200 physicians.
Besides being damaging to providers, burnout is associated with an increased risk of major medical errors. The American Journal of Medicine conducted a meta-analysis of 47 studies involving more than 42,000 physicians and found that physician burnout was associated with a doubled risk of adverse patient safety incidents.
Addressing clinician burnout through integrated workflow technology
As healthcare leaders examine ways to mitigate physician stress and salvage patient outcomes, technology should be a priority. Integrated clinical workflow tools can provide critical support to the clinical team.
EHRs are seldom an effective way to connect with patients. This leaves providers carrying the clerical burden of juggling communication and note-taking. But Healthcare Finance News reports that artificial intelligence (AI) and machine learning have helped bridge the gap, changing the ways physicians document and communicate patient care.
Technology that addresses EHR challenges and clerical burdens can ease workloads and reduce burnout for family physicians. For example, a voice-assisted AI tool for documentation that understands physician commands and can respond cuts out the need for dictation. In one case, this technology produced a 70% decrease in physician prep time and an increase of 38% in risk adjustment factor (RAF) scores, reports Healthcare Finance News. Physicians can also use voice technology to search for answers to clinical questions on their mobile devices, in their native language, saving time and increasing efficiency in settings where resources are stretched.
Monitoring that supports sepsis teams
AI in the form of natural language processing (NLP) has been found to improve sepsis surveillance when combined with proper workflow integration.
In the ICU, clinical NLP can be used to augment clinician judgment, tagging and identifying key clinical indicators from that could be missed by busy or overworked physicians. By getting this type of information to the correct team members at the right stage of treatment, patients who could be decompensating can be treated more promptly.
Additionally, providing accurate, specific evidence-based alerts at the point of care can alleviate physician and ICU staff burdens. Hospitals can raise sepsis alerts to 99% sensitivity and 97% specificity, while reducing the strain on physician resources. A study in the Journal of Informatics in Health and Biomedicine found a 53% reduction in sepsis mortality and a 31% reduction in related thirty-day readmissions using EHR-integrated solution Sentri7 Sepsis Monitor.
Clinical decision support at the point of care
Clinical decision support (CDS) technology supports clinical decision-making at the point of care by leveraging clinical prediction rules and combining them with patient data. This is vital in the emergency department, a complex, high-time-pressure environment where physicians have limited knowledge of the patient and fragmented EHR data.
In one study, participant workflows were extracted and loaded into software for analysis, entering the diagnostic pathway decisions for each participant and calculating the percent of correct decisions. A whopping 98% of participants followed the guideline-based workflow compared to 51% prior to implementation. But for CDS to provide these benefits, it has to demonstrate high levels of integration into workflows.
There is still a world of potential for CDS to provide the aligned decision-making and standardized delivery of care that improves patient outcomes and supports a positive physician experience. For example, evidence-based CDS tools support decision making for clinicians and can alleviate effort for short-staffed teams.
Reducing physician burnout across the healthcare enterprise
Achieving workflow integration while mitigating physician burnout requires high levels of consistency, especially for solutions that might span an entire hospital or healthcare system. For example, early diagnosis and intervention of standard sepsis protocols can improve patient outcomes, but these results are less likely to be realized when physicians are overworked.
Addressing barriers to adoption
While CDS systems can yield substantial benefits, leadership might encounter barriers in launching these solutions. Common challenges include:
- Low clinician demand
- Lack of clinician motivation (related to usability issues)
- Lack of integration into clinical workflows
- Concerns about autonomy
- Legal and ethical ramifications of either overriding or adhering to recommendations
- Over-alerting and high rates of alert overrides
- Concerns about achieving desired results or worsening outcomes
Healthcare leaders might find some inspiration from recent research out of George Washington University’s work on translational health sciences. In examining barriers and facilitators to technology adoption in oncology, the researchers identified several key facilitators in adoption among oncologists and technologists:
- A desire for collaboration
- A goal of improved patient outcomes
- Reduction of cost burden for patients
- Data and trends for research
Listening to physicians’ existing values and goals can aid CDS implementation and help earn buy-in.
As you work to optimize clinical workflows, know that you don’t have to choose among patient outcomes, cost reduction and physician health. By prioritizing efficiency in clinical decisions and embedded workflows, you can reduce physician burnout and improve the clinician experience.
Learn how Wolters Kluwer provides integrated workflow technology to support clinical staff and alleviate burnout.