EHRs cause a lot of stress for primary care clinicians. One reason for this stress is the sheer amount of time that these clinicians spend on their EHRs. A study of family medicine physicians using Epic EHRs found that physicians spent over 2.5 hours a day on documentation and administrative tasks, culminating into almost 6 hours a day on the EHR, with 86 minutes each day occurring after hours. Another study found that for every eight hours that ambulatory physicians had scheduled, they spent over five hours in the EHR.
This is contributing to severe consequences for the primary care workforce. 51% of family medicine physicians report burnout, which is one of the highest burnout percentages by speciality. And 60% of physicians say that administrative work and documentation are the main contributor to their burnout. The AAMC predicts that by 2034, the U.S. will face a shortage of between 17,800 and 48,000 primary care physicians.
While there are many organizational and systemic changes that can (and should) be made to address burnout and the clinician shortage, health systems can start today by taking these steps to reduce the EHR burden for primary care clinicians.
As administrative work is one of the top contributors to physician burnout, recruiting and retaining ample support staff can help alleviate the administrative burden. Two of the most common roles for staffing support are scribes and medical assistants.
Scribes have been shown to be beneficial to other clinicians. In primary care, scribes have been found to enhance productivity, increase clinician efficiency, and improve the provider experience without negatively impacting the patient experience. Research also shows that scribes reduce the time to close patient encounters and that physicians were more likely to review medication lists during scribed visits. While scribes can be a great source of support, this is essentially just shifting the work to someone else, when the ideal solution is to find a way to reduce the burden overall. In the long run, scribes may not be the most effective solution.
Similarly, MAs can support other clinicians in primary care. MAs’ roles have been expanding, and they can vary based on training and health system. However, new responsibilities that MAs are taking on include patient outreach, panel management, health coaching, and much more. Individual practices can choose the extent of their MAs’ roles, but whatever the responsibilities, MAs’ can reduce a lot of administrative work for other clinicians and give these clinicians more time to focus on caring for patients.
PCPs, on average, received 77 inbox notifications per day, compared to 29 that specialists received. Another study found that PCPs spend almost an hour a day managing their inbox. While communication is extremely important in healthcare, many of these inbox messages are repetitive, not medically necessary, or could be handled by another clinician on the care team.
Using a team-based approach is a great strategy for improving inbox management. Physicians can identify types of messages that can be routed to other team members and work with IT to automatically send these messages to other care team members instead of the physician, which can greatly reduce the number of notifications the physician receives. Alternatively, other care teams may choose to have nurses or medical assistants take a first look at the inbox and direct messages where appropriate. Having the entire care team manage the inbox gives physicians more time to focus on the care and issues that most need their attention.
Another way to improve inbox management is to streamline things that occur frequently. For example, the team can work together to develop workflows for common tasks, such as prior authorizations. If clinicians find that they are sending messages frequently – such as an email saying that a common test or screening came back normal – the team can create a template so that they don’t need to write each individual message from scratch, but can instead customize the individual information while keeping the same structure.
Clinician-focused approaches to technology can be a great asset for reducing EHR burden by reducing time spent in the EHR and streamlining workflows. It is estimated that 33% of tasks in clinical healthcare can be automated. This is not talking about making clinicians obsolete and ignoring the great value that clinicians play in healthcare, but it is focusing on the administrative tasks in clinical practice, such as charting, prior authorizations, and more. This tech frees clinicians from doing administrative work so they can spend more time caring for patients and themselves.
So, what are some ways tech can reduce the EHR burden? One example is by reducing time spent on documentation. Speech recognition software allows clinicians to dictate their notes, saving time typing. Other software eliminates duplicative documentation created from EHR workarounds, which greatly reduces clinicians time on charting. Another interesting tech being piloted is digital scribes, where AI is used to listen to a patient visit and take that information to create a progress note without the provider writing the note. This technology is only in the pilot stage and is still being tested for privacy and feasibility.
Reducing the EHR burden is a great step towards addressing clinician burnout and the clinician shortage. What steps is your organization taking to address burnout and retention? And ask yourselves, is it enough?