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Reducing Administrative Burden

Measuring success based on PCP burnout: The next frontier for modern EHRs

For at least 10 years, we’ve known that electronic health records (EHRs) are a contributing factor in physician burnout. Study after study has cited that the time clinicians spend in EHRs battling poor design, combined with other workplace stressors, add up to significant burden and burnout. Not only is this impacting individuals; it is affecting the entire healthcare landscape. According to the Association of American Medical Colleges (AAMC), the U.S. will see a shortage of up to 48,000 primary care physicians by 2034, with burnout cited as one of the reasons why the workforce gap is growing.

Yet in the last decade, EHRs haven’t changed very much. As recently as 2020, studies have replicated earlier physician burnout findings.

As an industry, it’s hard to manage what isn’t measured and today, there is no standard measure used by EHRs for reducing administrative burden and burnout, presenting us both a challenge and an opportunity.

Leading through transparency: New measures of success

EHRs have an enormous impact on the quality of life of the physicians they are (arguably) designed to serve, and as a result, the quality of care they’re able to give to patients. So the question remains—if there is so much useful data telling us that clinicians are burning out, shouldn’t preventing this be one of the main ways we as technologists, innovators, and experts can better measure our success as an industry? 

Most EHR key performance indicators reference measures such as data quality, safety, patient experience, revenue cycles, medical costs, and productivity. But these factors don’t take into account the sentiment and personal impact to the individual provider.

To explore how our own EHR is affecting users’ experience of administrative burden and burnout, we recently surveyed our customers to gain a holistic view of how Elation is impacting their quality of life.

What we found is that there is some good to build upon within Elation. Since adopting Elation:

32% of providers decreased their time spent on administrative tasks, and

42% of providers said their stress/burnout has decreased.

These data point to a clear positive impact of Elation on the experience of administrative burden and burnout, in contrast to the common narrative that EHRs are a key driver of those things. The results also point to an opportunity to drive even more impact in these areas.

Elation was also able to pinpoint what exactly is contributing to EHR-related administrative burden and burnout:

Not surprisingly, documentation burden was the leading contributor to both burden and burnout. 

Also contributing to the administrative burden (after documentation burden): Prior authorizations, schedule management, coding/claims/billing, and care between visits. 

The factors cited as contributing to burnout (following documentation burden) included: Care between visits, volume of patient demands, administrative duties and prior authorization.

It’s important to note that of the above stressors, better-designed EHRs can’t fully resolve them all; for instance, EHRs can’t independently resolve the volume of patient demands. Where EHRs have less direct impact, efforts to alleviate the burden can be accomplished by influencing policy, payment models, and workforce challenges.

Calling all EHRs: A hard truth and invitation for change

Being transparent about how our customers feel about Elation is the tip of the iceberg. The truth is that while we are excited to be able to share the results and act on this insightful survey, it’s just a starting point for how we should be measuring the success of EHRs as a standard. We alone can’t make the systemic, industry-wide change required to change the lives of PCPs across the nation. 

That’s why we are challenging ourselves and other EHR vendors to expand success measures to include administrative burden and burnout to drive meaningful change. 

While standard KPIs such as speed, value, and cost reduction will always remain important, until EHR solutions more robustly support the clinicians at the center of care, burden and burnout will continue to plague primary care.

Sara J. Pastoor, MD, MHA is Elation's Director of Primary Care Advancement and leader in primary care advocacy. Dr. Pastoor is a board certified and clinically active family medicine physician. Her experience as a primary care innovator spans a career in military medicine, academic medicine, private practice, and employer-sponsored delivery models. She received her MD from Rosalind Franklin University of Health Sciences and MHA from Trinity University.