Health information technology (IT), specifically electronic health records, came with promise of improving high-quality patient care. However, unintended consequences of the technology have exacerbated physician burnout in the United States. In response, HHS has released a draft strategy for addressing health IT–related burden.
Amidst a growing prevalence of physician burnout in the United States, HHS has issued a comprehensive draft strategy aimed at reducing both regulatory and administrative burdens related to the use of health information technology (IT) and electronic health records (EHRs).
The draft strategy, required by the 21st Century Cures Act and in partnership with CMS, outlines several strategies for addressing specific sources of physician burden through collaboration with a variety of stakeholders across the healthcare system, including government agencies, payers, and provider institutions.
Hoping to address burden associated with clinical documentation, health IT usability and the user experience, EHR reporting, and public health reporting, HHS’ strategy outlines 3 primary goals:
“In its role as a payer and regulator, we believe there are many steps HHS can take to reduce burden by reassessing and revising different regulatory and operational aspects of federal programs, and with effective leadership on the key challenges of health IT-related burden,” states the strategy report.
In a collective effort among healthcare stakeholders to address rising rates of burnout among US physicians, health IT, specifically EHRs, has continually been singled out as a major source of frustration for physicians, largely due to the reporting burden posed by the technology.
A recent study1 published in the Journal of the American Medical Informatics Association found that health IT—related stress was prevalent among 70% of 1792 surveyed physicians. The highest prevalence was observed in primary care–oriented specialties. Physicians who reported poor/marginal time for documentation had a nearly 3-fold risk of burnout, physicians who agreed that EHRs add to their daily frustration had 2.4 times the risk of burnout, and physicians who reported spending moderately/high excessive time on EHRs at home had a nearly 2-fold risk.
Similarly, a report from Geneia Analytics found that the nationwide Physician Misery Index has increased from 3.78 to 3.94 out of 5 since 2015. The survey of 300 physicians demonstrated that 96% of physicians believe EHRs should be better designed to seamlessly integrate with the technology systems used by their office and its insurance providers; 57% reported that their EHRs don’t currently integrate.
A significant majority (68%) also said that they lack the appropriate staff and resources to analyze and use EHR data to their full potential, which may be a contributing factor to the frustration they express with the time and quantity of data required.
Reflecting negative attitudes toward the administrative burdens, 86% of physicians agreed that the heightened demand for data reporting to support quality metrics and the business side of healthcare has diminished their joy in practicing medicine.
“Doctors are unhappy not only because there’s this problem of the data entry but also because the time it takes to do the data entry and being asked to enter information that may not be relevant to the visit at hand,” explained Sheree Starrett, MD, MS, board-certified hematologist/oncologist and former medical director with Aetna, in an interview with The American Journal of Managed Care® (AJMC®).
She added, “Doctors are burning out because they’re becoming data collection agents rather than doctors and spending more time looking at the computer screen than looking at the patient’s face.”
And the documentation doesn’t end with the patient visit, Starrett explained. Due to the abundance of information that needs to be collected, doctors are often entering data into the EHR after hours. It’s been estimated that for every hour a physician spends providing direct clinical care to patients, they spend nearly 2 hours on EHRs and other desk work, plus another 1 to 2 hours each night.2
A significant amount of documentation burden stems from the fact that there are a multitude of programs, either through private insurers or through Medicare, and there’s often no coordination between different programs. With different insurers requiring different information, EHRs sometimes don’t have the right fields set up for the submission of information requested by a certain insurer, explained Tom Gallo, president of the Association of Community Cancer Centers, in an interview with AJMC®.
To try to mitigate some of these reporting burdens, healthcare stakeholders have indicated that physicians often rely on checkboxes, templates, cut-and-paste functionality, and other workarounds that may counter the intended benefits of the technology, according to the HHS draft strategy.
Starrett sees the draft strategy, representing recognition from both HHS and CMS, as a step in the right direction for addressing some of these burdens facing providers. Gallo agreed, but noted that the process will be complicated.
“A big thing that needs to come out of this is fewer requirements for the information that needs to be documented,” he said. “One of the complaints of physicians is that they have to document a lot of things that don’t really provide any additional value to them in terms of their clinical decision making but have to document because they’re required for billing purposes.”
To address this, Gallo said that it will take collaboration between HHS and the providers themselves to determine which requirements are necessary and which are time wasters. He added that it will also take cooperation from the vendors providing the EHR systems to prioritize the streamlining of the processes and interfaces of the systems.
Reiterating the struggles providers face with the different programs not coordinating, Gallo explained that achieving interoperability between the programs will require the different vendors to enhance the capacity of these systems, which also adds a cost element.
The draft strategy is open for public comment until January 28, 2019. Some recommendations provided by the strategy include:
1. Gardner R, Cooper E, Haskell J, et al. Physician stress and burnout: the impact of health information technology [published online December 5, 2018]. J Am Med Inform Assoc. doi: 10.1093/jamia/ocy145.
2. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties [published online December 6, 2016]. Ann Intern Med. 2016;165(11):753-760. doi: 10.7326/M16-0961.