Physician burnout has been a growing global concern for more than a decade, with healthcare and physician organizations warning that it will not only affect future clinician retention, but the overall quality of patient care. Together with the Qatar Foundation and in collaboration with the World Health Organization (WHO), the World Innovation Summit for Health (WISH) published a report suggesting that at least one-quarter of healthcare providers report anxiety, depression and burnout symptoms. This report states that the world has “largely failed in [their] duty of care” for clinical professionals, exposing the widespread damage being done to the greater healthcare industry. It also calls for significant reforms to protect the mental health and well-being of doctors, including interventions that would reduce documentation burden and allow clinicians to spend more time with patients.¹

H.E. Mrs. Mubaraka Ibrahim, acting Chief Information Officer at Emirates Health Service (EHS), the federal health system serving the United Arab Emirates with 17 hospitals and 67 primary health centers distributed across the country, said that EHS physicians were reporting burnout and that, simultaneously, internal analyses of clinical documentation were showing declines in note quality.

“We saw that clinicians were spending too much time in doing the documentation for the patient files — but they were also finding it difficult to ensure their notes were accurate and comprehensive,” she said. “For that reason, we looked into solutions to address these two major challenges.”

Dr. Yaser Abuhajjaj, a Health Informatics Expert at EHS, said that he and his colleagues have long been concerned about the effects of physician burnout and were looking for ways to help.

“In studies, we saw that between 25% and 35% of physicians said that documentation and electronic medical record (EMR) tasks played a large role in impacting their work and productivity, and it was a main cause of burnout for them,” he said. “When we questioned our own physicians, we saw the same results. They were suffering from these documentation demands. We believed an artificial intelligence (AI)-powered speech recognition solution could help.”

Finding the right solution

EHS undertook a “careful and precise assessment” of different speech recognition solutions on the market and made sure to involve clinicians in the selection. The federal health system ultimately decided on 3M™ Fluency Direct because it determined that the solution could accurately and securely capture spoken dictation, adding important notes directly to a patient’s EMR. Both information technology stakeholders and providers appreciated the solution because of its high sensitivity and specificity, as well as its ability to accurately recognize speech from different voices and accents, Dr. Yaser noted.

“The providers liked the solution’s ability to learn their habits and behaviors while they are documenting. The machine learning and natural language processing added great value to their work, making it very easy to document clinical encounters,” he said. “They also liked that the solution provides computer-assisted documentation, instantly analyzing their notes and highlighting any deficiencies that need to be completed while they are already working in the record. They don’t need to wait for clinical coders to raise a query. If there is a question, it comes up while they are dictating.”

Dr. Hanan Alraeesi, a neonatal physician and acting Medical Director of EHS’s Khorfakkan Hospital, said that she and her colleagues appreciated that 3M Fluency Direct was “so flexible.”

“The doctors all have different experiences, different ages and not everyone is familiar with different applications,” she explained. “What is nice about this AI-powered speech-recognition solution is that it is very easy to use, even for those who do not like technology. It also has features that help us make our documentation more accurate in the patient medical record, which helps us avoid potential mistakes or misdiagnoses. It makes documentation much easier.”

Phasing in the solution

Because of EHS’s size, the federal health system took a phased approach to implementation. From the very beginning, the informatics team understood the importance of communicating with all facilities about the change and making it easy for physicians to adopt the new solution, according to Dr. Yaser. He added that EHS leaned on 3M’s implementation expertise and that they both came together in a “team spirit” to make sure that all hospitals had the support they needed to be successful.

“We did EMR documentation analysis to configure the hands-free navigation that comes with 3M Fluency Direct and then implemented the solution in groups of four or five hospitals at a time,” he said. “We also decided to connect each workstation to a microphone so that physicians would not have to carry around a speech mic. We had physician champions who were certified as trainers by 3M so they could help their colleagues learn how to use the solution. Communication and education are very important, and 3M’s guidance helped to make us successful.”

The implementation took one and a half years, but now all EHS hospitals and primary health centers are running the solution, and more than 1,800 of the system’s physicians have been trained to use it. While there was some initial resistance at Khorfakkan Hospital to the new tool, Dr. Hanan pointed out that the adoption rate is now rising.

“Over the past six months, we’ve clearly explained the benefits of the solution and how it can facilitate productivity, and we see our adoption rate going up,” she said. “The physicians like that they don’t need to speak slowly for the solution to detect what they are saying. They appreciate how accurate it is. But they also like that it saves them time.”

Dr. Hanan noted that most doctors get approximately 20 minutes per patient visit. “Before, it could take 10 of those minutes to do the documentation,” she said. “Now it has been dramatically reduced to 5 to 7 minutes, which we have verified by comparing actual time-saving metrics for a period of three months before and after the project’s implementation. This allows doctors to give more time to the patients and reduces patient waiting times.”

Dr. Yaser added that some facilities have seen 98% adoption, with a mean adoption rate of 70% across the service. To date, the federal health system has recorded more than 700,000 documentation minutes using the solution and will soon cross the million-minute mark.

“We’ve really seen excitement from our physicians, especially as they work with the functionality, the hands-free navigation and then see how quickly it can adapt to their voices and accents,” he said. “We’ve also done a survey to check physician satisfaction and how the solution is impacting their work. Ninety-four percent of users said it has reduced their documentation time by about 50%. They see improved patient satisfaction, they have improved their productivity and they have also said it has reduced their burnout.”

The deployment has been so successful that EHS plans to roll out 3M Fluency Direct to EHS’s public health centers and specialized dental centers, H.E. Mrs. Mubaraka Ibrahim announced.

“At EHS, we are on the forefront of embracing advanced technologies and our next steps will be to extend the benefits of this solution to other parts of EHS. It’s a very successful project and one that we succeeded in implementing with zero downtime and zero challenges. It’s something we can be proud of,” she said.

“We will continue working to increase the rate of adoption across the system, finding ways to overcome any challenges that providers may be facing with regards to documentation of patient data by continuously monitoring and adapting the usability of the system,” Mrs. Mubaraka added. “Our goal is to ensure and maintain high rates of adoption so we can continue to enhance the quality of documentation and achieve the highest quality patient care across the health service.”

Reference

1. Abdul Rahim, H.F., Fendt-Newlin, M., Al-Harahsheh, S.T., and Campbell, J. 2022. Our duty of care: A global call to action to protect the mental health of health and care workers. World Health Organization. https://cdn.who.int/media/docs/default-source/health-workforce/working4health/20221005-wish-duty.pdf?sfvrsn=a021c187_7&download=true.

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