Checklist for Health Care Leadership on Health IT and Clinician Burnout

The following are selections featured in Taking Action Against Clinician Burnout. Read the full report for more information.

Assessing a Health Insurance Portability and Accountability Act (HIPAA)–compliant text-paging system that was integrated within the existing EHR at a university-affiliated residency program in an urban hospital
The EHR-based text system was intended to reduce interruptions during patient care or educational activities and reduced time spent responding to traditional telephone pages. Unit clerks, nursing staff, case managers, and physicians could either use a traditional telephone number page with a request for call back or initiate a text page directly from the EHR system. The latter supported consult requests or sending communications about admissions, patient or family requests, diet orders, or medication reconciliation. The system allowed recipients to respond immediately in the EHR (e.g., place an order) without calling the sender. In surveys of a small sample of resident physicians, the vast majority preferred the text system to traditional paging. Respondents reported decreases in interruptions, stress, frustration, and workload and increased communication and satisfaction with the EHR-based text system. While the survey did not measure burnout or stress with validated instruments, the results seem promising and support the view that technology that improves clinical work efficacy and efficiency can have beneficial effects on clinician burnout and well-being.

Reducing technology-related workload and administrative burden 
A health care organization (HCO) asked all of its employees “to nominate anything in the EHR that they thought was poorly designed, unnecessary, or just plain stupid”. This program led to multiple changes in the EHR (e.g., removing 10 of 12 most frequent alerts for physicians), additional staff training (e.g., regarding documentation tools), and other organizational changes (e.g., reducing the frequency of required evaluation and documentation). While the impact of the program on clinician burnout was not evaluated, such an organizational intervention seems promising since it removes activities and work that should not be performed, therefore reducing clinician workload (a major contributor to clinician burnout).

Making use of medical scribes
Medical scribes have been proposed as a way of addressing clinician burnout since they can help reduce EHR-related demands experienced by clinicians and, in particular, by physicians (e.g., the administrative burden of documentation, time spent on EHRs outside of regular hours, or instances when EHRs interfered with patient–clinician relationships during encounters). Scribes are trained to assist physicians in documenting patient encounters in real time. Physicians review and approve the notes drafted by scribes. In a crossover study of 18 primary care physicians in 2 primary care facilities, primary care physicians reported spending less after-hours time in EHR documentation and more time interacting with patients with the use of medical scribes. Whereas the use of medical scribes seems to improve work system factors known to increase physician burnout (e.g., reducing administrative burden), there is no clear evidence for its impact on physician burnout.

Streamlining the login process in systems with a badge scan or biometrics, rather than requiring the manual entry of usernames and passwords
At the Yale School of Medicine, badge-scan log-in has saved up to 20 minutes per day per physician and is a relatively simple way to reduce keystrokes and save time. The Yale School of Medicine and other institutions across the country have also deployed voice recognition software that allows physicians to speak to the EHR, rather than type. By using this interface, they have reduced the time it takes for clinicians to complete and close encounters by half.

Valuing clinician input
Seek timely feedback from clinicians during the technology purchase and implementation decision-making processes and invite clinicians to be participants in vendor and organizational usability tests. Additionally, clinicians can attend relevant health IT training sessions to foster the successful implementation of health IT, put forth the effort needed to learn newly deployed health IT, work with organizational IT personnel to configure the applications to meet their work needs and patterns, and help others in the organization to learn and use the systems. The clinical teams engaged during development and configuration stages should be multidisciplinary, because multiple stakeholders with differing interests can unintentionally worsen the collective user experience of the care team if the planning is not collaborative. Nurses are essential as collaborators as the EHRs and other health IT continues to evolve. Clinicians also need to be willing reporters of usability and safety problems, to participate in health IT–related event analyses, and to serve on multidisciplinary teams assembled to create solutions to problems that have been identified. Finally, knowledgeable clinicians need to participate in relevant national societies and organizations that are working, for example, on health IT usability and risk standards (e.g., the Association for the Advancement of Medical Instrumentation) or standard EHR terminology. Greater clinician involvement in EHR deployment decisions clearly improves the success of deployments.