Before drifting off to sleep, most of us put on pajamas when it’s time to curl up with a good book or binge-watch what’s trending on Netflix—but not today’s doctors.
According to one previous study, physicians spend nearly two hours conducting EHR/paperwork every night at home. This after-hour activity is known in healthcare as “pajama time,” but don’t let the cutesy nickname fool you. Turns out, time spent mired with EHR data is becoming a growing problem for physicians. A subsequent study found that family physicians spend nearly 30 hours a month working after hours on their EHRs.
As a physician, Dr. Geeta Nayyar has stayed up many nights working in EHRs. While she also jokingly refers to this inconvenience as “pajama time,” she wholeheartedly recognizes the value of EHR technology. In this interview, she shares her personal experiences as an M.D., while also articulating her thoughts on what is needed of next-gen EHR’s to truly make a difference.
To start this discussion about physician burnout, let’s talk about how healthcare got to this point in the first place: According to an AMA- supported study, 50 percent of physicians log on to their electronic health record (EHR) from home after work to complete their documentation. The term for this — “pajama time” — denotes the sad reality that physicians do much of their charting about 10 p.m. on the weekends. So how did we get here? Being a physician yourself, what’s your take?
First off, I just want to say that as physicians, we love technology. The stethoscope, the MRI, CT scans, the da Vinci robot. We dig technology when it works. I think the challenge for physicians today is that there is much more to our jobs than ever before. In addition to having to interact with the different healthcare technologies, we’re also now tasked with managing the frequently changing requirements of insurers, government regulators and the health systems and being accessible to patients practically 24/7—all while being pressured to improve efficiency, deliver better care and see more patients. When you add all of this up, there’s truly just not enough time in the day for all of this work to be done. So, we take some of this work home – and most of the time that means wrapping up the evening by entering patient data into the EHR – alas, pajama time.
I am sure that a fair criticism is the rush to judgment some organizations made when it came to implementing their EHR technologies. In your opinion, what are the most significant flaws of today’s charting technologies?
I think there’s a lot to explore here. As with almost all things in life, there is never really a ‘one size fits all’ solution. Same goes for the EHR. Many of these systems are not customizable. And they should be – as each practices’ needs are going to be different. I also believe that many companies have rushed these products out the door in order to achieve first-mover advantage. In this case, faster isn’t always better. The focus should always be on getting it right. Finally, I think many EHR vendors fail to properly train their customers on how to use these technologies, so it leads to questions, concerns and quite frankly – frustration.
What about some of these innovators that have developed more sophisticated charting capabilities, such as NLP (natural language processing)? Do such features ease the burden in any way?
In my opinion, these capabilities are certainly easing the burden. Artificial intelligence can help here as well. Whatever can be done to reduce the amount of “clicks” certainly helps, as this cuts down the administrative process of entering data even more. That’s what excites me the most about the future of healthcare. Right now at Greenway, for example, we are focused on building our next-generation, state-of-the-art EHR and practice management platform, which we are calling Project Polaris. This new technology is designed to help physicians in a lot of ways – driving practice efficiencies to help providers avoid burnout, reduce costs and support new government payment models. In developing Project Polaris we’ve gathered input across our customer base, and their feedback is clear – these capabilities are critical for EHR’s of the future.
Aside from what we already addressed, what do you think are some of the most significant challenges physicians are facing in terms of the requirements of value-based care and the shortfalls of today’s EHR technology?
Great question. Achieving value-based care is critical. And there is evidence that this approach is already making an impact. When it comes to the transition from fee-to-service to value-based care, however, practices have to understand that they must make investments in new tools and solutions. The shortfall of EHR’s is that some of these systems are not interoperable. To support information sharing and interoperability, practices can benefit from adopting EHR’s that offer this connectivity and coordinated care.
How do you think this burnout issue is going to affect physicians if it continues this way? Is healthcare at risk for facing a physician shortage, you think? What about how this affects medical students entering the field?
We’re already facing a physician shortage. Research shows that by the time many medical students and residents enter clinical practice full time, they are already burning out in high numbers. Recognizing this, medical schools and programs need to put greater emphasis on student wellness as an organizational priority. And some schools are doing this very well. Vanderbilt, for example, has established the Wellness Program, an initiative to counteract burnout by supporting student well-being in five facets: physical, emotional/spiritual, interpersonal, academic/professional and environmental/community. The program provides resources to counteract the feelings of burnout and encourages fellow medical students to support one another. Pursuing a career in healthcare will always be demanding, but schools and students can work together to help manage the stress and prevent it from turning into burnout.
Now that we addressed the problems, let’s talk solutions: do you see a fix to this? Where does it begin? How can the entire industry work together to streamline doctor’s loads and give them more control over their daily responsibilities?
I do see a fix. When it comes to technology solutions specifically, I think it’s important to get a variety of perspectives to validate the idea or provide input on ways to improve its usability or physician impact. We do this at Greenway by gathering input from our Customer Advisory Board, and we also recently partnered with the College of Healthcare Information Management Executives (CHIME) to further gain insights into how we can all work together to close the digital gap and transform healthcare.
When it comes to streamlining doctors’ workloads, I think some of the things we discussed earlier, like optimizing EHR’s and integrating new capabilities such as AI and voice recognition – will certainly help.
For organizations looking to change or implement EHR technologies, how can they do better? What should they look for in the technology and what part should physicians play in the implementation process?
Practices implementing EHRs should seek products that were designed to not only be customizable, but that are clearly intended to meet physicians’ needs – both now and into the future. These solutions must reinvent the way physicians work. Before implementing any new technology, ask the right questions. Get perspective from all departments within the practice – from the front office to the back – to ensure all needs will be met. A big thing to focus on is the amount of training an EHR vendor provides, as physicians who report poor training are over 3.5 times more likely to report that their EHR does not enable them to deliver quality care.
We know things need to change from within organizations, but what can physicians who feel the burden right now do to help ameliorate the situation?
My best advice would be to work to drive change and inspire others within your organization to join you in this. If your technology solutions are lagging or contributing to burnout, do your research and find solutions that you think can help with this. Instead of harping on the challenges, find the solution. It’s also important to focus on yourself. Find a release and make time for it, whether that be through exercise, a hobby, painting, you name it. Find a support system. Maybe its other physicians within your practice or a friend or family member. Talk to them about your work stressors. Finally, while easier said than done, try to prioritize work-life balance. Tell others you are focused on this so they can hold you accountable.
What needs to change from a government standpoint? Does the structure of value-based care delivery need to change? If so, how?
According to a recent report, 27% of physicians said slashing government regulations would cut their burnout. But we’ve talked a lot today about how combating burnout once and for all requires many things from many different people – not just the government. In that same report, there were other elements listed, such as greater respect from patients, more positive attitudes from colleagues, and better opportunities for education and professional growth. To truly alleviate burnout, we cannot work in silos. The entire industry – technology vendors, government regulators, healthcare leaders, physicians – must come together.
Lastly, what is the key takeaway you would like our readers to gain from addressing this topic? Additionally, is there anything you want organizations to consider when it comes to the problems facing physicians? Should patients be aware of these issues as well?
Just being a physician is fraught with occupational stressors; you want to ensure you can provide the best, most effective care for each of your patients, while avoiding medical errors and malpractice suits. Add in the daily struggle between ethical values and economic targets, and the growing list of administrative work involved in the job and your stress can go off the charts. However, one way to proactively protect your practice and yourself against burnout is by making the right technology choices. By doing so, your work will become more meaningful and worthier of your time, talent, creativity and heartfelt commitment – which results in a more satisfying work environment.
Dr. Geeta Nayyar Bio
Greenway Health’s Chief Medical Officer Dr. Geeta Nayyar is a nationally recognized leader in health information technology, bringing the physician’s perspective to Greenway’s services and solutions.
Before joining Greenway, she was chief healthcare and innovation officer at Femwell Group Health, Inc., one of the largest management services organizations in Florida. During her tenure, Dr. Nayyar was instrumental in creating and launching innovations around physician and patient engagement technologies. She is also the former CMIO for AT&T.
Dr. Nayyar earned her Doctor of Medicine and Bachelor of Science degrees from the University of Miami and a Master of Business Administration from The George Washington University. She is an Assistant Clinical Professor of Medicine at Florida International University, where she maintains an active Rheumatology practice.