By James E. Tcheng, MD, FACC, chair of the ACC Informatics and Health Information Technology Taskforce. Written on behalf of the Taskforce.

Physician burnout has many undesirable consequences, including negative impacts on the delivery and quality of patient care, physician career dissatisfaction and adverse effects on personal and family health and life. Poorly designed electronic health record (EHR) systems have worsened physician burnout by increasing physician workload and creating redundancy in the medical charting process [1]. The health care regulatory environment has contributed to physician burnout by increasing the amount of administrative paperwork required for both billing purposes and quality of care monitoring [1]. It is important for health care providers to explore ways that make the EHR system work for them.

The ACC is cognizant of the importance of a functional, or “healthy,” EHR for improved patient health care and the cardiovascular health care provider’s job satisfaction. A key strategy of the ACC Informatics and Health Information Technology (IHIT) Taskforce is to work with EHR vendors, other professional cardiovascular societies and national registries to ensure that EHR systems work for cardiovascular health care providers and patients, and not the other way around. EHR usability and data interoperability are key ingredients of an optimally functioning EHR system. An interoperable EHR allows for the secure and easy exchange of available health care data between participating information technology systems. In collaboration with several other cardiovascular societies, the ACC released a 2016 health policy statement addressing the importance of EHR data interoperability [2]. The advantages of interoperable EHRs include reduction in health care costs and medical errors via easy and secure communication between health care providers taking care of a mutual patient, active patient participation in their health via ease of patient access to their personal health care records irrespective of their physical location, improved transparency in health care delivery, enhanced clinical research and quality of care assessment via accurate extraction of information from EHRs into national registries, and improved provider satisfaction by reducing and/or eliminating redundancy in medical charting. National and international data element definitions and standards are fundamental for the success of EHR interoperability [2].

Structured reporting will likely be a key to improving EHR usability, functionality and data interoperability. Structured reporting refers to the process whereby all members of the health care team – including the patient – participate in the capture and validation of standardized data elements that flow bi-directionally into and out of the EHR from various medical charts/reports including national registries [3]. The structured reporting process can be used in both procedure areas and the clinic, resulting in a concise, consistent and reproducible document [3]. The ACC is actively collaborating with EHR vendors and other cardiovascular societies to achieve widespread adoption of structured reporting into the cardiovascular workflow. The overall goal of the structured reporting process and EHR interoperability is to ensure improved health care quality, patient safety and efficiency in health care delivery and documentation. The ACC, the ACC IHIT Taskforce and their societal partners envision that the adoption of structured reporting and EHR interoperability by health care institutions will reduce and hopefully eliminate the contributory role of the EHR to physician burnout.  

Although EHRs are not perfect, the benefits of adopting an EHR system far outweigh the continued use of a paper-based health record system. With the advent of EHRs, health care providers have more efficient access to patient health information. Multiple providers can access the same health record simultaneously and remote access is feasible. Patients have access to their health care providers and their personal health records via online patient portals. Additionally, they can contribute health-related data to their own records through these portals. EHRs also eliminate the problems posed by illegible handwritten health records. Cardiologists, especially those early in their careers, can play an active and important role in improving EHR usability and reducing burnout through steps such as 1) engaging in the design of smart, efficient local EHR solutions and workflows 2) promoting advocacy to reduce excessive regulatory requirements 3) becoming EHR ‘super users’ and educating peers on optimal use of EHR and 4) embracing evidence-based health IT solutions for patient engagement and patient safety.

Check out a two-part series on “What Graduating Fellows Need to Know About Physician Burnout and EHRs in 2016,” written by Sumit Som, MD, and Sarah L. Timmapuri, MD, FACC, for the FIT page on ACC.org. Read Part I and Part II to learn more about the contributory role of health care regulation, specifically the EHR to physician burnout.

References:

1. Shanafelt, TD, Dyrbye, LN, Sinsky, C, et al. Mayo Clin Proc. 2016;91:836–848.
2. Windle, JR, Katz, AS, Dow, JP, et al. J Am Coll Cardiol. 2016;68(12):1348-64.
3. Sanborn, TA, Tcheng, JE, Anderson, HV, et al. J Am Coll Cardiol. 2014;63(23):2591-623.

Keywords: Burnout, Professional, Electronic Health Records, Family Health, Goals, Health Care Costs, Health Policy, Health Records, Personal, Job Satisfaction, Medical Errors, Medical Informatics, Patient Care, Patient Care Team, Patient Participation, Patient Safety, Personal Satisfaction, Physicians, Quality of Health Care, Registries, Workflow, Workload

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