The EHR is only one form of burnout-inducing tech, says ER doc who doubles as CMO of CDS supplier.
A recent article in the Journal of the American Medical Informatics Association (JAMIA) points out the continuing role of information technology and electronic health record (EHR) usability issues in aggravating clinician burnout.
Matt Lambert, MD, is a practicing emergency medicine physician, as well as chief medical officer of Curation Health, a supplier of clinical decision support software to healthcare providers. Lambert addressed the burnout issue and more in a conversation with HealthLeaders.
HealthLeaders: What do you think causes physician burnout?
Matt Lambert: Change coupled with inadequate support, resourcing, and education is a main cause of provider burnout in my opinion. We experienced this with the incented roll-out of electronic health records—and we are experiencing this again today in the taxing but vitally important transition from fee-for-service to value-based care (VBC).
In addition, the emotional impact—day-in and day-out—of doing everything you can to help your patients and not always being able to do so is a core cause of burnout. We deal in human lives and people trust us to, in some sense, save them no matter what. Not being able to always "save" patients is immensely harrowing and can wear on a providers' mental health.
Lastly, frustration with the healthcare system at-hand is a reality. Over time, things like why we can't get patients' medications delivered or ensure they have a ride to their dialysis appointments become intensely frustrating. Many of the issues mapping to social determinants of health (SDOH) fall into this bucket—essentially, they are simple changes and fixes that you don’t even need a provider for but that can have an immense impact on patient outcomes. Not having the resources to manage SDOH‒related issues that lead to poor outcomes is a consistent frustration leading to burnout.
Matt Lambert, MD, chief medical officer, Curation Health (Photo courtesy of Curation Health)
HL: Have you ever felt burnout? If so, what do you think was the main contributor?
Lambert: In my opinion, physician burnout is multifactorial, but the electronic health record does play a significant role in this issue, which is ironic, because my own burnout was one of the things that led me to diversify my career and landed me at the intersection of healthcare and technology. Emergency medicine is my clinical specialty, and the very nature of that job drives people to burnout. Choosing to be there for people in distress, while being away from your loved ones on nights, weekends, and holidays exposes you to a lot of pain and suffering—while also diminishing your own ability to manage stress. Being the point person for managing the gap between the expectations of patients and their families and the incentives for health systems and insurance companies, is no light lift either. Lastly, and [I'm] stating the obvious here, the pandemic has created unprecedented stress on the provider community.
Caring for others with very little margin for error is challenging. Doing so with poorly configured technology is even more difficult and can lead to burnout.
HL: How much of burnout comes from the EHR, and how much of it comes from other issues?
Lambert: Having embraced the adoption of healthcare technology, I find it less burdensome than providing acute care. I do empathize with my colleagues who list the electronic health record as higher on the burnout scale, however. If I had to break it down, I would say it’s a 60-40 split today, with 60% of provider burnout mapping to the electronic health record and 40% to other issues. I often say that we—at Curation Health—apply physician-level accountability and attention to detail with healthcare technology, and I expect the same from our electronic health record colleagues.
HL: What factors outside of the EHR might contribute to provider burnout?
Lambert: Regulators and the related guidelines they offer have a major impact on provider burden. Sometimes well-intentioned regulations wind up creating more challenges, and often, the unintended consequence of these regulations is greater administrative burden. Thomas Jefferson stated, “the man in the field, knows what is best for the man in the field,” and I hope the new administration will embrace this theme in developing guidelines moving forward.
Also, technology other than the electronic health record can also be immensely time-consuming and frustrating, which leads to burnout. Companies that create technology without understanding the unique intricacies of the providers’ workflow can create more challenges that drive provider burnout.
HL: What evolutions have occurred in clinical decision support (CDS) tools?
Lambert: Curation Health is a quality and risk adjustment platform that integrates with electronic health records at the point of care. Our platform helps providers and payers simplify the transition to VBC. We created the Curation Health platform to address a missing and mission-critical step in VBC—enabling physicians and care teams to code and document in a way that truly reflects the complexity of care they are providing, and to do so without adding new administrative burdens to their workload or asking them to operate in an unfamiliar workflow.
In my career as a physician informaticist and CMIO, I have created more than my fair share of CDS tools within several electronic health records. Aligning order sets with the latest clinical guidelines for the treatment of community acquired pneumonia or making it easier to comply with federal guidelines for sepsis is a very good use of healthcare software. But, at Curation Health, we have repurposed CDS to mean something completely different—Clinical Documentation Support.
“Companies that create technology without understanding the unique intricacies of the providers’ workflow can create more challenges that drive provider burnout.”
Matt Lambert, MD, chief medical officer, Curation Health
Scott Mace is a contributing writer for HealthLeaders.