How ChartMedic helps address clinician burnout

While we all know the COVID-19 pandemic has exacerbated healthcare worker burnout, clinician burnout was a major problem prior to the pandemic that is only now being addressed.  Among the myriad quotidian challenges physicians and physician extenders face, the electronic health record (EHR) is frequently cited as a major source of job dissatisfaction. Two months prior to the COVID-19 pandemic, researchers at the University of New Mexico who surveyed more than 275 clinicians at several health care institutions had this to say:

We are losing the equivalent of seven graduating classes of physicians yearly to burnout and, as they leave the profession, they point their finger at the time now required for them to document their work and how it has led to the loss of quality time spent with patients and families.

At the center of this are two things:

1. the purpose of the patient’s chart was expanded to facilitate non-clinical activities (think billing, coding, and quality control) and to include newly-created tasks to be performed during clinical encounters (such as data entry, computerized decision support, computerized order entry, and electronic prescribing)
2. the electronic chart was not designed around usability

As a result, physicians now spend two minutes at the computer for every one minute spent with patients, and their workdays have extended into their home lives.  It’s ironic, because the computer could help quite a bit.  COVID-19 has made healthcare worker burnout a crisis for medical organizations.

As a physician, one of the hardest tasks I face is getting the details of the patient’s story that matter. Once I understand what is bothering the patient, I need some information filled in to determine how to proceed — and getting that information is time-consuming.

Let’s take the example of a patient complaining of fatigue. Fatigue is a very common complaint, and at the same time, is notoriously difficult to evaluate because it can stem from a long list of possible problems. My patient could be fatigued because he or she...:

• has sleep apnea
• isn’t metabolizing a medication
• is anemic because of ongoing bleeding
• has developed diabetes that is uncontrolled
• has a thyroid problem
• had a previous heart attack and now has a heart that can’t support all the body’s organs adequately
• is experiencing anxiety and stress
• is clinically depressed

I could waste a lot of time and money chasing down every single one of those possibilities with tests and treating those I find, but it makes more sense to determine which possibility is most likely and start there. To do that, I need to ask a bunch of questions.  For the short list of possibilities above, I need to know which of the following are new, changed, or nonexistent:

• snoring
• daytime headache
• current medications
• nausea
• poor oral intake
• diarrhea
• constipation
• abnormal stool appearance
• swelling
• shortness of breath
• difficulty exercising / ascending stairs
• changes in appetite
• changes in sleep pattern

It’s impossible to do that in a twenty-minute clinic visit, much less answer questions and have the patient leave the office feeling satisfied. But the less I know, the less focused and less efficient my plan for the patient is.

After all this, I still need to write everything down in the chart so that I can understand my thoughts for the next time I see the patient and determine how to proceed if I still don’t have an explanation.

This is where well-designed patient intake software like ChartMedic comes in. ChartMedic acts as an electronic history-taking assistant, asking the rote questions and documenting the patient’s responses as I would. Instead of spending seven or eight minutes running through all those questions, they’re already all asked for me and succinctly documented as they would be in a chart note. I can confirm the most salient details with the patient, formulate and share a plan, and answer an extra question or two for the patient. And when I need to document, no typing is required. A few clicks place the draft documentation in the EHR for me to edit or amend.

It doesn’t correct all the problems with the EHR, but ChartMedic helps bring some joy back into my day as a healthcare provider.