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Electronic health records have been widely blamed for physician burnout.
Jonathan Bush, CEO of EHR vendor AthenaHealth Inc. sympathizes with overwhelmed and overworked physicians.
However, perhaps not surprisingly, Bush doesn't fault EHRs.
Instead, what Bush thinks is mostly triggering the physician burnout wave is doctors' frustration with a loss of autonomy as their practices are gobbled up by big health systems.
AthenaHealth chief targets doc burnout in keynote
"That's a big deal, and it's a big deal to AthenaHealth, which profits in lockstep with the profits and destiny of physicians," Bush said in a keynote at the HLTH: The Future of Healthcare conference in Las Vegas. "There was a lot of stuff that doctors did in the course of their day that included latitude that went away when they sold their practice."
Bush and others focusing on physician burnout also cite as a big factor the profusion of government healthcare quality reporting mandates represented at one time mostly by meaningful use and now by programs like the Merit-based Incentive Payment System (MIPS). Weak health data interoperability doesn't help.
EHRs and lack of engagement drive burnout
Another driver is what physicians see as technology changing too rapidly. And yes, more than a few experts pinpoint EHRs themselves as a big culprit, though some EHR vendors, including AthenaHealth, claim they are redesigning EHR user interfaces and workflows to take pressure off doctors.
Also, a lack of physician engagement as a cause of burnout has drawn the interest of a leading employee engagement software vendor Limeade. The company, which comes out of the HR technology sector, has formed a caregiver burnout consortium.
Bush's position that industry consolidation is most at fault could be perceived as self-serving because AthenaHealth's main market is physician practices, but it's also a view held by noted medical researchers.
At HLTH, Bush invoked the much cited Mayo Clinic finding that 54% of physicians reported feeling overwhelmed by work.
Mayo Clinic expert on physician burnout
Indeed, Liselotte Dyrbye, M.D., a veteran Mayo Clinic researcher who helped do the original research on the phenomenon of physician burnout, echoed Bush's position on physicians' perceived loss of autonomy, but she also put the onus on EHRs.
"With 50% of your workforce having substantial symptoms of burnout ... it's really a reflection of a system-level problem," Dyrbye told SearchHealthIT. "The electronic health record is certainly a component. Physicians spend two hours interacting with the electronic health record for every one hour they spend with patients."
Dyrbye argued that EHRs originally evolved from medical billing systems and were ill-adapted for clinicians from the outset.
However, she applauded an EHR vendor like AthenaHealth for paying attention to the problem and said competition in the EHR industry is positive and could lead to substantial improvements for clinical users.
Other major drivers of physician burnout are dramatically bigger workloads, more acuity of symptoms and multiple comorbidities with the prevalence of chronic conditions among baby boomers, according to Dyrbye.
"It's problems with workloads, job demands and problems with efficiency of practice," Dyrbye said.
The Mayo Clinic has developed a variety of strategies and tools for dealing with the problem, including a physician well-being index app.
HR tech vendor targets health systems
For Limeade, which sells its employee engagement and well-being software system to large employers in the healthcare market, physician burnout brings along with it a substantial opportunity, CEO Henry Albrecht said in an interview at the HLTH conference.
"We've noticed that the No. 1 issue large health systems and hospitals face is caregiver burnout. Burnout is a hot topic, but nowhere is it as big as in healthcare," Albrecht said. "People aren't just burning out and affecting patient outcomes, they're burning out and leaving the field altogether."
In addition to its consortium, Limeade recently introduced a burnout risk indicator function on its engagement dashboard. It also unveiled research showing that job-related stress and exhaustion manifest in employee exhaustion, cynicism and inefficacy.
Henry AlbrechtCEO, Limeade
Based on data from machine-learning-based pulse surveys, the Limeade burnout graph calculates the number of highly engaged employees at risk for burnout and uses predictive analytics to filter out those at greatest risk.
The Limeade system then pushes information to the most at-risk employees about activities to promote sleep health, work-life balance and well-being.
While Albrecht downplayed the role of EHRs and technology in triggering physician burnout, one fledgling EHR vendor is basing its business model on a user interface that minimizes clicks and typing and is informed by the risk of physician burnout.
New vendor touts more usable EHR
Modernizing Medicine's cloud and mobile-based EHR -- aimed at physician practices -- was developed with insight into how physicians work, including tracking their eye movements around a display screen, said Andrew Schall, director of user experience (UX).
Schall maintained that older EHRs are littered with "UX debt," or old functions and navigation buttons that are no longer needed but reappear continually in system updates.
The EHR vendor's focus on usability and user experience is all part of contemporary user-centered design. That approach is "certainly not specific to healthcare," Schall said.
"But traditionally healthcare really hasn't taken a user-centered design approach," he said. "It's been very much a development-centered approach, unfortunately."