Physician burnout is an epidemic, and like most epidemics, there isn’t one simple solution. Hospitals, healthcare systems, and physician groups must invest in addressing burnout in order to sustain high-quality patient care. The imperatives to succeed in today’s healthcare industry are to improve quality and reduce costs, and these goals can’t be achieved if physicians and clinicians are burning out at staggering rates.
A recent report in Medscape found that 44% of physicians reported at least one symptom of burnout in 2019. The proportion of physicians screening positive for depression continued to rise to almost 42%, and the rate of suicide and depression in doctors is more than twice the general population. This equates to more than one medical school graduating class a year dying from suicide, a grim reminder of one of the most devastating impacts of burnout. There is a return on investment for addressing physician burnout, and it’s also the right thing to do.
There are several leading drivers of physician burnout, and often physicians struggle with a combination of stressors. First, there is emotional exhaustion and the inability to recover when away from work. This is a prevalent issue for physicians whose decisions can significantly impact a patient’s life. This can often lead to depersonalization, when physicians are unable to connect with their patients and develop a negative or cynical attitude. Additionally, the added stress and unaccounted time required to integrate the electronic health record (EHR) with patient care pulls physicians and clinicians away from the gratification of direct patient interaction.
The EHR also adds many hours of unaccounted for and uncompensated work after hours, putting added strain on work-home balance. Physicians feel their work with patients is being reduced to a set of metrics, usually metrics they feel don’t reflect the quality and value of their work. A study by the Rhode Island Department of Health reported that 70% of physicians using EHRs measured one symptom of IT-related stress, and of that group, less than 30% reported that EHRs improve job satisfaction. When physicians experience a reduced sense of personal accomplishment, an overall dissatisfaction with their job sets in.
Ultimately, burnout is a symptom of a broken healthcare system.
We are in the midst of a revolution in public accountability for quality and value in healthcare, and while the pressure to perform on metrics isn’t going away anytime soon, physician leadership can adapt to better serve the needs of physicians. We need a new kind of physician leader who can provide “translational leadership” or leading in a manner that helps connect the passion physicians have for providing patient care to achieving target performance.
To meaningfully impact physician burnout, establishing institutional awareness and commitment to moving the needle on the epidemic are key. When physicians burnout, the health system suffers from increased turnover rates, decreased productivity, and often decreased patient satisfaction. By cultivating institutional leadership recognition that there is an ROI for reducing physician burnout/distress, a commitment to measuring and improving physician well-being can be achieved.
Often, physician burnout is linked to high-conflict and low-trust environments. If applicable to your organization, undertaking a process to address and heal these issues can minimize the adverse effects of physician burnout. When developing an action plan to address conflict and low trust, it’s important that leaders specifically name and acknowledge the past tensions, develop a shared vision for a preferred future, and establish ground rules for how they will conduct themselves going forward. By doing a substantive piece of work together while demonstrating adherence to the ground rules, physicians and management leaders can slowly rebuild a modicum of trust and integration. Repeating this cycle will reap positive benefits in the long-term satisfaction and improved performance of your physicians.
By Adarsh Jain, editor, Transparency Market Research.
Timely diagnosis and advanced treatment measures are imperative for better healthcare outcomes. But, little have we realized the criticality of patient’s history in treatment. It is human to remember information about major healthcare incidents, but it is impossible for individuals to store every detail of medical history. And sometimes, the lack of details on medical history can be the difference between life and death.
Over the years, as information technology and computers began finding applications in healthcare diagnosis and treatment, it is also emerged as a critical tool to store and retract data. Synonymous to a business, where all major decisions are data-driven, healthcare providers, too, realize the need for data on patient’s health to decipher treatment and diagnosis. As we realize the potential for big data analytics across industry verticals, cloud computing has enabled tech giants develop tools that could come in handy in critical situations. Transparency Market Research states that the global electronic health records market stood at $3,225 million in 2016, and predicts that it will grow to $38,278 million by the end of 2025.
Electronic Health Records are Older than the Internet
It was in 1960s, three decades before the internet bubble, when attempts were made to introduce electronic health record systems. Larry Weed first developed a system to record problem-oriented health records. And, in 1972, Regenstrief Institute, developed a possible system to record health data electronically. However, huge cost and lack of feasible infrastructure remained an impediment to electronic health record tools.
Things began to change at the turn of the century when internet became a phenomenon, and tech companies began sensing the need for data-driven approach for every business. In short order, tech giants – from Google to everyone else — started working to develop products for electronic health records.
North America At the Forefront
It is, perhaps, safe to state that U.S. is at the top when it comes to healthcare infrastructure. With consistent financial and policy-level support from the U.S. government, and conducive environment for pharmaceutical, medical devices, and the IT industry, the region has leaped miles ahead from others. And, electronic health records is no different. Out of the $23,225 million reaped by the global electronic health records market, more than 46% came from North America.
While the overall market share for North America is expected to dip marginally by 2% by 2025, TMR analysts predict that it will continue to hold a mammoth share of growth in the eight-year-forecast period. Of the $15,000 million growth potential, North America alone is expected to garner $6,000 million.
How Government Policies Made a Difference?
The market for electronic health records in North America owes a large share of its success to favorable government policies. From Presidents George W. Bush to Barack Obama, each have introduced policies, set up bodies, and funded projects that have today, led to a robust set up for electronic health records in the U.S. It was in President Bush’s regime that the first move to improve healthcare IT became evident. With budget for the sector doubled, the Bush government also introduced an exclusive position in the cabinet for the National Health Information Coordinator. Further, the government under Bush also set 2014 as the deadline to adopt electronic health record systems. Taking cues from here, the Obama government too increased funds for initiatives promoting implementation of electronic health record systems.
The Influence of IT Infrastructure
Most tech giants in the world are headquartered in the U.S. and this provides North America the advantage over other regions. With conducive environment created by the government, there is little for tech giants to worry about. And with history for electronic health records born in the country, the spirit for developing products has always been higher in the region. Efforts are underway to soon launch products that could change the approach of healthcare in the country, and attempts look ripe to expand the efforts globally. A fallout of the efforts in the U.S. is taking shape in Asia Pacific, where both government, and business organizations, have begun taking baby steps in moving towards a future in electronic health records.
As a physician, one of the most rewarding parts of my job is building relationships with my patients. In developing this connection, I’m able to better understand their healthcare challenges and frustrations, which enables me to ultimately help them achieve their health goals.
But establishing strong patient engagement is getting harder, in part due to the ever-changing regulations and daily demands we as physicians must manage.
Consider this: During a 20-minute appointment, physicians spend only about 12 minutes interacting with the patient and 8 minutes documenting their visit on the electronic health record (EHR). Once the patient leaves, we spend another 11 minutes completing documentation in an effort to keep up with payer demands and comply with other requirements.
While healthcare tech – in the forms of EHRs, patient portals, secure messaging or mobile apps – are proven to help foster stronger connections between physicians and patients, it’s the personal touch, the solid relationship between the patient and the provider, that’s most important.
Building a Trusted Relationship: The Patient <> Provider Connection
Despite best intentions, many healthcare practices fail to provide solid patient experiences. Considering today’s healthcare environment where individuals now foot more of their healthcare bill than ever before, patients are seeking greater value and convenience for their money.
According to a recent study, nearly half of all healthcare consumers are frustrated with their healthcare experiences. Why? Because there is a gap in perception between providers and consumers on the quality of experience currently being provided.
To overcome this disconnect, let’s go back to the basics. As a child, you’re taught that it’s proper etiquette to shake someone’s hand and look them in the eyes when speaking with them. This is true for physicians as well.
The first step in building better relationships with patients is to make eye contact with them. In fact, a recent JAMA study found that patients equate engagement with eye contact from the provider. As simple as this seems, many physicians (myself included) sometimes struggle with this due to the fact that we are heads down in our technology systems.
However, eye contact is a powerful form of nonverbal communication and shows our patients that we are giving them our undivided attention. Trust me – patients notice whether or not their doctors make eye contact. If we are constantly looking at our computer or tablet during an office visit, the patient automatically feels the disconnect and will rate their overall healthcare experience much lower.
Overcoming the Pitfalls of Technology to Improve the Patient Experience
While the human element in healthcare is of paramount importance, there is still a role for patient engagement technology, which can enhance and strengthen our personal relationships with patients. However, practices must make sure these tools are integrated and operate seamlessly. While patient engagement technologies look great on paper, when put into practice, they often require patients to use different apps or access a variety of unconnected systems.
Portals are one of the most common technologies that can be used to engage patients, however research shows that more than 56% of patients have said they’ve never been encouraged to use an online medical record by practice staff, and 47% of patients offered access to a portal have never viewed their health info. In addition to making patients aware that these technologies exist, it’s also crucial to discuss the benefits of patient portals, such as simplified processes for refilling prescriptions, scheduling appointments, reviewing health information and more.
Fostering a Successful Technology-Enabled Patient Engagement Strategy
While it’s true that it takes both people and software to truly engage patients, applications of patient engagement technology can be successful when enabled by a compassionate and sincere strategy. Some key considerations when implementing these technologies include:
By Jeff Solis, senior product marketing manager, eFax Corporate.
Jeff Solis
The survival of highly regulated industries such as healthcare depend on secure information exchange.
Healthcare organizations, or “covered entities,” as they’re known, exchange large volumes of sensitive data daily: billing and medical records, prescriptions and refill requests, lab requisitions, clinical field trial results, patient clinical data, plus insurance claims, denials, appeals, and invoices.
Traditional analog fax, relic that it is, still transmits over the public telephone network, and remains difficult, if not impossible to intercept. For this reason, it is regarded as a more secure form of communication than email. In fact, a report on the health industry’s use of fax machines showed 75 percent of medical communication in the United States takes place via fax. Recent high-profile incidents of massive cyber-attacks exposing the personal details of millions of customers and patients reinforce the view that email remains a highly vulnerable means of business communication.
However, fax remains a viable means of exchanging protected healthcare information (PHI) for other reasons too. A recent IDC study noted that 25% of large businesses surveyed prefer fax over email because they believe it reduces their risk of violating data privacy regulations. An additional 28% prefer fax because it makes document tracking easier and sends alerts as to the success or failure of a transmission.
Then there’s the regulatory factor. Federal regulators who enforce healthcare data-privacy rules have exempted fax (and phone calls) from certain aspects of the HIPAA Security Rules. This has led to the widespread perception that fax is more compliant than other types of electronic communication for the transmission of PHI.
So fax persists. But the world has changed, and so have old notions about fax reliability. In fact, the issue has taken on greater importance with the Centers for Medicare & Medicaid Services Administrator Seema Verma challenging software developers to make physicians’ offices fax-free by 2020.
The Trouble with Legacy Fax
If you still use a fax machine, multifunction printer, or rely upon on-premises fax servers to transmit your faxes, then you support legacy fax.
This is a huge problem! Why? Because legacy fax can fail in ways that threaten an organization’s data security, and if in today’s data-driven world covered entities can’t keep the PHI of patients free from unauthorized exposure, they’d better, well, cover their entities as HIPAA violations are expensive and can torpedo your reputation, even your livelihood.
One of the greatest challenges in healthcare is keeping up with the changing landscape. Considering only since the beginning of 2019, the Centers for Medicare and Medicaid Services (CMS) and other federal agencies, such as the Office of National Coordinator of Health IT (ONC) and the Department of Health and Human Services (HHS), have introduced a number of rules as a measure of upholding their goal of empowering patients and enhancing healthcare efficiency. We’re at a very critical juncture in healthcare and from a regulatory perspective, there are a few key rules that merit a special focus which will have a great impact from both a clinical and financial standpoint.
The MyHealthEData Initiative in 2019
The MyHealthEData initiative, launched in March 2018, aims to “empower patients by ensuring that they control their healthcare data and can decide how their data is going to be used, all while keeping that information safe and secure.” Only a few days back, CMS upped the ante for better data access by expanding this initiative and announcing the pilot of “Data at the Point of Care.”
The Data at the Point of Care (DPC) pilot will be connecting providers with Blue Button data, where providers can access claims data to learn more about their patients and their previous diagnoses, procedures, and prescriptions. While providers had to comb through several hundred data sets previously, the DPC program would aim to make access to data easier and right within their workflows.
This announcement follows the relaunch of the Blue Button initiative, or Blue Button 2.0, that grants access to health data and enables patients to send that information using FHIR-based healthcare apps.
In a nutshell, these moves come as an overall push from CMS to promote better access to data and 100% healthcare interoperability. In addition to enabling data access, CMS has also been targeting information blocking, as reflected by 2019 MyHealthEData updates. With these measures, both patients and providers will have the required insights to make more informed healthcare decisions.
The Trusted Exchange Framework and Common Agreement
In April 2019, ONC published its second draft of the Trusted Exchange Framework and Common Agreement (TEFCA), focusing on three high-level goals:
Providing a single ‘on-ramp’ to nationwide connectivity
Enabling Electronic Health Information (EHI) to securely follow the patient wherever needed
Supporting nationwide scalability
TEFCA is basically a common set of principles which serve as “rules of the road” for nationwide electronic health information exchange across disparate health information networks (HINs). The framework, which was mandated by the 21st Century Cures Act, provides a set of policies and procedures along with technical standards required to enable healthcare data exchange among providers, state and regional HINs, and federal agencies.
In the age of internet and online shopping, striving to make it into the future by relying on traditional or outdated practices will get you nowhere! Thanks to the younger generations, various private and public departments are favoring online presence more now and we think, healthcare department should follow suit!
According to a survey by Accenture, the younger generations (millennials and Generation Z) will likely prefer new care models like retail clinics and virtual visits over the traditional methods. This spells trouble for the healthcare department since they still lack the tools to embrace the digital culture.
Digital Transformation in the Healthcare Sector
There is nothing wrong with the traditional health IT sector. It is just that many of the younger generations are outgrowing the traditional methods and now expect a different standard of service.
In the age of self-diagnosis from Google and WebMD, the young individuals constantly express dissatisfaction with the existing healthcare models. They are more comfortable with researching healthcare options online and are more likely to utilize non-traditional methods of engaging with the health department. Because of the reliance on the latest cutting-edge options, healthcare must understand that there is a need to adopt advanced techniques.
Currently, we are living in the digital age and the consumers are always on the lookout for a digital front-end experience. Since the internet has blurred boundaries, the younger generation is more aware of what they want and how they want it. At this point, the healthcare department seriously lacks the necessary digital tool to provide a better experience.
In a way, it is not just about the adoption of certain tools. Instead, we are talking about a complete transformation that will provide the healthcare department with the boost it needs to make things easier for the upcoming generations. The redesign will mean that high-quality, accessible, affordable, and effective healthcare can be provided through digital tools.
By Dr. Michael Blackman, medical director, population health and analytics, Allscripts.
Dr. Michael Blackman
As healthcare delivery continues to evolve, healthcare technology needs to be there to support it. But, how will technology facilitate healthcare as we move forward?
Healthcare accessibility, especially for certain populations, continues to be problematic. The expansion of telemedicine has the potential to improve access, especially for populations that have difficulty accessing care, such as those with mobility or transportation issues.
Additionally, looking from a primary care standpoint alone, a fair percentage of patient visits can be conducted remotely while continuing to insure care quality. Telemedicine can extend a clinician’s reach by freeing up office time for those who gain extra benefit from being seen in person. However, the technology must support both the clinician and patient interaction, while not creating new barriers.
Potential barriers can come not just from factors implicit in the technology, but from the way it is implemented as well. For example, simple things such as a clinician needing to turn his or her back to a patient to access the system disrupts the clinician/patient relationship. Workflow considerations need to be front and center for all technology-related changes.
Leverage what you have – especially the data
There’s continually a desire to pursue the next shiny object, the next buzzword, the next big technology. But it comes down to why? What are you trying to accomplish with new technology that you can’t already do today? If it serves a strategic goal, then the new technology may be highly beneficial, but have you optimized what you are using now?
Electronic health records (EHRs) and other healthcare technology have brought us a plethora of data, but how many of us are using this data effectively?
The original goal of capturing data in EHRs was to improve care. We need to use that data to understand and improve care delivery. Sometimes that requires new technology, but whether one is using new technology or not, improving care requires a change in the way business is conducted.
Are AI and machine learning the future of healthcare?
Both AI and machine learning are likely to be integral components of healthcare’s future, but the underlying culture and business framework supporting these technologies will determine if we are able to get the most from them. Differences in organizational culture and business processes often explain why some succeed and others fail using the same technology.
Definitive Healthcare released results from its 2019 Outpatient Telehealth Study. In this survey, Definitive Healthcare polled physicians and healthcare administrators to determine to determine telehealth adoption trends, technology, and services.
• Adoption Remains Flat 2018 to 2019: Adoption rates of telehealth solutions/services by outpatient physician practices remained relatively flat from 2018 to 2019, lingering at about 44 percent. However, the mix of telehealth technology solutions did shift this year, with an increase in two-way video/webcam, mobile applications for concierge services, and clinical grade remote patient monitoring devices.
• Telehealth Technologies Regarded Effective: Physician practices with telehealth solutions already in place rated the effectiveness of these technologies relatively high at an average of 6.51 out of 10 – well above the midpoint, and above all other survey categories. This indicates that, despite hurdles that hinder telehealth investment or adoption, these solutions are effective when in use.
• Providers with Telehealth Solutions Likely to Re-Invest: Roughly 65 percent of physician practices with a telehealth solution already in place plan to make further investments, up from 45 percent in 2018. Nearly 90 percent that plan to make an investment plan to do so in the next 18 months.
• No Need to Fix What’s Not Broken: Unlike the inpatient market, the priciness of telehealth solutions was not the primary barrier for outpatient adoption. In this survey, the majority of respondents (20.2%) cited “satisfaction with their practice’s current solutions and services” as their primary barrier when considering adopting telehealth technologies. Another major barrier for respondents, at 12.6%, was uncertainty surrounding reimbursement policies from insurance companies and at the national level.
Jason Krantz
“Based on these survey results, and the trends we’ve been observing in the market, there are three main hurdles that are currently hindering outpatient telehealth adoption. There is not only a need for more clarity around reimbursement policies, but also a need for more interoperable telehealth solutions that can be accessed through EHR or EMR systems as well as a better understanding about what types of telehealth options are available,” said Jason Krantz, CEO of Definitive Healthcare. “Until some of these issues are addressed, it may be some time before substantial outpatient investment is made in the telehealth arena.”
Timely diagnosis and advanced treatment measures are imperative for better healthcare outcomes. But, little have we realized the criticality of patient’s history in treatment. It is human to remember information about major healthcare incidents, but it is impossible for individuals to store every detail of medical history. And sometimes, the lack of details on medical history can be the difference between life and death.
