Administrative Burden: The Root of the Problem

A recent article in The Atlantic points to one overwhelming problem — electronic health records (EHRs). Regulations that governed the use of EHRs appeared in 2009, and have only gotten more demanding of a physician’s time since then.

ACC surveys over the last several years support this trend, with cardiovascular professionals ranking EHRs among their top administrative burdens. A Health Affairs study in April 2017 shows time spent on documentation has edged out time spent with patients. There are clear benefits to EHRs, but current designs are often rules-focused instead of provider-focused. When more time is spent on entering and collecting data than actually treating patients, it’s not surprising that burnout sets in.

While EHRs are not the only problem, they do sit at an intersection where many smaller problems collide. Other areas of administrative burden cited by cardiovascular professionals include prior authorization, maintenance of certification requirements and increasing state and federal regulatory programs tying reimbursement to quality improvement activities.

A Focus on Wellness

Mentioning the word “wellness” often conjures up images of yoga mats and step monitors. But the American Medical Association (AMA) wants us to take a different look at the term. As part of a larger initiative to prevent burnout, the AMA posits that physician wellness should be a quality indicator for a practice.

Tying physician wellness to quality indicators seems good in theory, but what does it look like in practice? For that answer, we can go back to the Medscape report and physicians’ own solutions to reduce their stress.

Looking at broad categories, surveyed physicians break down their causes of burnout to two areas: financial stress and time constraints.

The average medical school graduate walks away with a degree...and over $200,000 in debt. Most students take at least 10 years to pay off their loans and many reach the 20-year threshold. The health care field on the whole struggles to find enough physicians to keep up with demand, and burnout is higher among the younger population. They are often making the least amount of money while still trying to repay their college loans. What level of wellness is being offered to young physicians? What hope are they being given that “things will get better?” All the while, more regulations and more responsibilities are being piled on.

The answer seems simple — pay them more money so they have less financial stress. Sadly, the mixture of for-profit health care, lower insurance repayment and expanded quality metrics leaves little room for increased salaries.

Shifting Perspectives

Clinicians are often given no choice but to work with the tools provided to them. As such, exploring innovation isn’t high on their to-do list. But today’s landscape requires that every person in the physician’s circle take an active role in helping ease the causes of burnout.

One area where innovation can have significant impact is in offering physicians more time with patients. Medical scribes ease the pain of EHR duties for the physician, but their use is often seen as a bandage to a broken-arm problem. What we need are companies that work toward providing information to the physician when it’s needed, and integrating with existing workflows without making them more complex.

At the recent HIMSS18 conference in Las Vegas, several companies, including athenahealth, AllScripts and Cerner, discussed their plans to ease the physician workload by using artificial intelligence to help complete EHR mandates. Machine learning is also an increasingly hot topic. Several studies presented at ACC.18 in Orlando demonstrated how machine learning can be used to accurately predict clinical outcomes in patients with known or potential heart problems. Collectively, the findings suggest that machine learning may usher in a new era in digital health care tools capable of aiding routine processes and helping physicians assess patients’ risk.

The unfortunate truth of many innovations is that top-down approval is required to see them implemented. This challenge is not unknown to the world of innovators, so some companies are offering their products to individuals as well as institutions.

This brings us back to the importance of the AMA’s point toward wellness. Institutions and individuals alike must work together to ensure physician wellness that prevents burnout. This is an ongoing process, requiring surveys, interventions and champions for the initiatives within the institution. But even beyond that, it’s a personal process that every physician needs to examine, to make sure their needs are being met.

Interested in health care innovation? Learn more about ACC’s newest Member Section at ACC.org/Innovation.

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This article was authored by Brad McCarty at AngelMD.

Keywords: ACC Publications, Cardiology Magazine, Workload, Burnout, Professional, American Medical Association, Biocompatible Materials, Schools, Medical, Quality Improvement, Physicians, Delivery of Health Care, Electronic Health Records, Salaries and Fringe Benefits, Documentation, Certification, Students, Pain, Catheterization, Peripheral

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