Physician burnout is on the rise, according to some recent studies, potentially exacerbating the provider shortage at a time when the need for primary care is unprecedented. This issue has been recognized by patient-safety advocates, who have taken it seriously enough to propose a goal be added the Triple Aim. The Quadruple Aim includes a fourth goal, namely, enhancing the provider experience, to the originals of improving patient care, making populations healthier, and reducing costs.
Improving the provider experience is also critical to delivering on the promise of better care in a “value-based” world, regardless of who sits in the White House.
Health IT has taken a lot of criticism for adding new chores to practitioners’ to-do lists, but it can be an important ally in attaining this fourth aim. EHRs, which are already being used to expedite medical histories, record-keeping, and billing, could be updated to provide physicians the information they need in a familiar, easily accessible place. These include:
- Enhanced decision support, alerts, reminders, and medical information
- Performance improvement tools, including real-time quality reporting
- Complete documentation that facilitates accurate coding and billing
- Interfaces with labs, registries and other EHRs
- Safer, more reliable prescription processes
These capabilities might mean less work for general practitioners and others. For example, emerging clinical decision support aides help physicians play an active role in curtailing opioid abuse via access to patients’ prescription history, information on alternative therapies, and bulletins from healthcare and enforcement agencies.
Similarly, antibiotic stewardship is an idea that is long overdue, and some envision an EHR application that monitors antibiotic prescribing the same way opioid prescriptions are tracked. Additionally, a blood test to distinguish bacterial infections from viral illnesses may be getting closer, allowing physicians to quickly determine which infections will respond to antibiotics and prescribe them accordingly.
Many organizations are turning to electronic consultation and referral, known as eCR systems, which can enable direct, documented consultations between primary care physicians and specialists. Practices with eCR capabilities can provide more cost-effective and convenient care for patients while improving access to and coordination of specialty care, provided the user interface is easy to learn and adaptable enough to fit a practice’s ways of delivering care.
Error reporting and reduction
Reporting and sharing information about medical errors might not seem like a way to counter physician burnout, but it should be considered as part of the solution. Burned-out physicians are more likely to make mistakes, and those errors can be costly.
In a much-publicized study that appeared in The British Medical Journal, researchers reported medical error is the third leading cause of death in the US. The solution is to share data about medical error in the same way that data about disease is shared. Medical error should not be exempt from the approach of scientific inquiry, the researchers stated.
A survey of nearly 8,000 surgeons published recently in the Annals of Surgery found that 9 percent reported they had made a major medical error in the previous three months. Approximately 70 percent attributed their perceived errors to issues such as fatigue, stress, or a lapse in judgment.
However, receiving reports is only the first step in error reduction. Sufficient attention must be devoted to analyzing and understanding the causes of errors in order to make improvements, as the landmark book To Err is Human: Building a Safer Health System pointed out almost 20 years ago.
Yet EHRs can be cited as contributors to certain errors that may end up in a report, especially if the system is based on outdated software, staff members haven’t been adequately trained regarding information input or coding, or patient information contains errors or has not been updated. In some practices, different departments or practitioners might enter the same information using different formats.
Data gleaned from medical error reports can identify problem areas or patterns within a practice, so staff and practitioners can take the necessary steps to improve. Error information from other practices can show how a particular office compares to others.
There are myriad stressors that can lead to physician burnout, and the same challenges will create burnout faster for one physician than for another. Nevertheless, there’s real hope that new EHR and practice management software versatility can help combat physician burnout while safeguarding quality care.
