On March 18th, 2019 Fred Schulte and Erika Fry published the article “Death by 1,000 Clicks” on Kaiser Health News (KHN), a collaboration between KHN and Fortune Magazine. The article reviewed the findings of a three-month long investigation into the United State’s implementation of electronic health systems. Their key take-aways are summarized below.
Read the whole article at khn.org/news/death-by-a-thousand-clicks/
Part 2 – Physician Burnout
Our community has seen it in seminars and conferences; the topic of “physician burnout” is an oft-revisited one. A 2018 Merritt Hawkins survey found that 78 percent of doctors suffered symptoms of burnout. As more and more time is being spent on tasks that don’t directly benefit patients, what may have once been dismissed is becoming acknowledged as a public health crisis.
Burnout is, of course, caused by many things. When related to EHRs, the most common trends are frustrations with how technology has changed the doctor-patient relationship, and with errors that occur due to faulty or unintuitive programs. The Joint Commission raised awareness of the issue of false alarms. Between 85 and 99 percent of all EHR and medical device alerts are false alarms. A study by researches at Oregon Health & Science University estimates that as many as 7,000 alerts pester the average provider working in an intensive care unit. These false alarms or passive alerts all take a heavy toll on the provider’s ability to distinguish when an important alert surfaces. The Joint Commission tallied 170 reports of patient harm that were related to alarm management and alert fatigue. Of 170 reports, 101 incidents resulted in patient deaths.
Many doctors today have developed “low-tech” workarounds to the EHR systems they are tasked with using. An emergency medicine physician in Washington, D.C. often leaves important notes on a whiteboard to communicate with other doctors, or even writes the note on a paper towel and leaves it on their colleague’s keyboard.
Further frustrations arise from mysterious bugs within the EHRs themselves. Occasionally, common shorthand, such as enclosing notes in brackets, would cause entire sections of text to be deleted. This ‘feature’ was unbeknownst to both the doctors and the EHR maker, and took weeks of study and trial-and-error to discover.
Underlying all of these is the other frustration – that of the changing dynamic within the consulting room itself. Where a doctor only has 7 to 11 minutes on average to actually spend with a patient, every second spent clicking between menus, searching for the correct history, figuring out where to input notes, and checking countless checkboxes that pop up regardless of pertinence grinds away at the core of why most doctors enter the field; to connect with and help their patients.
The professional frustration, the physical and mental stress, and the fear of errors all contribute to physician burnout as they relate to the technology they use. None of these issues, alone, could be made into a case to abandon the electronic systems, but they all must be taken into account as these systems continue to evolve and move our health care field with them. When so much time and money has been invested into a system it is logical to clamor for needed changes to improve it.
Our summary coverage of this topic shall continue next month as we cover the costs and ideals of the system.