By Christopher Maiona, M.D., SFHM, chief medical officer, PatientKeeper, Inc.
Christopher Maiona, M.D.
After all that transpired in 2020, it’s understandable if people are reluctant to make predictions about what will happen in 2021. I suspect some prognosticators retired their crystal balls, or at least are finding the view a bit hazy right now.
And yet, in the healthcare IT domain, I’d argue that the major trends entering 2020 continued – some even accelerated – during the unpredicted chaos of last year. The movements in health IT toward greater mobility, interoperability, and remote care capabilities all manifested themselves in profound ways during the pandemic. Each will remain a priority for provider organizations in 2021, and I predict (warily) will see progress in the coming year.
Mobility Plus
Even as mobile devices have become more commonplace in healthcare settings, provider organizations still face challenges in realizing the full potential of these platforms. While there is utility in the ability to view clinical results or send messages (hopefully HIPAA-compliant ones) to colleagues, the real value is to integrate these features into a larger bundle of capabilities central to common provider workflows. Doing so places the entire technological ecosystem in the palm of a clinician’s hand. I predict we will see continued feature growth in the mobile space to better facilitate a provider’s ability to deliver care in the moment, wherever and whenever that moment may be.
To highlight where this evolution of mobility is leading us, consider this scenario. A provider reviews a concerning test or lab result on their phone. Without waiting to address this on a desktop station, they can utilize CPOE on their mobile device to order a follow-up study, and request a notification be “pushed” to them when the study is completed (or there is no result in timely fashion). They can query their fully-integrated messaging feature to identify the appropriate specialist on call and immediately send a secure text, which automatically incorporates a link to the patient’s full chart and all relevant data, and offers the user the ability to add a few lines of text to clarify the reason for consultation. The attending can confirm consult receipt and may further discuss the care plan. The consultant in turn may enter preliminary orders while the attending can message the larger care team (nurse, case manager, etc.) with an update before dictating a quick note.
With the continued advances in NLP and note automation, I anticipate the provider component of note generation will once again focus on pertinent positives/negatives, thought process and the plan, leaving the more administrative documentation to the system. Taken together, these advances will help free the provider from the constraints of the desktop terminal and facilitate the advancement of care. I don’t expect all of this to come to fruition in 2021, but we will take initial steps along the path.
Finally, on the mobile front, I would expect to see continued development of virtual assistants, which will one day move us from simple screen navigation to CPOE and touch-free engagement.
Unfortunately, nurse burnout has reached epidemic proportions. That’s not to illicit hopelessness, rather it’s a call to action.
Nurses comprise of the largest healthcare workforce in the United States. According to The American Nurses Association, by 2022 there will be more registered nurse jobs available than any other profession in the US. And with an aging population—those of the Baby Boomer generation are moving towards increased health care needs—now is the time to look for resources to prepare for the future.
For context, in 2011, 41 million Americans were over 65 and in 2019 that number rose to 71 million. The number of Americans over 80 years old reached 12.7 million in 2018 up from 11.2 million in 2010. Aptly called “the graying of America” this trend is one to take note of for healthcare administrators who may be seeing a few grays too, as they try to prepare their workforce for the future.
The good news is that we’re beginning to understand and reduce the stressors nurses face that can accelerate turnover. The industry is taking note and conducting nurse surveys to get to the heart of the matter.
Through our research at CareThrough, we’ve learned that nurses on the front lines face a myriad of forces hindering their ability to deliver quality care. From increased patient ratios, understaffing, overtime hours coupled with a shortage of nurses due to many leaving the profession, it’s no wonder health systems nationwide are concerned with nurse burnout, and how best to curtail the effects.
Solutions
One health system implemented routine check-ins with nurses, utilizing 60 and 90 day periods to ensure morale remains high, and to solicit feedback. This method, though incredibly important, still leaves nurses unsupported during the time between check-ins. In another hospital I visited, nurses were supported with nurse techs, although sometimes there was only one tech per unit. As you can imagine, several nurses relying on the support of only one tech performing clerical and clinical duties may limit the level of optimization health systems would like to gain.
Every day, similar scenarios of imbalanced support take place in hospitals and Emergency Departments across the country. Nurses, overburdened by administrative duties, lack the bandwidth to deliver the most effective patient care. Working long hours coupled with a feeling of overwhelm lead to lack of job satisfaction. Depression poses a health risk to nurses themselves.
At CareThrough, we’ve found that embedding dedicated, highly skilled support adds value simply and efficiently. For successful nurse workflows, Nurse Care Team Assistants, under the supervision of nurses, are able to mitigate the daily burdens of patient care. CTAs comfort round on patients, take vital signs, perform ancillary tasks, assist with hydration, blood draws and much more to ensure nurses work top-of-license.
By Steve Simmons, marketing and business analysis manager, eCare Vault.
Care coordination by definition is a strategy that is focused on bringing together the multiple parties of a patient’s care team to knock down barriers of communication in order to enable the best outcomes for your patients.
However, by doing so, your healthcare organization stands to see significant savings on your bottom line. Here are a few ways we’ve seen care coordination can nurture the financial health of your organization:
Reducing Unnecessary Additional Treatments
When providers aren’t on the same page the result is additional tests and treatment for patients that could have been avoided otherwise. Gaps of information in patient care are common since providers across separate organizations rarely communicate with each other on what types of care they are providing for their patients.
As a patient, very rarely will you go against the advice of a physician or specialist, as their job is to provide you with the care to live as healthy of a life as possible.
This drives up costs exponentially across the entire continuum of care, and subsequently, providers and patients end up spending more for treatment that could be avoided in the first place. Proper coordination across multiple organizations can help patient care team members collaborate on the exact types of care and testing that is being administered to patients, helping to streamline the care that patients receive and reduce costs across altogether.
Reducing Physician Burnout To Preventing Costly Staff Turnover
With less communication and collaboration, physicians, nurses, practitioners, caregivers, and allied health professionals are forced to work and operate in silos, the consequences of which can affect not only the financial health of the clinic but the type of care patients receive.
The added stress and decrease in personal achievement for all roles mean less motivation and more cognitive impairment, which leads to a lesser quality of care, mistakes in care, and worse outcomes for patients. For organizations, burnout eventually results in staff either quitting or being fired for inadequate performance, which means recruiting, hiring and training new staff.
The costs associated with this can range from $2,500 or even more than $100,000 for higher-level positions within the clinic, hospital, home healthcare agency and every place in between.
Care coordination helps prevent this, as it empowers meaningful working relationships both internally and across organizations, helping multiple care team members strive toward the goal of providing the best care for the patient or client.
It allows your staff to break free from redundant work that can be accomplished in a fraction of the time, streamlines workflow management, and reduces operational inefficiencies across the board – giving your employees the power to operate at the top of their license, saving your organization thousands to millions of dollars of budget in the process.
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.
The time physicians spend on desktop medicine appears to be increasing compared to the amount of time they can spend with patients. The cause of this switch is likely the obvious current enemy of healthcare: electronic health record (EHR) documentation.
In particular, it’s the emails generated by EHRs that are the problem.
According to a new study, physicians’ EHR inboxes are stuffed with system-generated messages on behalf of the electronic health records they are operating within their organizations, which can lead to job dissatisfaction and even burnout, Health Affairs reported.
The rest of my article appears here on MultiBriefs.
By Michelle Davey, CEO and co-founder, Enzyme Health.
Michelle Davey
Today, our healthcare system is changing, and it’s changing quickly.
What’s leading the way for the remarkable shifts we’re seeing in our industry? Record-breaking investments into digital health (more than $14 billion in 2018 alone). Every day, we see digital health leaders working toward more affordable and accessible care for patients everywhere.
However, as we evolve and advance, we can’t ignore the glaring problem that still plagues the industry: clinician burnout. It’s a terrible symptom of a system that’s no longer working. Clinicians are 15 times more likely to experience burnout compared to any other working professional, and they’re killing themselves at alarming rates — the highest of any profession.
I believe the very technology we’re creating to better serve patients can also save clinicians — as long as we’re mindful of how we bring forth change. Here’s how we can do it.
Tech is helping clinicians prioritize flexibility, autonomy and career mobility
Our most recent generation of clinicians are approaching work very differently than their predecessors. Studies show that more Millennials are choosing to stay at home than Gen X before them. Many attribute this to our current economic climate and a changing attitude towards work-life balance.
In healthcare, technology is keeping pace with this cultural shift by empowering clinicians to live on their own terms. How? Currently, one in five physicians use telehealth. That number is expected to triple to more than 60 percent by 2022, with many stating that they plan to adopt new technology because they’re experiencing burnout and want more flexibility.
What does this new work-life balance look like for clinicians? A level of career mobility that hasn’t been available to them until now. For example, with asynchronous medical assessments, the days of darting from exam room to exam are behind us. These software-enabled questionnaires mirror a clinician-patient interaction, so clinicians can review responses on their own time to diagnose and develop a treatment plan in a matter of minutes.
Technology is alleviating the pressure felt from a growing physician shortage
Burnout is intensifying another crucial problem in the healthcare industry: our physician shortage. Recent findings suggest that by 2030, the United States will have a shortage of 120,000.
What does burnout have to do with this? Many clinicians are reducing hours at work to alleviate their feelings of burnout. This is especially true for young clinicians who are starting families. Female clinicians in particular take on a disproportionate share of child care and family responsibilities. To manage this new chapter in life, they’re often faced with taking a “career detour.”
New digital health solutions are shifting this reality, offering options that allow clinicians to work when and where they want. This is a significant win for the healthcare system. We get to retain highly qualified clinicians who might otherwise have no other option but to leave the profession–temporarily or permanently. It’s also a huge win for our clinicians. They no longer have to ask, “is it possible to work,” and instead get to decide “when and how am I going to work.”
Clinicians’ jobs are becoming more and more efficient
One reason we’re seeing the fast adoption of telehealth technology among clinicians is because it’s making their jobs more efficient–not more difficult. We might think it’s a no-brainer that technology should make our lives easier, but in healthcare, that hasn’t always been the case. For example, with past advancements like electronic health records, a common complaint was the cumbersome administrative tasks that came with them.
By Brooke Faulkner, freelance writer; @faulknercreek
Picture a long day — one that’s longer than most. Maybe you wake up early, have a checklist of morning tasks to do, then head off to catch a flight. Once you land, you have to change, make your way to a work conference, give a speech, and mingle for an hour. Back at the hotel, you unpack, shower, and work some more until 1 a.m., when you can finally sleep.
Exhausting, right? Now imagine that for that entire day, you’re on your feet and working. There’s no flight to relax on and no mingling with people for an hour. During that time, your main goal is to take care of others; you’re solely responsible for their health and well-being. How exhausted would you be then? This is what doctors and nurses go through, and for anyone outside of the healthcare industry, it’s nearly impossible to envision what a week, or even a shift, is like.
What is healthcare provider fatigue?
Healthcare providers work incredibly long hours. Nurses often work 12-hour night shifts — sometimes even longer if there’s a nursing shortage. Doctors may work for double that, especially when they’re new to the job. Indeed, medical residents in the United States can work up to 28 hours in one shift. Without proper rest and sleep, fatigue and burnout can set in. This can impact the individual’s health and well-being, and it can also have negative consequences for patients.
There’s another type of burnout, too: compassion fatigue, a central problem to balancing work and personal life as a nurse. This happens when healthcare providers are emotionally or physically distressed from forming emotional connections with their patients. This often happens when dealing with patients who are going through a serious medical event, like a trauma or a chronic illness. Creating a work-life balance is one of the best ways to combat compassion fatigue.
Consequences of healthcare provider fatigue
When healthcare providers don’t have enough time to rest and sleep, it can result in negative patient outcomes, such as inaccuracies when administering drugs, injuries from accidental needle sticks, surgical errors, and poor operation of medical equipment. Other signs of burnout include:
Cynicism
Impaired cognition and learning ability
Low career engagement
Negative feelings and moods
Poor communication skills
Poor sense of achievement
Slow reaction time
The good news is that burnout is manageable. Healthcare organizations have to treat burnout before it becomes a problem. Once they do so, job performance and the number of errors in patient care will both be improved.
6 ways to improve healthcare provider fatigue
Fatigue isn’t a random occurrence; it’s the culmination of patterns related to scheduling disorganization and poor organizational policies. Since you can point to specific causes of fatigue, the problem can also be fixed with personal and organizational changes.
This report won’t come as news to the millions of physicians spending huge chunks of their days on clerical and administrative work, instead of the patient work for which they’ve studied and practiced many long years.
But it also presents an enormous opportunity, as the report reveals reducing data entry can be a crucial (and pretty realistic, given modern technology) step in retaining key physicians, as well as increasing operational accuracy and efficiency. Let’s get physicians away from data entry and back to practicing top of license.
What’s behind increased data entry requirements?
Before we look at solutions to reduce the data entry burden on physicians, it’s critical to know where the demand is coming from. Multiple factors contribute to this problem, including:
The ubiquity of EHR systems
The professed goal of EHR systems was to give physicians access to vital patient data and streamline billing and coding processes. All too often, however, doctors find themselves bogged down by data entry instead of caring for their patients. To save time, many physicians copy and paste clinical documentation from one record to the next, providing more opportunity for dangerous inaccuracies to slip into patient files.
Lack of integration
Healthcare providers today use multiple different systems to coordinate care, and more often than not, those systems don’t talk to each other. Building integrations between these systems takes a lot of time and resources, and it is especially taxing on IT teams already working through huge backlogs. In the meantime, who’s responsible for ensuring the right data goes into all the applicable systems? Overtired physicians who’d rather be doing anything else.
Care coordination by definition is a strategy that is focused on bringing together the multiple parties of a patient’s care team to knock down barriers of communication in order to enable the best outcomes for your patients.
Picture a long day — one that’s longer than most. Maybe you wake up early, have a checklist of morning tasks to do, then head off to catch a flight. Once you land, you have to change, make your way to a work conference, give a speech, and mingle for an hour. Back at the hotel, you unpack, shower, and work some more until 1 a.m., when you can finally sleep.