To see all of the feature stories in the Burnout in the Age of COVID-19 series, click here.

When the subject of burnout in healthcare is raised, perhaps the highest profile victim is the physician. Without doubt, they are under a lot of stress – especially during a pandemic where they are regularly making life and death decisions.

But it’s not just the huge workload that COVID-19 has brought with it, and the sometimes terrible decisions that must be made. It’s also routine stressors like administrative work and the IT used to do it. IT can add stress, and it can also alleviate stress. It just depends on the application, how well it has been crafted to meet clinician needs, and whether physicians like it. Electronic health record systems are a usual suspect for stress, though they can help, too.

This is the third feature story in Healthcare IT News’ Burnout in Healthcare During the Age of COVID-19 series. It focuses on what causes physician burnout and how successful doctors are in fighting the stress that leads to burnout. This feature follows the first two, one on healthcare consumer burnout and the other on healthcare CIO burnout.

Following are the experiences and opinions of six medical doctors from various backgrounds and healthcare provider organizations, including Atrium Health, Compass Medical, Garza Medical Group, Orlando Internal Medicine and Saint Peter’s University Hospital. The physicians discuss the stressors of 2020 and tips for their peers throughout the industry to help avoid burnout.

The stress of patient workload during the pandemic

Healthcare IT has played a huge part in medical care during the pandemic in the form of telemedicine. This virtual care took off as states went into lockdown and people wanted to avoid being near other, potentially infected people.

“Our health system largely was designed to operate under the circumstances where patients were expected to physically travel to us and receive healthcare, or in rare instances healthcare physically would go to a patient’s home through visiting nurses and house calls,” said Dr. Dhrumil Shah, a family physician and chief medical information officer at Compass Medical, an ambulatory primary care practice in East Bridgewater, Massachusetts. “Delivering 20-40% of care virtually as part of nationwide change is something none of us expected to happen this rapidly.”

Patient workload stress has been affected largely from three aspects: when, how and where to receive or provide care, he added.

"Delivering 20-40% of care virtually as part of nationwide change is something none of us expected to happen this rapidly."

Dr. Dhrumil Shah, Compass Medical

“Being an ambulatory primary care practice, we realized the impact of these stress vectors immediately as we physically closed some of our departments, virtually closed all waiting rooms and applied administrative controls at all front doors of our buildings,” he explained. “The number of physical appointments reduced drastically, and telephonic triage exploded well before telemedicine regulations were made available to facilitate reimbursements and before mechanics of telemedicine were in place.”

Immediate impact of this pandemic on pre-existing burnout largely was felt as a shock and as uncertainty around the lack of scientific guidance available to carry out duties as a provider of care, he said.

“One way we mitigated this at Compass Medical was by creating a pool of administrative clinical leaders to provide 24/7 support for all of our physicians and clinical team members on rapidly evolving COVID-19 protocols as point-of-care practices were changing,” Shah explained.

“Our case medical management team, under the leadership of our chief medical officer, became a rapid response team that all clinicians relied on in the beginning, which tremendously helped us reduce burnout and allowed point-of-care teams to focus on redesigning patient workload from physical to virtual models of care and from reactive to proactive by applying population health insights.”

Proactively changing appointments to virtual visits when appropriate and rescheduling preventive visits when feasible allowed physicians’ schedules to accommodate the rapidly increasing demand of telephonic triage-based same-day appointments, he added.

“My burnout as a physician is partly measured in response to my professional satisfaction achieved via practicing good medicine at the end of my daily routine,” Shah stated. “During this pandemic, having a team around me making sure we get back to what matters the most – practicing good medicine – was crucial to avoid what could have been an exercise of emotional exhaustion if done in isolation.”

Bottom line: A team is what helps physicians avoid burnout and bring joy to the practice of medicine, he said. If a physician did not have a team before the pandemic, they certainly have one now if they still are practicing, he added. “Perhaps it just needed to be realized through this crisis,” he said. “Balance of life, support of professional teams and practice of self-awareness is the key to preventing burnout.”

Ever-changing information

There are many unknowns related to COVID-19, and over the course of the pandemic, information has been fluid. As physicians provide care for large volumes of patients across ambulatory, acute-care, long-term acute care and skilled nursing facilities, staying on top of ever-changing details that need to be communicated to patients, colleagues and peers about care and treatment has been very important, said Dr. Pradeep Vangala of Florida’s Orlando Internal Medicine.

“We deal with the stress brought on by the workload in a number of ways, all of them supported by technology in some way, from staying informed, collaborating with teams and the community, and sharing information with patients,” he said.

Another point of stress is ensuring that patients have detailed instructions when they leave the hospital, he said.

“Due to non-compliance or misunderstanding care instructions, patients are being put back on the schedule to be seen in a very short amount of time,” he said. “To ease this challenge, patients should be properly advised during their visits. New technologies integrated with our communications tools are making coping with this focus area at scale easier and helps relieve the associated stress.”

Optimizing workflow, reducing burden

Clinician burnout is real: It’s critical for healthcare organization leadership to call it out and acknowledge it; only then can it be addressed with measures that not just deal with the issues but creatively reduce and prevent factors that contribute to burnout, said Dr. Rasu Shrestha, executive vice president and chief strategy and transformation officer at Atrium Health, which has 39 locations in its health system, anticipating approval for a deal in October that will bring that number up to 55 hospitals.

“I am a firm believer that you cannot yoga your way out of burnout,” said Shrestha. “While it is critical to focus on clinician wellness, I spend a good bit of my energy trying to address the factors that contribute to the burnout in the first place. These include optimizing workflow challenges, reducing administrative burden, and formulating creative care models that emphasize care team coordination and person-centered care.”

"We deal with the stress brought on by the workload in a number of ways, all of them supported by technology in some way."

Dr. Pradeep Vangala, Orlando Internal Medicine

Additionally, it’s important for clinicians to be self-aware and mindful, he said.

“I find new strength every time I think about our mission to improve health, elevate hope and advance healing for all,” he explained. “I am at one with this mission, and that provides me the resilience and vigor needed to work with my teammates to truly address the core issues of clinician burnout head-on. It has been said that you should allow your passion to become your purpose, and it will one day become your profession. Aligning the passion, the purpose and the profession, hence, is critical.”

Do not succumb to fear

The coronavirus pandemic afforded many physicians the opportunity to grow new skills personally and organizationally.

“We made the decision early on to be informed and to not succumb to fear,” stated Dr. Nora Garza, a primary care physician at and physician owner of Garza Medical Group in San Antonio, Texas. “Each morning our team would have a morning huddle specifically to discuss the latest COVID-19 information. We discussed the number of local cases as well as national counts, number of deaths, type of people affected, children versus elderly, etc.”

Garza brought in articles she had just read that morning in her medical literature, updating staff on the latest in viral detection, epidemiology and treatment options. All information shared was dynamic and unique with each day. Each staff member contributed actively, sharing what each one had recently learned from local news or even from social media.

“I realized that this task of sharing amongst the team was more than just a sharing of information,” she said. “We shared our fears. These morning huddles became our action plan for the day and in a soft, private way, our fears dissipated. I reminded the staff that to move in the direction of helping people at this time was not just an act of bravery, but also an act of holiness.”

Staff bolstered each other with confirmation, she added, and took joy in doing the right thing for the community.

“After the strongest wave of the disease had passed, I awarded each member a bonus and a formal certificate of appreciation that read: ‘Garza Medical Group honors (employee name) for Outstanding Community Service during the COVID-19 Pandemic Crisis of 2020,” she said.

“We dubbed ourselves COVID Warriors as we recognized the work was done not without fear, but despite the fear. These framed certificates now hang in the homes of each staff member so that the parents, the children and the grandchildren know the recognition of this work reflects the ethic of an entire family.”

For Garza, the most “nourishing” way she dealt with the work to be done to combat the pandemic started before her reading of medical information. Intentionally, she focused on faith first.

“I spent my early morning time reading the daily Catholic mass, studied the reading for the day,” she related. “Some mornings I delved deeper into books about the gospels and studied books from authors that shed light on what a faith-based life looks like. I was moved by how relevant this type of study was to the day I was about to face.”

During the early months of the pandemic, Garza shared her anxieties as well as augmented her COVID-19 medical information with a small group of private practice owners – each one of the group owns their own company and each one would group text at all hours of the day.

"I am a firm believer that you cannot yoga your way out of burnout."

Dr. Rasu Shrestha, Atrium Health

“As soon as any new bit of information surfaced, or any critical data was discovered, we would share it,” Garza said. “When one of us in the group needed PPE, the other would send some. When one of us got infected with COVID-19, the other quickly responded by sending an ambulance to the home. We were each other’s lighthouse as we led our own staff through the murky unknown of the epidemic.”

This was a “think-tank” that sustained Garza when she had severe doubts. “I could not have led with the confidence that I did without this support team,” she said. “I am forever thankful for their support during those critical days.”

Take care of yourself

In the midst of a pandemic, it certainly is easy for a physician to become overwhelmed by work. He is able to do more work, and oftentimes from home.

It also is more difficult to be around others and keep a normal schedule, said Dr. James Rachal, a psychiatrist and academic chair of the department of psychiatry at Atrium Health, which has 39 locations in its health system, anticipating approval for a deal in October that will bring that number up to 55 hospitals.

“Perhaps the most important thing to avoid burnout is making sure you take care of yourself,” he advised. “Maintaining a schedule is imperative; it is easy to sleep during the day and stay up all night. Work can bleed over into the night and onto weekends since the things we have used in the past to break up our days and weekends are gone. Many of us can see patients from home and we can start earlier and stay later.”

Social schedules have been broken during the pandemic. Making sure physicians keep a regular sleep/wake schedule is very important, Rachal said.

“It also is important that we continue to exercise,” he suggested. “While gyms and other recreational facilities have been closed, parks remain open. We are still able to run and cycle. Exercising helps break up the day as well as act as distraction. It also releases endorphins. Exercise also brings us in contact with others and allows us to socialize even if at a distance.”

Continuing to socialize is very important, as well, he added.

“Even during a pandemic, we can use technology to socialize, as well,” he said. “Also, arranging time when we can meet friends even if it is at a distance helps. Without outside influences, our world can become very small, very quickly, and work can move to the center and appear magnified. It is important also to maintain a good diet. Our diet can affect how we feel and our energy.”

Weight gain can lead to low self-esteem and amplify problems at work, he added. Really monitoring time in front of news can be helpful, too, as news can be very negative and impact people emotionally, which can amplify problems at work, he said.

"These morning huddles became our action plan for the day and in a soft, private way, our fears dissipated."

Dr. Nora Garza, Garza Medical Group

“Making sure to seek help when needed also is important,” Rachal advised. “Healthcare workers are great at taking care of others but not always the best at seeking help. There is much stigma and concern about privacy that impairs us from seeking help. Atrium Health has started the PATH program with the hope of overcoming that stigma and making sure our workers have a place to get help.”

PATH offers psychotherapy and psychiatry services free of charge. The health system offers these services after hours as well as during business hours for the convenience of the healthcare worker or provider. The services are offered in person or via phone.

“Burnout also can result from not finding meaning in your work,” Rachal said. “It is important that we keep reminders every day of why our work is important. I try to thank or acknowledge something a coworker does on a daily basis. I do this as much for me as for them. By doing this it reminds me why what I do is important and brings a smile to someone else’s face.”

Family time and hobbies

Dr. Balaji Yegneswaran, physician director, clinical documentation and care coordination, and academic staff intensivist at Saint Peter’s University Hospital, in New Brunswick, New Jersey, said COVID-19 has been a very interesting period for the state of New Jersey, a onetime hotspot.

“It was the first time in my career I have seen such a huge volume of very sick patients at the same time,” Yegneswaran related. “Where my average length of stay on a ventilator was around five days, this time was the first time that I saw people on the ventilator for about 20 days. That did put a lot of stress on me and I think what helped me avoid burnout was spending time with my loved ones and connecting with my friends emotionally and socially, as meeting physically and being physically close to them was not an option.”

Another thing Yegneswaran does that he believes would help others is to try a new hobby.

“I have started carpentry as a hobby, and it has helped me with my stress at work,” he said. “It was very rewarding when I built a garden bed with my family and I spent a lot of time gardening. I also built benches, and that was a new thing that I learned, where I could see something physically being made.”

Ways IT can hurt a docs’ ability to cope

While IT can be a great help to physicians needing to manage great amounts of information, IT can also be a hindrance, and help lead to burnout. Clumsy EHRs are one frequent complaint from physicians. And there are others.

“As a physician informaticist CMIO, my bias always has been that information technology is there as a tool and it depends on the operator to make it a success or a failure,” said Shah of Compass Medical. “The biggest challenge we have faced in healthcare when it comes to information technology is by setting the wrong expectation for frontline workers, including physicians, that these tools were designed to make their lives and their job better.”

Healthcare has come a long way in realizing that with proper design, personalization and cultural alignment, the same technologies in two different settings can yield different results, Shah said.

“You can have the most satisfied and least burnt-out user base on one side, and the opposite is true for another setting where personalization, training and cultural changes have not been accounted for to achieve positive results,” he added.

Some ways information technology hurts are when organizations apply solutions without deep understanding of problems they are trying to solve and new problems they are creating, he said.

“For example, implementing telemedicine, which we all have done during the pandemic, is not by any mean going to change how we address the digital divide and literacy-related challenges for our most vulnerable population,” he explained.

"Without outside influences, our world can become very small, very quickly, and work can move to the center and appear magnified."

Dr. James Rachal, Atrium Health

“Promoting online symptom checkers, chatbots and digital health applications may be of tremendous value to certain population groups, but this can bring harm to others by increasing anxiety, unnecessary tests and healthcare costs.”

Understanding one’s population through means of data, psychographics and risk stratification models can help one streamline application of innovative technologies and create value, he added.

EHR click fatigue

One of the most common problems for physicians with EHR technology is that it leads to click fatigue, said Yegneswaran of Saint Peter’s University Hospital.

“With so much data that is pulled into the EHR systems with repeated updates and tweaks, the workflow changes a lot and the amount of work has been increasing,” he said. “The non-availability of a unified electronic medical record creates a disconnect between inpatient and outpatient medical records.

“If a patient is transferred from one hospital to another, a lot of information is lost and physicians spend a lot of time gathering data. One of the primary uses of the EHR led to bigger challenges for physicians to dig into data.”

Managing clinical alerts and virtual care

Managing the abundance of clinical information and alerts coming from the electronic health record continues to be a challenge for physicians and contributes significantly to burnout, said Vangala of Orlando Internal Medicine.

“Urgent clinical data needs to be pushed at the appropriate time and acted on immediately, not buried in scores of other alerts and results, forcing providers to take precious time to locate the correct data,” he explained. “In addition to the variety of clinical data needing review, another complicating factor is the data is located in disparate electronic health records across multiple care settings. Interoperability continues to be a big issue.”

Using multiple EHRs is challenging for physicians, especially if patient data needs to be quickly pulled together from several EHRs in order to have a comprehensive view of the patient record, he added.

“Add to the challenge the fact that the pandemic has forced physicians to become acquainted with virtual care technologies overnight,” he said. “Without connecting virtual care and communication tools to the clinical data contained in the EHRs, an additional drag on time and efficiency is created and that increases stress on providers and detracts from the patient experience.”

Further, Vangala said, moving the practice to a remote care setting posed a number of challenges for the established and new patients, who had expectations aligned with in-person visits.

“Initially, the technology we used for virtual care enablement was inadequate and was not a scalable model,” he said. “We did not have the capabilities we needed to provide a satisfactory interaction with our patients. We were experiencing high appointment abandonment rates, up to 50%, and it was impacting the quality of care we were able to deliver.”

The top priority became to find a sustainable virtual care platform that would allow staff to deliver the experiences patients deserved and expected, he noted.

“As healthcare providers, our top priority is gaining the trust of our patients,” Vangala stated. “When our patients feel that the technology is not effective, lower satisfaction ratings are another source of stress. Our initial telehealth implementation was a temporary Band-Aid, and we recognized we needed a more robust solution for a sustainable virtual care strategy.”

EHR and virtual care pains

There are many IT issues that lead to burnout; the EHR can cause more work than it saves especially when it freezes or physicians end up repeating work due to doing something incorrectly because it is counterintuitive, said Rachal of Atrium Health.

“IT also has allowed us to see our patients virtually,” he added. “This is much more convenient for the patients and helps prevent spread of coronavirus, but it also takes away something from the interaction. Most physicians went into medicine because we enjoy the doctor/patient interaction. We also enjoy people in general. While IT allows for some of the interaction, it has definitely changed. It puts up barriers in communication.”

"What helped me avoid burnout was spending time with my loved ones and connecting with my friends emotionally and socially, as meeting physically and being physically close to them was not an option."

Dr. Balaji Yegneswaran, Saint Peter’s University Hospital

Physicians cannot see body language, often body parts appear differently on screen and there is the frustration when the technology does not work, which takes more time and puts up even more barriers, he said.

Data rich, information poor

Healthcare in 2020 is data rich and information poor, said Shrestha of Atrium Health.

“Physicians often are more detectives than they are clinicians – hunting for key nuggets of data, piecing together relevant clues around their patient’s conditions from across various information silos,” he explained. “Information technology should not be an impediment to care, but more an enabler of better care.”

When key pieces of data are buried in silos of information systems that do not seamlessly interoperate, physicians are left with the challenge of struggling to glue these pieces together, leaving less time for actual human interactions with the patient and the care team, he added.

“Equally disruptive is the fact that patients often have troves of data as well as specific preferences and real-world elements that influence their decisions – and these data points and facts often are not available seamlessly to clinicians,” he pointed out. “While patient portals provide a small window into this world, they are far from where they need to be to truly bring the patient into the collaborative care models that are needed.”

Missing side conversations and daily chit-chat

Rachal of Atrium Health notes that with the pandemic, he and his colleagues never have meetings in person.

“Again, the technology is more convenient and often I have many more people at a video conference than when it is in person; but personal interactions are missed,” he said. “It is much harder to have side conversations and daily chit-chat is missed. We no longer are able to mingle. All this is loss in social interactions and leads to burnout.

“We also rely on virtual resources in the community,” he continued. “They are simply not as good. We know that we are giving our patient resources that are suboptimal sometimes because there is simply nothing else to give. This is not a good feeling and can lead to burnout.”

Ways information technology helps

When digital is done right, IT helps physicians avoid burnout, said Shrestha of Atrium Health.

“Having lived through the analog era in healthcare, where we had to deal with paper charts, paper folders and film – digital done right definitely brings forward key advantages for clinicians,” he stated. “When I put on my radiologist hat, I can tell you that the anywhere/anytime nature of digital imaging has been a great blessing to healthcare. Studies are available instantly once the scan is complete, and available for interpretation and collaboration across the hospital or across the state or country.”

Physicians do not have to struggle with lost or misplaced films and are able to scale their clinical operations and care collaboration in agile ways, he added.

“The need at hand is to build on these advances, and truly leverage capabilities such as artificial intelligence, voice recognition and natural language processing to truly enhance our workflows and the value to the system,” Shrestha said. “As health systems embrace value-based care models, technologies such as these can help us become better clinicians, augmenting the care we’re providing, and allowing more time for us to focus on more of the human elements of relationships and decision making.”

Becoming proficient at EHRs

When a physician becomes proficient with their EHR, it can become a real time-saver.

“I often type my note while seeing the patient and doing billing as well,” said Rachal. “I then let the patient read my note, collaborative documentation. This helps in multiple ways. First, it is a major time-saver, plus I am documenting in real time so I do not forget anything. I allow the patient to read the note before signing and allow them to give input and correct any misunderstanding.”

This helps make the patient a partner in their care. This helps prevent misunderstanding and build trust.

“I think this really improves the doctor/patient relationship,” he said. “The better the relationship, the better I and they appreciate the care that we have together provided. This keeps the patient in the center of their care and more likely to carry out the plan we have collaborated to create. If we have happy, healthier patients it helps us feel better about our work and less likely to burn out.”

While IT can be isolating, it also can allow physicians to contact people they would otherwise not be able to see, he added.

“Because of the convenience of being seen by phone or computer, our patients are less likely to no-show appointments,” he explained. “This helps increase patient compliance, which is essential to their health and well-being. Patients also have a high satisfaction from virtual appointments. No-shows can be very frustrating for providers, especially as we see worse outcomes associated with no-shows.”

Relieving this stress plus high satisfaction from patients helps avoid burnout, he said.

“Many of our providers have started to embrace the positives of IT,” he noted. “Focusing on the decrease in no-shows. They also use it to get a window into where our patients live. Encouraging patients to use the video screens to increase connectedness and also see where their patients reside. Medicine from years back used to visit patients in the home to better understand the patient. The videos at home allow us to do that.”

Physicians also can more easily talk to patients’ family members, who might not otherwise come to the office, he added. When physicians see a patient where they live, it is more easy to see them as a person and not a patient, he said.

“It also has allowed us to convene with people we may not be able to,” he said. “Virtual meetings allow more people to attend and make people from different sites feel more like a community. It allows us to disperse important information and share instructions with more people. I believe that while IT has impaired some more intimate communications, it has allowed for large groups who are at different locations to feel more like a community. We know that feelings of belonging decrease feelings of loneliness, and connectedness decreases burnout.”

Remote AI scribing and EHR usability

There are many examples of how healthcare provider organizations can help improve physician wellness and avoid burnout with the help of technology, said Shah of Compass Medical.

“Secure communication platforms have enabled remote scribing models and there are evolving AI-enabled scribes that are promising, as well,” he said. “Dictation platforms have come a long way to yield accuracy and improve efficiency for physicians. EHRs are increasingly focusing on usability to improve user experience, and interoperability advances are making leaps and bounds in integrating daily workflows for end users, including physicians.”

Shah notes that today, from his smartphone, he can securely review EHR data, dictate his notes, take pictures of a rash, get notified when patients are in the hospital, collaborate with his care management team members and more.

“Technology has enabled work-from-home capabilities for clinicians and their team members,” he said. “Managing life balance with a flexible schedule where I can have dedicated telemedicine sessions from home, have care management teams be enabled through technologies such as remote physiological monitoring and other patient engagement platforms have created opportunities for us to deliver care remotely and balance in-person care for more comprehensive needs.”

IT helps with documentation

Physicians spend a lot of time completing documentation, and this is definitely a place where IT can help combat burnout.

“At one point in the COVID-19 surge, I had to take care of 20 patients with multiple code blues and all patients were on the ventilator,” said Yegneswaran of Saint Peter’s University Hospital. “I have been an intensivist for 10 years and had never seen anything like this. To avoid physician burnout during the COVID-19 surge, the hospital had procured Speke technology to help with documentation.”

The best part of Speke, he said, is that dictation occurs at the same time the plan of care is being discussed during rounds.

“The scribe would transcribe thorough documentation within a couple of hours,” he explained. “The notes required minimal proofreading, while generally, without Speke, I spend more than three hours on documentation per shift. This addition of information technology reduced my time spent on documentation to less than an hour.”

This increase in efficiency with documentation leads to a decrease in burnout, he said, and he feels that has played a vital role in him taking good care of his patients during COVID-19.

Adopting the right technology

As Orlando Internal Medicine ramps up its virtual care offerings, it has been important to Vangala and his colleagues to have a solid strategy that encompasses EHR integration, team collaboration (including external care teams such as PCPs) and post-care – and that means adopting the right technology tools to support physicians and better serve patients.

“To help with this endeavor, we have implemented Andor Health’s virtual care and care team collaboration toolset to transform the way our care teams connect, collaborate and communicate,” he noted. “Streamlined communication and EHR integration, both inside and outside of the internal care team, has been a great benefit across the practice.”

For example, he added, with a few voice or text commands, physicians and care teams can access patient information directly during virtual care visits, no longer having to pull information from disparate clinical systems.

“This includes lab results, X-rays and more,” he explained. “Now our physicians can make faster, more informed treatment decisions, as well as improve patient outcomes. The improvements we have seen are significant, including a 30% reduction in abandonment rates and a staff time savings of 8-12 minutes per patient visit.”

From critical lab notifications to pre-op notifications to discharge summaries, Orlando Internal Medicine is using a secure platform for care teams, as well as the larger care community, to collaborate via audio, video and text. This increased level of communication has mitigated stress and concerns regarding gaps in clinical information, Vangala said.

“We also are using virtual rounding to safely monitor patients during a hospital stay or at home,” he added. “We are using artificial intelligence to help us conduct patient follow-up, provide care summaries and schedule future appointments. This AI-driven engagement with patients has been a tremendous benefit and has helped create even stronger patient relationships.”

Surround yourself with helpful partners

The mission at Garza Medical Group is, simply put, to help people, Garza said. Caring for people, helping them get through their day, and addressing their health concerns, is more than just a job to Garza and her team.

“When COVID-19 hit our hometown of San Antonio, it was a moment in which every piece of training, every patient and every diagnosis I’ve ever made brought me to this point,” she said. “I knew in my gut that I was built for this. I knew I had to get better prepared, better educated to be available for my patients and staff more than ever before.”

Garza’s biggest tip for doctors to avoid burnout is for physicians to surround themselves with great IT companies that provide efficient tools to help them succeed.

“Our EHR partner, athenahealth, has been a member of our team and the key in helping me support the community during this difficult time,” she said. “Part of sustainability in the healthcare industry is being able to harvest data within the system. I’m able to support members of the community and my staff with athenahealth’s partnership and innovative technology.”

Using athenahealth’s technology, Garza said the practice has reassured patients with regular text communications and robust online information flow with care team members who were physically separated.

“To help calm the panic from very early on, I’ve used athenaCommunicator to text every single patient during the pandemic,” she related. “It goes well beyond medical scheduling software by improving all patient interactions outside of our office.”

Technology bridging traditional divides

On another front, technology can help bridge traditional divides that have contributed to clinician burnout in healthcare, said Shrestha of Atrium Health.

“The divide between clinicians and patients is a real one, and often causes undue stress and strain in communications between clinicians and patients, as well as in data flow across the two worlds,” he said. “Clinicians do much of their work around the electronic health record system. Patients do not. They may have a smartphone, or may have devices that measure various parameters such as blood glucose and continuous monitoring of other vital signs.”

Atrium Health uses technology from IT vendor Xealth to bridge these two divides and create a more seamless flow of data and content from the EHR to the patient’s world, and vice versa, Shrestha said.

“We can effectively ‘prescribe’ an app to our patient, directly from the EHR – much like how we can prescribe a medication to our patients,” he explained. “This triggers a secure connection between the two divides, and we’re able to securely view data that the patient sends our way directly within our own workflows.

“Women’s health is a key strategic priority for us at Atrium Health, and our implementation of Babyscripts takes advantage of this bridging capability – driving us to reinvent maternal healthcare and elevate the experience for patients as well as clinicians in this important journey forward.”

Tech creates a different approach

Another way technology is helping physicians avoid burnout is by forcing everyone to think differently – as providers, as payers and as patients, said Shah of Compass Medical.

“Just the other day, I had a patient who brought in their Apple Watch EKG reading, which picked up a type of arrythmia that I would have missed on a regular EKG since the patient was asymptomatic when in my office,” he recalled. “Previously, I would have ordered more tests to investigate this, but now, knowing it was a benign arrythmia when the patient was symptomatic at home, we could manage this conservatively.”

Payers are seeing the value of digital health tools and technologies as well, including diabetes prevention plans delivered entirely virtually, which helps reduce total medical expenses, he noted.

“Sleep studies are being done at home, hospital at home is a model becoming more adopted across the nation,” he observed. “Self-disease management, health and wellness through data and technologies are going to continue to shift the way we operate in healthcare, which will directly impact physician burnout positively over time.”

Bringing in family members

Over the past 10 years, physicians have been working toward creating a care environment where family members, in addition to patients, are involved in that patient’s entire care journey, said Vangala of Orlando Internal Medicine.

“The goal is to make sure the patients have the support they need,” he said. “The majority of patients in our practice are elderly, and when they do not have a care advocate available during their visit, they can feel overwhelmed by care instructions. Simple changes in medications can be overwhelming and makes them prone to non-compliance. Now, family members can be invited into a patient’s virtual visit, helping the patient feel more at ease during their encounter with the physician and ensuring that the patient and their family member understand the care plan.”

If physicians are looking to enhance their patient satisfaction ratings, this is a great way to do it, he added. Inviting patients’ family members into virtual calls allows families to collaborate on care efforts and next steps and has helped Orlando Internal Medicine build a greater rapport with patients, he said.

“Introducing AI-integrated virtual health technology into our practice has helped bridge a big communications gap, which is a large contributor to physician burnout,” he noted. “With information changing on a daily basis for COVID-19, this has never been more critical. Our practice is now prepared to deal with the ‘new normal’ and I am confident that our virtual health strategy is beneficial to our patients.”

Staying socially connected

On the subject of telemedicine, physicians have been able to communicate via telemedicine with one another for a long time. During COVID-19, helping patients from a physical distance pretty much became the norm, said Garza of Garza Medical Group.

“We chose to stay socially connected though we had to stay physically distanced,” she said. “I do not like the term new normal. There is no such thing. People will always need to be socially connected, always. That is how we are built. Patients need to stay connected to their physician, via telemedicine for now, but eventually going back in the office for that reassuring touch. There is nothing new about touch. It will always be a human need.”

The sooner people learn to re-embrace that, the healthier society will become, she said.

“Telemedicine will hopefully have a permanent place in medical practices because it is so convenient in some aspects,” she said. “There is a niche for it. However, it is like taking a shower with your clothes on and not quite the authentic experience that is accomplished in the refreshing primary care office setting. I would like to see telemedicine remain in my practice but only for about 20% of my billable encounters.

“Telehealth allowed me to be empathetic again and allowed me to see my patients one on one again,” she concluded. “Almost as great as hugging a patient live is that kiss that I could blow to my patient while onscreen. I loved the patients that blew that kiss back at me, especially the elderly with their whole heart shining through their smiling eyes.”

Coming soon, the fourth feature story in our special report on burnout in the age of COVID-19: EHR vendors and their staff - how these key health IT companies are handling employee stress during the pandemic.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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