SOUTHERN CALIFORNIA HIT SUMMIT RECAP UCSD Health’s CIO Examines Some of
the Issues Around EHRs and Burnout During the Southern California Health IT Summit in San Diego, UC San Diego Health’s Christopher Longhurst, M.D., shared his perspectives on the physician-burnout issue and related EHR issues
By Mark Hagland O
n April 23 at the InterContinental Hotel in downtown San Diego, Christopher Longhurst, M.D., the chief information officer (CIO) and asso- ciate chief medical officer (CMO) at UC San Diego Health, shared his perspec- tives on the challenges around electronic health records (EHRs) and physician burnout, during the Southern California Health IT Summit, sponsored by Health- care Innovation.
Speaking on the topic “Physician Burnout and Data-Driven Medicine in the EHR Era,” Dr. Longhurst, a practic- ing pediatrician, shared with his audi- ence of healthcare leaders some fasci- nating research and his perspectives on that research. Longhurst is helping to lead colleagues forward not only at the 8,900-employee, 1,286-physician, two-campus UC San Diego Health, but also, with a team of fellow CIOs across the five-health system University of California (UC Health) organization; the collaborative of CIOs from those health systems is working to evolve forward some large-scale initiatives around data and IT, including efforts to improve phy- sician satisfaction with EHR use across UC Health. With the goals of the Quadruple Aim—including the fourth goal, around caregiver well-being, first suggested by medical researchers in 2014—top of mind, Longhurst and his colleagues at UC Health have been trying to determine how EHRs and EHR-related processes can possibly be improved in order to reduce or end physician burnout around EHR use. An early step in that journey was the creation of the UC San Diego EMR Satisfaction and Efficiency project, which involved the surveying of UCSD Health medical staff in 2017 and 2018. With regard to that survey, not only did Longhurst and his colleagues exe- cute the survey twice; but it was nation- alized, with the leaders of individual patient care organizations able to gauge the level of satisfaction or dissatisfac- tion of their physicians, relative to the experiences of physicians in other orga- nizations. “If you listen to physicians, it may sound as though everyone’s
upset nationwide,” Longhurst told his audience. “But on this scale that ran from -100 to +100, we actually scored a +27.4 score, which put us in the 75th percentile” of patient care organizations nationwide. So while there certainly are UCSD Health physicians who are highly dissatisfied with their organiza- tion’s EHR, there are also many who are relatively positive about their EHR experience.
Meanwhile, Longhurst told his audi- ence, “We need to look at a range of issues” to address physician burnout, not just around EHR dissatisfaction itself, but also such factors as “rapid patient turnover, decreased autonomy, merging hospital systems, an aging pop- ulation, and the increasing complexity of patients,” all of which are impacting physicians, and which are not EHR- related specifically, but which tie into physicians’ perceptions of EHR use. The fact of the diversity of actual causes, came home to Longhurst when he was in Singapore a couple of years ago, having been asked to observe an EHR rollout. “I was there observing the rollout, and was asking physicians how they liked the EHR, which is from the same vendor we use,” he told the audi- ence. “I went back to the CMIO, and I asked, ‘Why are your doctors happy?’ And he said, ‘I don’t know, Chris, but why are your doctors unhappy?’ And one of my observations during that visit was that when the doctors there wrote notes, they were about the patients and patient care, not about billing, or finance or regulatory compliance.”
Following that visit, Longhurst and
some of his colleagues did an analysis of the various lengths of physician notes in the EHR. “There’s a bell-shaped curve in the U.S. around note length,” he said, “with a median note length of 4,000 characters—that’s a novel!” he told the audience. “And then we looked at the international clients of our EHR vendor, and the median there among its interna- tional clients was 500 characters. Also, the shortest note lengths are among phy- sicians at capitated organizations in the U.S. So we wrote all that up in the Annals
of Internal Medicine, in July 2018,” he noted, in an article entitled “Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause?” Longhurst added, “My bias is that EHR burnout is a symptom for something else—the fact that we’re documenting things other than documenting patient care.”
Following up on that point, Long- hurst asked, “So what can we do about this problem of the EHR contributing to physician burnout? First of all, you need to use local data to understand how your physicians are using the system,” he said. “We’ve expanded our EHR plat- form to over 200 locally affiliated spe- cialists. They’re spending significantly less periods of time putting in orders, because significantly bigger portions of orders are being teed up by their sup- port staff—in contrast to what they have to do inside our organization. We’ve also launched the UCSD Home for Din- ner Program,” he said, describing the program he has helped to lead at UCSD Health, which is working to reduce the amount of time that practicing phy- sicians need to spend documenting every day and evening—a key source of frustration for doctors. Significant reductions in documentation time have resulted, he noted: in particular, the pro- gram has resulted in a median reduction of 75 percent of after-hours documenta- tion time. The goal, he noted, is to close visits before seeing the next patient. And the Home for Dinner program is aligned with the organization’s Primary Care Flow Collaborative.
At the same time, Longhurst noted that workflow redesign, as supported by the information systems team in an orga- nization, are needed, in order to ensure that all clinicians are practicing at the top of their license—a key source of sat- isfaction for physicians and all clinicians. And, he added, using data analytics to target areas of impact can be very useful as well. He also discussed the connection between and among improved physician documentation, patient engagement, and OpenNotes, which the entire UC Health system has embraced. HI
MAY/JUNE 2019 |
hcinnovationgroup.com 25
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32
