As hospitals and health systems seek new ways to combat the growing challenge of physician burnout, new research from the Palo Alto Medical Foundations suggests that tailoring electronic health record workflows for more efficient in-basket messaging could be a big help.

WHY IT MATTERS
The Health Affairs study, which centered on administrative and clinical data from Palo Alto Medical Foundation's primary and specialty physicians, found that the number of messages received by these docs had a correlation with their probability of burnout.

"Despite concerns about physicians’ workload associated with electronic health records, little attention has been paid to the relationship between physicians’ well-being and the in-basket messages physicians receive – specifically, their volume and sources," said PAMF researchers.

Their study of physicians in a multispecialty practice found that in-basket messages generated by the EHR itself accounted for nearly half the 243 weekly in-basket messages received per physician, on average – 114 of them, far than the 53 notes received from colleagues and 30 from patients.

Meanwhile, more than one in three physicians reported experiencing burnout symptoms, and 29% said they plan to cut back clinical work time in the upcoming year.

"Receiving more than the average number of system-generated in-basket messages was associated with a 40% higher probability of burnout and 38% higher probability of intending to reduce clinical work time," according to the report.

The challenge lies in how the messages are generated – nearly half of those in the study came from EHR algorithms. Family physicians and internists received more than 2.5 as many system-generated messages as surgeons did, and 5 times as many as nonsurgical proceduralists.

"Some of those messages are generated by population health management algorithms that remind physicians to perform work that might have otherwise been overlooked," researchers explained. "These were in addition to messages coming directly from patients and from other physicians or care team members."

The result, they said, was that "perceived and realized loss of autonomy over their work schedules could leave physicians feeling defeated, even though some of these system-generated messages have been shown to improve certain processes of care for patients with chronic illnesses."

That's a challenging balance to strike, but the PAMF researchers suggest that health systems think harder about how they're presenting these nudges within the EHR workflow.

For instance, frontline physicians "might not be the most appropriate recipients of some system-generated messages," they said. In addition, health systems should "reconsider whether system-generated automatic messages are the best way to ensure quality of care."

THE LARGER TREND
Physician burnout is a serious issue across healthcare, and has been for years. And not just for the physicians themselves, but for patients – ECRI, for instance, listed it as one of its top patient safety concerns for 2019.

Better system design and configuration is one way to help. Better training is another. But it's critical to do something to alleviate the burden put on caregivers and clinicians.

"You are not imagining that it is really hard to practice medicine these days," said Dr. Thomas Jenike, chief human experience officer at North Carolina-based Novant Health, at the Cleveland Clinic and HIMSS Patient Experience Summit this spring. But EHRs are "not going away."

ON THE RECORD
"The electronic health record potentially creates a 24/7 work environment for physicians," according to the PAMF study. "Its impact on physicians’ wellness has become a challenge for most healthcare delivery organizations. Understanding the relationships between physicians’ well-being and 'desktop medicine' work in the EHR and work environment is critical if burnout is to be addressed more effectively.

"Despite concerns about the amount of physicians’ time spent on EHR in-baskets, the literature is relatively silent regarding the sources of in-basket messages and their relative volumes," researchers added. "Given the correlation between physician workload and desktop medicine1 and the rising number of physicians who report burnout, it is important to carefully examine the relationship between pivotal aspects of desktop medicine and physicians’ well-being."