Beating Burnout: Are EHRs the Enemy?

Arthur L. Caplan, PhD; Robert W. Brenner, MD; Richard I. Levin, MD; Carol A. Bernstein, MD; Christine Sinsky, MD


October 19, 2016

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Medscape held a panel discussion called "Beating Burnout: An Essential Guide for Physicians" on July 28, 2016. The following is an excerpt from that summit.

Arthur L. Caplan, PhD: What is wrong with the electronic health record (EHR)? Why do people hate it so much? It's leading the charge in contributing to burnout.

Robert W. Brenner, MD: Previous to this, Dr Sinsky and I had a lot of discussion about workflow. There are a couple of points that I want to make, one about the EHR. If it is implemented without a change in the workflow in the office, too much data entry falls on the physician. That is what is adding to the huge burden. Then, you compound that with something else. We've gone to value-based care in many of our practices, whether we're in an accountable care organization (ACO) or we have shared savings with quality metrics that we have to attend to. That has added to and compounded what we have to enter into the EHR, particularly in primary care and definitely in other specialties. It's not only the EHR but also implementing it properly with the right support staff who have the right training.

Dr Caplan: Wasn't this supposed to be a panacea and make things efficient?

Dr Brenner: I never thought it would be a panacea. It is increasing your ability to collect data, but somebody has to put it in. If it's all falling onto a physician, then you're going to increase the burnout rate. I have been part of the implementation of EHRs and I've seen physicians at their wits' end, absolutely panic-stricken about how they're going to see patients and do what they have to do.

Richard I. Levin, MD: A wonderful essayist in the 1970s, Lewis Thomas, wrote about halfway technologies, defined what they were, and described how they were so costly and so painful for patients. Unfortunately, the EHR was introduced as a halfway technology and it has taken away much time from doctors establishing relationships with patients and providing care.

A study done at Johns Hopkins showed that interns are spending 12% of their time with patients and more than 40% in front of a computer screen.[1]

Carol A. Bernstein, MD: The other piece of it, besides the amount of time it takes and how overwhelming the EHR is, is that everybody's carried away with collecting data. It's really disrupting how we train the next generation of physicians. One of my major concerns is that, in addition to spending all of their time in front of a computer, they're cutting and pasting. They're not learning to think. Everything is about an algorithm. I know that this is a little bit of a sidestep from burnout, but what is meaningful is our capacity to really take care of our patients, to help them and make them well. It's why these kids went into medicine in the first place, but they're not learning how to think anymore or to relate to the patients. I think that healthcare is suffering on multiple levels and leading to problems that are going to be very bad in the future.

Christine Sinsky, MD: It's a very complicated issue, and I don't think it's fair to simply scapegoat the EHR as the sole problem. It's not just the design of the EHR, although it certainly could be much better. The EHR should be designed to be delightful. But it's also the implementation. In many organizations, rules such as meaningful use have been overinterpreted by the local institution, with the result that physicians are the ones doing all of the data entry, as if meaningful use requires that the physician does computerized order entry, which it does not.

Computerized order entry can be shared among the team members, but many institutions overly interpret this, so that's a pain point for physicians. It's the design of EHRs, it's the implementation of EHRs, and it's the regulation. I think all of those have combined to make this a source of pain for physicians, and a barrier to providing the kind of care that we would like to and having the relationships that we would like to with our patients.

Dr Brenner: I see that there are upsides and downsides. It's not just a black-and-white answer. It's very complicated, as Christine said. For somebody who is managing physicians and practices and trying to organizationally improve quality and care, getting aggregate data will help you manage. Having said that, we're here to talk about physician burnout. How those data get in is the critical part. Although it does become cumbersome, sometimes I see people blaming it on the EHR when it is also because of how we have designed workflow, what kind of training you've received, and what we're demanding that you put into the computer. Sometimes, it's clearly not due to the design of the EHR. It's how you've managed to get that data in.

Medscape's "Beating Burnout" panel discussion can be viewed in its entirety on Medscape's Facebook page.


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