Clinician burnout: a hot topic and getting hotter. Are electronic - - PowerPoint PPT Presentation

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Clinician burnout: a hot topic and getting hotter. Are electronic - - PowerPoint PPT Presentation

Nov 02, 2022 373 likes •1.21k views

Clinician burnout: a hot topic and getting hotter. Are electronic medical records fuelling the fire? Mike South , Paediatrician & Chief Medical Information Officer Clinician burnout: a hot topic and getting hotter. Are electronic medical

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Clinician burnout: a hot topic and getting hotter. Are electronic medical records fuelling the fire?

Mike South, Paediatrician & Chief Medical Information Officer

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  • 1. Clinician Burnout
  • 2. The impact of computers
  • 3. The impact of Electronic Medical Records
  • 4. What can we do as players in the Health IT space?

Clinician burnout: a hot topic and getting hotter.

Are electronic medical records fuelling the fire?

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Participant poll 1

  • A. Doctor
  • B. Nurse
  • C. Allied Health
  • D. Manager
  • E. Hospital/Primary Care: IT / EMR / Informatics

F. Industry

  • G. Other
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Burnout: a brief history

1961

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Burnout: a brief history

1971 US air traffic controllers were commonly reporting “vocational ‘burn out,’ a form

  • f exhaustion, which is manifested in a

decline in quantity and quality of work production.” After several fatal mid-air collisions due to human error the FAA commissioned a study of 416 air traffic controllers over 3 years

Rose RM, Jenkins CD, Hurst MW. Air traffic controller health change

  • study. Reportprepared by Boston University School of Medicine for US

Dept of Transportation, FAA Office of Aviation Medicine: 1978. Report

  • No. FAA AM-78/39.
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Burnout: a brief history

More competent individuals Burnout was not simply a failure of personal resilience: most air traffic controllers had experienced military service and had dealt with extremely challenging conditions. The paradox here: workers who strive hardest to meet internal and external professional ideals may increase their risk

  • f burnout, which then contributes to

them falling short of these professional ideals.

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Burnout: a brief history

Herbert Freudenberger

Particularly pertinent to caring professionals. Still conceptualised as particularly affecting those in emotionally demanding professional roles

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Burnout: in the literature

“Burnout” 123 Million hits “ Burnout -"car“ ” ~125,000 hits “Burnout” 18,700 articles Last 12 months: Medline

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2019 Medline Examples

Effects of a resiliency program on burnout and resiliency in family medicine residents. Clinician burnout and its association with team based care in the Emergency Department. Physical discomfort, professional satisfaction, and burnout in vascular surgeons. The Relationships between Problem-Solving, Creativity, and Job Burnout in Iranian Occupational Therapists.

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Burnout: a medical diagnosis?

No DSM-5 No mention of burnout ICD11 (2022) “Factors influencing health status” Notes Framing it as a medical diagnosis may be counterproductive Not a diagnosis therefore not accepted in workplace compensation / insurance claims

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Participant poll 2

  • A. No burnout

B. Under stress C. Feeling burned out sometimes

  • D. Feeling burned out most of the time

E. Completely burned out

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Burnout: so what is it?

Common definition:

No 100% agreed definition Many descriptions

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Prevalence

Higher in women Higher in younger doctors Higher in high acuity specialties

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Is clinician burnout a big topic in Australia?

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2% attempted suicide 2013

n= 14,000

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Participant poll 2

  • A. No burnout

B. Under stress C. Feeling burned out sometimes

  • D. Feeling burned out most of the time

E. Completely burned out

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RCH Burnout Survey

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Burnout: Discussion

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  • 1. Clinician Burnout
  • 2. The impact of computers
  • 3. The impact of Electronic Medical Records
  • 4. What can we do as players in the Health IT space?

Clinician burnout: a hot topic and getting hotter.

Are electronic medical records fuelling the fire?

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Don’t just sit there!

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? Alternate sitting / standing

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Death By 1,000 Clicks: Where Electronic Health Records Went Wrong

The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer and cheaper. Ten years and $36 billion later, the system is an unholy mess. Inside a digital revolution that took a bad turn.

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The Doctor 1891 Luke Fildes

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Is clinician burnout a big topic in Australia? Is the use of EMRs commonly cited as a contributing factor in Australia?

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USA RCH

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Abraham Verghese, New York Times Magazine, May 16, 2018

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11.5

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Large international benchmarking survey ~100,000 clinician respondents All EMR systems RCH 1,067 respondents (23% active users)

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RCH Staff Satisfaction

92% – All 93% - Nurses 92% - Allied Health 89% - Doctors 85% - Consultants 94% - Trainees

Satisfied / highly satisfied

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RCH in top 10% for many items RCH the top non-US hospital for overall user satisfaction

Net EMR experience

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So what is going on here?

Same EMR system

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So what is going on here?

“Note Bloat”

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Documentation - clinics

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So what is going on here?

USA RCH

Problem: Abdominal pain The problem has been getting

  • worse. The pain is in the Right

Lower Quadrant. The pain is currently at a severity level of 8/10. The quality of the pain is

  • sharp. Associated symptoms

currently include fever Abdo pain

  • RLQ
  • Sharp
  • getting worse
  • Now 8/10
  • Febrile

We actively encourage this style Epic Note Writer tools reconfigured

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So what is going on here?

“Time-saving” tools

Transcription into notes Scribes Voice recognition Copy Forward

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So what is going on here?

USA - Documentation driven by something other than clinical care?

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Compliance Revenue Anticipating litigation Perfunctory

Documentation

So what is going on here?

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Compliance Revenue Anticipating litigation Perfunctory Documentation

So what is going on here?

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Australia Clinical care At RCH – no staff other than clinicians look at the outpatient notes. (Patients and families) There are minimal drivers for clinicians to document anything more than what is needed for good clinical care USA The documentation seems to serve many non-clinical purposes. Clinical care often seems to be a secondary purpose There are strong drivers for clinicians to document more

What is the documentation in a note for?

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Inbasket Messages

It’s not just documentation

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We also do much less Ordering Linking orders to diagnoses Co-signing orders Attesting trainees notes Marking things as “reviewed”

It’s not just documentation

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We also do much less Alerting – drug and other warnings Average US Epic hospital displays drug alerts 6 times RCH rate

(RCH 1/11, some US hospitals >1/1)

US Many more non-drug alerts +++

It’s not just documentation

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Method A Good theoretical basis Introduced into practice No monitoring Outcome Efficacy unknown Headache Chronic fatigue

New drug analogy

Method B Good theoretical basis Pilot studies promising Randomised trials Outcome Efficacy found to be limited Headache Chronic fatigue

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? Something missing

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Now you're in New York These streets will make you feel brand new Big lights will inspire you Let's hear it for New York, New York, New York

?

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So – what is to be done?

Maintain the clinical focus for notes Avoid attempts to drive CRAP documentation Hands off our medical record!!! Encourage concise clear clinical note keeping Only ask clinicians to do tasks that add value in their eyes Be very careful about alerts etc Rigorous informatics methodology Clinicians involved +++

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Conclusion

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Scribes Private Practice software 24/7

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Medical Records in Mesopotamia Iraq and parts of Iran, Syria and Turkey. >5000 years ago. Scribes ICD -5000BC ?

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24-50% error rate

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