The Executive Suite: Reducing clinician burnout by getting rid of “stupid stuff” in EHRs

Over the last year, the American Medical Association (AMA) has offered guidance to reduce “unnecessary daily burdens for clinicians.” The AMA’s “Getting Rid of Stupid Stuff” (GROSS) initiative has more than just a great name; it also provides timely and appropriate advice for eliminating unnecessary tasks that add to heavy clinician workloads and contribute to burnout.

The AMA defines “stupid stuff” as everything from irrelevant training requirements, well-intentioned but not useful risk management processes, and overinterpretations of health information requirements, especially HIPAA. Not surprisingly, the AMA also calls out EHRs as a great source of “stupid stuff” that create significantly more work for clinicians. I would also throw in all the extraneous administrative, electronic, and managerial tasks that clinicians must perform that have nothing to do with practicing medicine.

If we made getting rid of the “stupid stuff” in EHRs a top priority, we could make a significant impact on physician well-being and satisfaction. Amidst the current health crisis, clinicians are under extreme duress and have little power to minimize the impact of rising case numbers, staff shortages, and high rates of infection. Healthcare leaders can provide some relief by addressing some of the stupid inefficiencies of EHRs that create clinician stress and frustration.

The big three

EHR inefficiencies stem from three big issues:

Most EHRs were designed to meet coding and billing requirements, not to support clinical decision-making
EHRs lack interoperability, making it difficult for clinicians to share critical patient information between disparate clinical systems and between providers
Clinicians must enter an overabundance of data to satisfy quality reporting requirements for proper reimbursement

Ridding EHRs of “stupid stuff” starts with tackling these three big issues.

Supporting the needs of clinicians

Few EHRs were designed to meet the needs of clinicians. Instead, they were created to help billers and coders get the details they need to do their jobs, and clinicians were tasked with feeding the computer all the data to support financial teams.

Instead of requiring clinicians to be data entry clerks–which is a “stupid stuff” task–we need smart computers that work behind the scenes to automatically interpret billing and coding details from within clinical documentation. We must empower clinicians with workflows that support how they practice medicine and deliver the information they need for clinical decision making at the point of care. This includes making it easy for them to find patient and problem specific information, without having to search through multiple screens. It requires technology that can sift through all the clinical noise in the chart and deliver the right information at the right time to inform clinical decisions.

We also need to get rid of disruptive EHR features that attempt to make medical decisions on a clinician’s behalf. The smartest computer in any exam room is between the clinician’s ears;any extra keystrokes that stand in the way of clinical decision making are a stupid waste of time.

Improve interoperability

COVID-19 has underscored the need for interoperable systems that facilitate the exchange of comprehensive and usable patient information, including details on preexisting conditions, medication histories, and test results; it has also revealed how much more work needs to be done to achieve true interoperability.

At a time when clinicians need ready access to patient information to accelerate treatment, we are still relying on faxes and PDFs to share COVID-19 test results and other critical patient details. We are dumping these records into EHRs and requiring clinicians to click and open multiple files to glean a complete view of a patient’s health.

Though the government has approved rules to enhance interoperability, enforcement has been delayed due to the many unforeseen challenges of COVID-19. However, without improved interoperability between EHRs and providers, clinicians will be forced to keep doing a lot of stupid stuff that takes away from quality patient care and creates stress and frustration. Rather than waiting on the government to push needed changes, healthcare leaders can alternatively embrace technologies that facilitate interoperability and give clinicians the key information they need to deliver care.

More quality care, less data entry

CMS and other payers continue to mandate quality initiatives designed to assure high quality healthcare. These programs require healthcare organizations to track and report various quality metrics that demonstrate quality healthcare processes, outcomes, patient satisfaction and other goals.

Despite the best of intentions, these initiatives have created more stupid tasks for clinicians, who are primarily the ones inputting all the required quality measures into the EHR so that financial analysts have data for reporting. Instead of focusing on the delivery of quality care, these programs often divert clinicians’ attention away from the patient and onto the computer screen. Rather than burdening clinicians with more data input, healthcare leaders should seek solutions that simplify the tracking of quality measurements by allowing clinicians to follow their usual clinical workflow and spend more time on patient care.

Get rid of stupid stuff in EHRs – without getting rid of the EHR

Reducing clinician burdens and getting rid of stupid stuff within EHRs doesn’t require that organizations get rid of their complete EHR platform. Healthcare systems can instead preserve their EHR investment and add technologies that make workflows more efficient for clinicians, improve interoperability, and give users more time to focus on the delivery of quality care. At a time that clinician burnout is reaching new highs, it’s time for healthcare leaders to embrace new solutions that make EHRs a little less stupid.