A new PAMF (Palo Alto Medical Foundation) study on the connection between EMR and physician burnout is getting a lot of attention. The study has limitations (e.g., it focuses on one organization, one EMR and set of workflows, and it aims to infer much from a single question). But despite the need for caveats, the study is valuable because it confirms what intuition suggests about EMRs and physicians’ stress. What’s more, the authors tested workflow modifications and found they helped alleviate EMR-related burnout at PAMF.
You can read about the study here. To summarize it, the study validated that when EMRs encourage message overload, they significantly increase physician stress.
The study found that about half of all messages the physicians in the PAMF study received were EMR-generated–i.e., things like health maintenance alerts and medication reminders that the system generates automatically. The researchers found that many of these messages could be handled, or at least triaged, by other members of the care team. For example, medication messages could be routed first to a pharmacist, who would involve the physician only if needed. Nurses and MAs could also handle much of the automated message volume, such as follow-up appointment reminders.
Not surprisingly, when PAMF experimented with diverting these lower-complexity messages to others, the burden (and stress) on physicians decreased substantially.
Can PAMF’s solution work in your practice?
PAMF is a large, integrated healthcare organization. Healthcare Dive reported that PAMF launched an initiative called MIST–Multi-Disciplinary Inbox Support Team–to test the idea of sharing the message workload. One year in, MIST seems to have helped reduce physician message loads (and stress) substantially. But what if your practice is not a huge organization with IT and workflow experts or pharmacists on staff?
In our consulting work, we often recommend practices involve staff in more meaningful work. To enable physicians to focus as much as possible on tasks that only they can do (working at the top of their licenses), everyone else needs to do as much as they can. Expanding the roles of staff — within their skills and scope, of course — can help physicians spend more time on the work they trained to do.
There’s another advantage to this that is easy to overlook. Expanding staff responsibilities makes their jobs more interesting. Staff may feel more engaged and valued when they’re contributing more to patient care. Entrusting them with more important work may strengthen their commitment to you, your practice, and your patients.
Regardless of the size of your practice, you can give this aspect of PAMF’s experiment a try. (In fact, in a smaller practice, it may even be easier to test new methods of working together with staff, and adjust as you experiment.)
Are you up-to-date on all your system can do?
PAMF tweaked their technology to reroute messages so that the MIST group received some of them first. This may not be as easy to do without in-house IT help. But on the other hand, most practices we work with have not explored every setting or possible customization of their systems. Message delivery may have options you haven’t tried yet. For example, even if you can’t divert messages by type and patient to a specific MA for handling, it might be possible to set up a separate mailbox for, say, pharmacy messages that a specific MA or nurse could handle for your entire practice.
We’ve noticed that many practices haven’t established a routine of checking in with their system vendors. Relying on what colleagues say about the limitations of a system or how to use it best seems like a short-cut. But if no one has checked in with the builders of the system recently, the entire grapevine’s information might be outdated.
Ask your EMR vendor for a refresher on features (including message settings) if you haven’t done so in a year or more. If it turns out you can’t fine-tune messaging as much as you’d like to, find out if custom development is a reasonable solution. Even if it isn’t, your time won’t be wasted: you’ll still have an opportunity to suggest changes to the messaging part of your system. Remember that the more frequently your vendors hear feature requests, the more likely they are to make them a priority.
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