Less face time with patients
Less free time
Less personal satisfaction with practice
“After we get the kids to bed, I spend 2 or 3 hours at night finishing my charts.” “I’ve become a glorified data entry clerk.” “Is this really meaningful use?” During the last several years, I’ve heard these phrases from many of my colleagues in clinical practice, almost irrespective of their specialty. Dissatisfaction with the current state of the electronic medical record (EMR) is now widely recognized as an important contributor to physician “burnout.”
Burnout includes several dimensions including loss of enthusiasm for work, increased feeling of cynicism, and a feeling of being more callous with co-workers. Beyond purely personal concerns, burnout has broader societal impact by potentially reducing the quality of care and, with premature physician retirement, reducing access to medical services.
A recent (2015) Medscape survey reported 46% of all physicians were experiencing burnout. 3 of the top 4 reasons were related to the EMR:
- Too many bureaucratic tasks
- Too many hours at work
- Increasing computerization
A 2014 survey of more than 400 practicing internists by the American College of Physicians found writing a note took more time in the EMR for 64% of respondents and the resultant loss of “free time” attributed to the EMR approached one hour daily. (JAMA Inter Med 2014; 174: 1860-63) Multiplied over the typical physician’s 7 day, 60-70 hour work week, this loss represents a major hit to productivity and quality of life. Of note, 70% of the doctors felt that the EMR decreased face time with patients, likely affecting both personal and patient satisfaction.
In a recent publication entitled “10 bold steps to prevent burnout in general internal medicine,” Linzer identified “decrease stress from electronic health records” as a key strategy to deal with the growing problem of physician burnout. (Jour Gen Int Med 2014;29:18-20) While this is a laudable goal, it will require re-inventing the EMR using currently available technology not found in many “dinosaur-era” EMR systems. Achieving this will require physician involvement from day one in redesigning the EMR workflow in a clinically relevant and useful way.
Using current state-of-the-art technology to build user friendly interfaces must reduce the documentation workload and increase “free time.” Ultimately, reducing physician stress, i.e., burnout, with a vastly improved EMR experience will lead to a more satisfying encounter for both doctor and patient with an improved clinical outcome.