That crispy feeling is real. Unlike the overflowing paper forms, charts, and faxes of olden days (!), doctors and clinical staff now not only deal with paper, but also with what physicians call their ‘electronic masters’. The volume is astounding and has led to numerous studies of physician burnout. One of the latest has been published in Health Affairs (free access), a directional study which will not cheer up anyone concerned with doctor health and retention in the field.
A study of over 900 physicians at the Palo Alto Medical Foundation found that almost half (114, 47 percent) of the 243 weekly in-basket messages received per physician, on average, were algorithmically generated out of their Epic EHR. This far exceeded emails from colleagues (53), from themselves (31, e.g. reports), and patients (30). Other findings from the study:
- 36 percent of the physicians reported burnout symptoms
- 29 percent intended to reduce their clinical work time in the upcoming year
- 45 percent with burnout symptoms received greater-than-average numbers of weekly EHR-generated in-basket messages
- Receiving more than the average number of system-generated in-basket messages was associated with 40 percent higher probability of burnout and 38 percent higher probability of intending to reduce clinical work time
- EHR message volume was highest for internal medicine, family medicine, and pediatrics
While this is only one group of physicians in one location, and limited by specialties,this excerpt from the concluding discussion tends to say nearly all:
Therefore, both perceived and realized loss of autonomy over their work schedules could leave physicians feeling defeated, even though some of these system-generated messages have been shown to improve certain processes of care for patients with chronic illnesses.
Health care organizations need to reconsider some of their approaches to improving the quality of care and population health. Physicians might not be the most appropriate recipients of some system-generated messages. Payers and government regulators may need to be part of the solution in enabling physicians to practice at the top of their license. EHR design engineers also need to reconsider whether system-generated automatic messages are the best way to ensure quality of care. It may be time to examine whether every reminder to order routine chronic disease management lab tests (for example, periodic glycosylated hemoglobin A1c tests) must be signed and placed by a physician.
Health care organizations may benefit from engaging with their physicians in creating optimal policies on email work, in addition to helping them with such work. (e.g delegation to non-physician clinicians–Ed.)
Add to that phone calls and endless prior authorizations from insurers–should we have a ‘Be Kind To Your Doctor Week’? Hat tip to HIStalk.
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