Physician Burnout: A Doctor’s Take on How Health IT Can Help Depleted Providers

As a physician, I know all too well that burnout plagues my colleagues. The World Health Organization, which recently gave burnout an official medical diagnosis, describes it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” The phenomenon, as experienced in healthcare, is not going away. And providers are speaking out about how they’re regularly lost in a sea of administrative tasks.

Dr. Daniel Marchalik’s recent story in the Washington Post provided a glimpse of why so many doctors and clinicians are feeling so depleted—even walking away from practice. These highly trained professionals spend countless hours on the phone waiting for patients’ tests or prescription approvals, jump through administrative hoops to access patient’s past medical information and tarry long into the night trying to finish the day’s clinical notes. That’s time not spent in front of patients. According to a study quoted in the story, half of American doctors demonstrate symptoms of burnout. That’s seriously concerning.

Despite the headaches and fatigue, there is some good news. According to Surescripts 2018 National Progress Report, which serves as an annual report on the state of health IT nationwide, the industry is making progress to address some of the issues that contribute to malaise and poor care experiences amongst providers and patients alike. And while not a panacea, health information technology is leading the way. As the report’s numbers indicate, we’re on the right track towards improving prescription accuracy, addressing the opioid epidemic and delivering better care because of greater interoperability.  

Pursuing the Perfect Prescription

The report revealed that e-prescription accuracy has improved by 14%. So, what does a 14% increase in e-prescription accuracy really mean? To visualize the impact, picture walking into any physician’s office. Faxes whir and screech, spilling and spitting out paper. Phones ring and red lights flash off multiple lines. Staff are busy responding to calls from pharmacies and patients asking about prescriptions. Rework, clarifications or requests for changes drive most of these communications, which throughout the day add up to hours of extra work for the provider and the office staff. When I talk to my physician colleagues, they recount that this type of administrative burden contributes significantly to the burnout and depression they’re experiencing. So, why is this rework still happening, when 85% of prescriptions are sent electronically?

We have identified a few reasons. While all EHRs are certified to safely send electronic transactions, subtle variations remain in the ways EHRs have implemented the prescribing process. This lack of standardization causes pharmacists to call and fax prescribers out of an overabundance of caution. In addition, other communications between the pharmacy and the provider still happen over the phone, such as when a pharmacist has a suggestion for an alternative medication. In other situations, a critical change might not have been communicated between the two parties, such as the prescriber discontinuing a prescription in the EHR, which might prompt the pharmacist to ask the prescriber to clarify.

So how is the 14% increase in accuracy felt by prescribers? For them, it means fewer phone calls and faxes to clarify a prescription after it’s been written. It means eliminating renewal requests when the prescriber has already discontinued the medication in the EHR. It means fewer phone calls and faxes between the pharmacist and the prescriber as medication and prescription changes are communicated electronically via the EHR. And, most importantly, it means that the prescribing process is safer for patients and performed correctly the first time. While there is still more work to be done, I’m both proud and excited to see how this progress in quality can and will positively impact everyone who touches a prescription.

Delivering a More Complete Picture of a Patient’s Care

During my years as a hospitalist, I often found it challenging to formulate a complete story of a patient’s medical history upon admission. Even though my hospital used a system-wide EHR, I mostly worked weekends, and it was virtually impossible to get outside information, especially from the patients who spent a large part of their year outside the state (to avoid the very cold winters!) or from those who were visiting Minnesota.

We’re solving this challenge with a unique, nationwide record locator and exchange solution. The problem we’re addressing is the very same one I faced: find all care records for a patient from across the country, regardless of care setting, and deliver that history directly—and quickly—to the EHR. In 2018, we continued to bring interoperability to life for thousands of healthcare organizations, giving more than 100,000 clinicians access to nationwide health information exchange through a single connection at the point of care. The technology also found more than 100 million retrievable clinical records. But beyond the numbers lie the stories about patient and provider impact. When I recently visited health systems using this technology, I heard providers recount real-world stories about how it has helped to inform care corrections. One such story involved a transplant coordination team that was able to pull records from afar for a new patient. In doing so, the team learned the patient had a blood clotting disorder, which left untreated, could have had catastrophic consequences.

Reining in the Opioid Epidemic

Like most Americans, physicians are feeling the impact of the national opioid crisis. I’ve heard countless stories from colleagues about how the epidemic is affecting their practice. They talk about the time it takes to manage patients struggling with addiction, about the fallout from having a stolen DEA number, or about patients altering prescriptions. Yet amidst the despair and struggle, glimmers of hope exist. Health IT is being increasingly leveraged to help rein in the crisis, most notably with the electronic prescribing of controlled substances (EPCS). The elimination of paper opioid prescriptions has many benefits—some of the most obvious include eliminating the ability to forge or alter the prescription or steal a prescriber’s identity.

For years, various state laws and multi-factor authentication requirements limited EPCS adoption amongst prescribers. But four years ago, EPCS became legal in all states. Fast forward to 2018, and 15 states had mandated its use, with dozens more expected to pass similar legislation this year. What’s more, the application of more efficient approaches has solved the workflow challenges of multi-factor authentication, including one-time codes, fingerprint readers or push notifications. While virtually all EHRs and pharmacies are now able to send and receive electronic prescriptions for controlled substances, what I find most encouraging, is the surge in prescriber and pharmacy adoption.

The release of the National Progress Report gives us a moment to step back and recognize the tremendous progress made by the Surescripts Network Alliance over the past year. It’s a moment for us to look at how we’re helping more than 1.6 million providers chip away at the administrative burdens contributing to burnout, how we’re enabling clinicians to electronically prescribe opioids while reining in identity theft and forgery, and how we’re delivering more complete care histories with a nationwide model for healthcare interoperability. This progress paves the way for providers to return to why they got into medicine in the first place: taking care of patients. I’m proud to tell this story on behalf of my colleagues and our partners. And I look forward to more progress in the year ahead.