What if LeBron James spent half his day manning the ticket windows and phone lines for the Los Angeles Lakers? Would he be as great a basketball player as we know him? Or would he be completely satisfied with the road he went down? James is one of the best basketball players of our time, and none of his accomplishments would be nearly as extensive if he didn’t do what he did best- play the game.
That is one of the biggest problems in healthcare. The physicians, the ones standing on the front lines of care delivery, are nowhere close to providing care to their patients efficiently. Why? Because for every hour physicians spend on seeing patients, they spend an extra two hours on paperwork. The Annals of Internal Medicine found that for a physician, 49.2% of their time goes into doing paperwork- which includes EHRs.
Not only paperwork is a waste of time for physicians, it’s also a waste of time for patients- who come for the physician’s medical expertise. Instead, they go home lamenting, “my doctor just taps away at the keyboard and has no time for me!”
Where do physicians spend most of their time?
The study, led by the American Medical Association, followed by 57 U.S. physicians in family medicine, internal medicine, orthopedics, and cardiology for a total of 430 hours.
Nearly half the day, 49.2% to be precise, goes into paperwork including updating their EHRs and documenting the quality measures- compared to 27% of their time seeing patients. The physicians, even when they were in the examination room, spent 37% of their time on their EHRs. And the ones who kept track of what they did after getting home, admitted that one to two hours of their time went into more paperwork.
I wish I could say these results were surprising. In a different study, physicians aged 40 to 69 were shown to work 40-60 hours a week. For the ones under 40, two-thirds of them worked between 40-60 hours per week. The number of hours physicians are putting in is really huge, but a significant percentage of it goes into keying in numbers and checking boxes.
The reasons why a lot of physicians’ time is wasted
Many physicians used to send and decipher messages on sticky notes when healthcare was largely paper-based. They made time-consuming calls to payers, pharmacies, and other avenues to gather data and search for results among piles of paper on their desk. Then, they would file this information back on paper charts and sent it along. With EHRs, the paper has been somewhat replaced by multiple windows, and rather than sifting through papers, physicians now click away.
Some of the major challenges physicians face are:
Trying to identify the missed screenings/diagnosis/tests in patient care
Physicians have to invest considerable time in figuring out- what measures are due, how many times did the patient visit the ED, did they follow through their referrals, what are additional screening/tests needed and more.
Looking for dropped codes in patients’ diagnoses which are leading to lower payouts
The physician will just sift through papers, going back and forth the patient records to find more details about diagnoses and dropped codes and fill in the sheet of paper.
Relaying information back to the team for a continued care
A physician needs to coordinate with payers, administrators, referral specialists, and more- but the communication is hardly smooth or even reliable.
Doctors didn’t design the system
It’s like using 90s technology with countless drop-down menus and manual data inputs that just overwhelm physicians with a dozen clicks. The physicians didn’t design the EHRs or formulate strategies around gathering information, which is why the one designing these workflows has little clue on how to make physicians’ lives easier.
As a result of these excruciatingly long processes with no change in sight, physicians simply don’t have time to do what matters the most- look after their patients, society, and their organizations at which they work. All of this leads to physicians becoming dissatisfied with their EHRs and ultimately burning out. Studies have also shown that physician dissatisfaction leads to poor patient care and dissatisfaction. It’s understandable. You wouldn’t want an annoyed chef or a pilot- then why a doctor?
How to save time for physicians rather than losing it?
The most important thing to notice is that the additional workload that comes with reading and processing the paperwork and EHR-related jobs remains uncompensated in an era of reduced reimbursements. Although these are the focal point of quality-improvement efforts, there has to be some way to make them efficient.
Here are 7 ways to liberate, rather than oppress, physicians:
1. The care gaps and consolidated clinical information has to be made available to the physicians- just the patient’s medical situation, diagnoses, and the specific problems the physician should address.
2. The clinical risks and trajectories of the patient, such as their frequent visits to the ED, the tendency of no-shows, are something a physician needs to know beforehand and should be easily accessible to help them narrow down their efforts.
3. Scouring through papers or month-long clinical records to find the wrongly-entered codes, missed codes, or dropped ones could be eliminated if they were properly documented and accessible with the individual patient’s profile.
4. All of this information should not come with additional clicks. The patient information should be discreet and available to the physician on their screen, without them hopping off to different platforms or documentation.
5. Not just access; the physicians should also be able to relay the updated information instantly to other providers like the specialist, the health coach, or the care team to have them all on the same page.
6. The tasks that take up most of the time and paperwork have to be automated, such as referrals. Managing referrals is a task is which is significant to improve population health and the network utilization, and has to be made simpler for both the PCP and the specialist.
7. Clinical systems have to be a lot smarter to adapt to a physician’s workflow, eliminate needless and duplicative documentation, and absurd data requirements.
According to a study, physicians are spending almost 18 minutes per patient visit on EHRs and desk work. This is more than the amount of time spent face-to-face with the patient. Using an efficient technology stack that reduces manual effort, can increase the patient-physician interaction time twofold.
Something has to change
No physician ever stepped into medical school thinking “I really want to do loads of paperwork.” No medical school curriculum is around how to gather information. In a space notoriously known for data silos and fragmented information, it’s the physicians who face the biggest disconnect. And the notion of ‘data-driven care’ has become more like finding a needle in the haystack.
Physicians don’t need to spend a good part of their day just finding data- neither did they train for it. They need to be provided with actionable information– just what is relevant to them. Otherwise, physicians will just have less and less amount of time to actually examine and treat patients. It’s time we convert physicians from victims of poor technology to advocates of a system that truly delivers value.