Two decades ago, technology was presented as the solution to so many of the U.S. health care system’s ills. EHRs and other tools were going to streamline recordkeeping, allow seamless communication between providers and payers, and, most importantly, free up clinicians to spend more time on patient care and less on administration and paperwork.
Unfortunately, EHRs are sticky in that everyone uses one, but they lack in driving clinical outcomes as a standalone solution - which just makes things worse and detracts from payer/provider alignment. This is in direct contrast to what I encountered growing up in Israel, where patients, physicians, and the national insurer are all fully integrated, both in terms of interoperability and alignment of interests.
Technology hasn’t improved efficiency to the extent promised or inserted more caring into health care. It hasn’t driven down costs for patients and payers, and it hasn’t saved practices money. As a result, providers at all levels are still working below their licenses.
Nowhere is tech’s failure clearer than its role in clinician burnout, a long-smoldering problem that has burst into flames since the introduction of the “meaningful use” incentive program.
U.S. Surgeon General Dr. Vivek Murthy sounded the alarm on clinician burnout in an advisory this May. The report detailed how an already serious problem has been exacerbated by the COVID-19 pandemic, causing providers to leave medicine in record numbers at a time when they’re needed more than ever before.
The advisory concluded that the country needs 1.1 million new registered nurses and faces a projected national shortage of more than 3 million low-wage health workers. The Association of American Medical Colleges predicts a shortage of as many as 139,000 physicians by 2033, with the greatest gaps in primary care.
The Surgeon General’s report is only the latest piece of research to cite administrative demands and EHRs as leading causes of burnout. It found that, on average, for every one hour of direct patient care, a primary care provider will spend two hours a day on administrative tasks. That not only frustrates clinicians, but it also contributes to poorer health outcomes for patients.
So, what’s the solution to technology-caused burnout? Technology.
It seems counterintuitive to prescribe technology to treat burnout caused by technology, but the answer is not simply more tech, but better tech — tech that will finally deliver on those 20-year-old promises.
Of course, there’s no turning back the clock. We’re not going back to paper records and manila folders. The American health care system will not be streamlined and simplified anytime soon; it will remain a thicket of incompatible systems and competing priorities.
Only tech whose design and processes are informed by the failures of previous systems can solve these problems. Unlike current systems, these tools will need to increase the efficiency of clinicians using them and drive down costs.
The good news is the problems aren’t insurmountable. In fact, they’re being addressed right now.
“And if you gaze long enough into an abyss, the abyss will gaze back into you.”
The philosopher Friedrich Nietzsche wasn’t referring to health tech when he wrote this, but any provider who has spent hours staring at a poorly designed EHR interface can relate.
It’s not surprising that a 2020 study in Mayo Clinic Proceedings found that EHRs scored in the bottom 9th percentile of technologies when evaluated for usability. They were supposed to package multiple streams of patient and payer information into simple, easy-to-manage bundles. That hasn’t happened.
But EHR experiences can be improved, primarily in two ways. The first is by investing in local provider organizations to improve workflows, implement user feedback loops, etc. The second is to deploy complementary tech solutions that improve the user experience, such as robotic process automation, integrated workflows, and EHR overlays.
These solutions can make health workers more efficient by reducing the need for them to manage disparate workflows, thereby lowering labor costs, and making it easier to manage the health worker shortage. EHRs are here to stay. Technology that understands this and mitigates their shortcomings for clinicians are indispensable in combating rising health care costs and reducing burnout.
Tech is simultaneously overwhelming and underperforming.
Clinicians and others must use too many tools and click too many times only to be delivered insufficient results.
Too many tech tools and non-integrated data sources result in information silos; obtaining a comprehensive picture of a patient’s care can require assembling data from emails, paper notes, EHRs, portals, and even faxes.
That sort of copy-and-paste recordkeeping wastes time and leads to lost data, compromised patient information, and poor patient experience. Health workers need a way to assemble all the information from multiple sources into a user-friendly interface.
Tech can consolidate touchpoints and tools and implement interoperability standards. Automation of routine tasks, such as checking authorizations, handling referrals, and entering ICD codes, reduces the number of tech touchpoints and frees providers to focus on the far more crucial lifesaving work we ask of them.
Everyone from patients to payers has an interest in keeping clinicians happy, engaged, and, most importantly, on the job and operating at peak efficiency.
Independent practitioners often suffer the most from tech burnout because they have fewer resources and less time to manage administration. As a result, many surrender and sell their practices to health care systems just to free themselves from drawing under administrative demands. However, that can result in higher costs for society and poorer care, while also carrying its own stresses for clinicians.
Tech that empowers smaller, independent practices to not only stay viable but to succeed in shared initiatives, such as value-based care models, can help preserve the dwindling ranks of independent practices and general practitioners.
Poor technology got us into this mess; good technology can get us out. In fact, it’s the only thing that can.
Oron Afek is the CEO of Vim, a technology company building digital infrastructure for U.S. health care.