MHI-815-INFORMATICS FOR ADVANCED PRACTICE
Module 6: Discussion
Assignment Description:
Health Information System
Technology is only as effective as the extent to which it is used. To the healthcare provider, it is a valuable tool. But are we setting these providers up for burn-out?
Read the Harris and Hilliard articles and write your response:
1. How would you define EHR or technology-related stress?
2. How can you overcome this challenge in your APN role?
“Two thirds of physicians and half of APNs report EHRs add to the frustration of the workday” (Hillard, Haskell & Gardner, 2020, p. 1402). I find this statement to be fairly accurate in the organization I work for. We use EPIC for our EHR and personally it is one of the better systems I've used as far as functionality and ease of use, although it does have some drawbacks like being able to document one thing in several ways. The customization of the EHR is both a blessing and a curse in instances of viewing information and being able to document. EHR and technology related stress can come from a variety of things we use all of the time in healthcare. Most recently my work laptop has not been functioning correctly and most of my applications won't run, they stall out or crash, or glitch when trying to do multiple things like be on a call and open a document to share. This has been extremely frustrating and stressful when my entire job relies on the use of my laptop and the applications on it. Having to take time out of what I have to do and push back deadlines is stressful. The same thing can happen when our EHR isn't functioning up to standard. If our clarity or dashboard reports are slow or crash or won't download it can be stressful, especially when you need them for meetings and presentations. The EHR itself can be stressful when items won't abstract correctly, or updates make things harder. Sometimes it's something as simple as not being able to document because of having to see so many patients during the day so the “free time” that is to be had after hours is actually taken up by finishing up work. The article by Hillard et al (2020) discusses how providers are frustrated by non physician level work, dealing with paperwork, and the amount of time spent in the EHR. One interesting thing mentioned in the article was how a lot of providers use a copy paste method for their notes and I've seen this in our practices as both an employee and a patient. May times they will have a pre-bult note saved as a dot phrase with a lot of the items filled in (like breath sounds and things) and it's funny in a not sort of way because they don't actually check those things. Sometimes the quick fix is not the best and can lead to errors and issues later on.
One way we are combating this is to round with our practices. The amount of stress, burnout, frustration, and anger that is out there when it comes to the technology we use is astonishing. From our point of care testing to our diabetic eye exam cameras, and the EHR everyone is worn out with at least one of the pieces of technology we use. We have to do better for our staff and our providers so they are able to give our patients the best care possible. Having working tools and resources is just one part of that. Being able to modify the EHR to work for us and be more beneficial and streamlined is also imperative. Breining (2018) discusses how the National Academy of Medicine launched an initiative about physician wellbeing, especially related to EHR use and how many providers have to take work home with them. One of the big ways to help is by allowing the physician to focus on things only they can do. We can delegate out other things like paperwork being filled out or the EHR in-baskets being reviewed by the medical assistant or nurse. Updating the EHR to be more user friendly and useful is also important in that being able to see what is needed right away is important to reducing unnecessary time within the chart. Workload control also needs to be taken into account. If a provider sees patients every 10 minutes then it is no wonder they don't have time to document or do anything else during work hours. It also brings up the question of how are all the patients needs being met as far as medication and screening reviews happening during this short amount of time on top of the actual examination that is happening. Standardizing the workload and workflows is beneficial for reducing the amount of errors and stress that can come from a chaotic environment. One thing we have done is standardize the rooming process for our practices and have modified and locked down the EHR to reflect the workflow. The biggest thing is to be open to feedback and concerns. Collaboration with end users and being open to change if something isn't working is the best way to overcome the challenges.
References
Breining, G. (2018). Reducing stress associated with electronic health records. Retrieved from https://www.aamc.org/news/reducing-stress-associated-electronic-health-records
Hillard, R., Haskell, J., & Gardner, R. (2020). Are specific elements of electronic health record use associated with clinician burnout more than others? Journal of the American Medical Informatics Association, 27 (9), pp. 1401 – 1410. doi: 10.1093/jamia/ocaa092
Kroth, P., Morioka-Douglas, N., Veres, S., Babbott, S., Poplau, S., Qeadan, F., Parshall, C., Corrigan, K., & Linzer, M. (2019). Association of electronic health record design and use factors with clinician stress and burnout. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2748054
1. How would you define EHR or technology-related stress?
With health information technology becoming an increasingly larger part of the medical practice landscape, patients are able to have easier access to providers, documentation time is lessened, providers take documentation home with them, provider frustration with the electronic medical records have increased, workflows have lengthened to meet standards and regulations, etc. (Harris, Haskell, Cooper, Crouse, & Gardener, 2018) (Hilliard, Haskell, & Gardner, 2020). All of these things have increased provider burnout with technology and the electronic medical records. All of these factors have implications on patient satisfaction, billing, and employee experience and are typically monitored by hospitals and clinics. My organization keeps track of primary care providers who cannot close their visits by the end of the business day. My providers have 20-minute blocks of time for every patient, regardless of what type of visit it is (physical, acute, chronic acute, video, etc.) and during the day they are expected to see between 22-26 patients. On top of this, we are expected to see walk-ins and double books for “increased access” to help reduce our emergency room. With all these added patients, my providers are not given added time during the day to finish their charting.
2. How can you overcome this challenge in your APN role?
As an APN, it is my duty to come up with ways to combine individual workflows, improve charting time by allowing providers time to chart, empower licensed staff and ancillary staff to work at the highest level of their license and certifications to only handle patient messages once and collect as much data as possible (Hilliard, Haskell, & Gardner, 2020). I would also work with the electronic medical record builder to engage clinical data algorithms into patient questionnaires to help mitigate messages to the providers (Tietze & Hoelscher, 2023). I am currently on a committee at work to improve primary care overall. This includes improving standing delegated orders for licensed staff, improved patient portal questionnaires, and improving primary care design overall. I we have been at this for one year now and so far, our providers speak very highly of what we are doing for them. The main goal is to improve provider support. We have created a patient portal center full of LVNs to screen messages for things that need to be scheduled, sent to an RN for triage, or have a chart researched and respond to the patient. We have created a refill center with CMAs that have delegated authority from providers to refill maintenance medications under standing delegated orders. Primary Care clinics have increased the amount of standing delegated orders they have on hand. For example, if a patient walks in the clinic with a sore throat, the clinical staff can schedule a nurse book and swab for a wide array of things to rule out any concerns. If the tests come back positive, then the nurse visit flips to a provider visit and they become a work in. If the tests are negative the patient is scheduled for a visit within 48-72 hours with a provider to review symptoms. It is a work in progress, but it is well worth the reduced burnout.
References
Harris, D., Haskell, J., Cooper, E., Crouse, N., & Gardener, R. (2018). Estimating the association between burnout and electronic health record-related stress among advance practice registered nurses. Applied Nursing Research, 43, 36-41. doi:10.1016/j.apnr.2018.06.014
Hilliard, R., Haskell, J., & Gardner, R. (2020). Are specific elements of electronic health record use associated with clinician burnout more than others? J AM Med Inform Assoc., 27(1), 1401-1410. doi:10.1093/jamia/ocaa092
Tietze, M., & Hoelscher, S. (2023). Personal health records and patient portals. In S. McBride, & M. Tietze, Nursing Informatics for the Advanced Practice Nurse: Patient Safety, Quality, Outcomes, and Interprofessionalism (3rd ed., pp. 365-385). New York, NY: Springer Publishing.
Technology is only as effective as the extent to which it is used. To the healthcare provider, it is a valuable tool. But are we setting these providers up for burn-out?
1. How would you define EHR or technology-related stress?
Technology- related stress exists both at home and work. Our world is run by computers. It seems that almost everything we do involves some sort of chip, the internet or is somehow attached to a computer. I define technology-related stress as a combination of things. As nurses we are expected to be competent on an EHR. EHRs come along with frustration. EHRs tend to freeze, have problems with signing in, if there is another provider working on the same patient, we are not able to sign in. These issues all cause stress and frustration. Healthcare workers have enough stress with patient’s lives in their hands.
Nurses are one of the most important and largest health care team groups providing direct health care services to patients, and determining the needs of patients, and determining the use of required medical care, equipment and materials. That is why nurses are one of the most important users of EMR systems, which transfer health care data to the electronic environment. (Eris, 2016 as cited in Ozer, 2019, p.76)
I felt this quote summed up the importance of the nurse on the healthcare team. EHRs will always be a part of the job. Hopefully, someday the EHR will become easier to access. It is a very important part of the team and an asset to patient care.
2. How can you overcome this challenge in your APN role?
Overcoming technology-related stress can be a difficult challenge to undertake. As the APN making sure that the nurses are not short staffed, and the census is appropriate is a great place to start. Education involving the EHR should be ongoing, there are constantly updates and changes taking place with the EHR. Setting time aside for the nurses to be appropriately trained is the first task to consider. Nurses should be able to train on the EHR with an appropriate superuser and in a quiet area. Providing technical support 24/7 is a great tool to provide the staff (Bondanini, 2020). The APN should always advocate for her staff and make sure that appropriate breaks are taken by the staff.
References:
Bondanini, G., Giorgi, G., Ariza-Montes, A., Vega-Muñoz, A., & Andreucci-Annunziata, P. (2020). Technostress dark side of technology in the workplace: A scientometric analysis. International Journal of Environmental Research and Public Health, 17(21), 8013.
Özer, Ö., & Şantaş, F. (2019). Effects of electronic medical records on patient safety culture: The perspective of nurses. Journal of Evaluation in Clinical Practice, 26(1), 72–78.
1. How would you define EHR or technology-related stress?
Most of the EHR stress has to do with the increasing number of workflows that are consistently being added which is creating frustration and more time being spent on the administrative duties of documentation for reimbursement and quality initiatives. This increasing commitment of time has created a negative attitude towards the EHR as it interferes with work-life balance and decreases direct patient care. I recall the implementation of our new EHR program in 2017 and the provider discourse it created as the organization used the opportunity to improve workflows that were suggested by licensing and accreditation agencies as best practices. With this implementation the physician was tasked with doing CPOE (computer physician order entry) and medication reconciliation. Both tasks were still taking place on paper and primarily being completed by hospital staff as the prior EHR required a hybrid documentation system as it did not have the technology to support either of these programs. The complaints this change generated was numerous and at time the providers behavior bordered on complete defiance although support was being provided to them by subject matter experts. Overall, it made the environment in the hospital between nursing and providers quite hostile at times for the first few weeks as behaviors were being addressed to help with adoption. Given these events, I am cautious as the organization rolls out optimization in documentation especially if the providers are impacted (Harris et al., 2018).
2. How can you overcome this challenge in your APN role?
In my role as a nursing leader, I need to be the advocate for optimization and improvements with documentation and workflow enhancements. I often focus on the end user and encourage for ease of use and products to combine navigation. EHR’s are typically designed to optimize documentation around billing and quality improvements which do not often align with ease of use. Decreasing the burden on staff and providers to complete clerical tasks through optimization of charting and addition of support staff like scribes can assist with completing and focusing on the end product. In addition, providing them with frequent time in their workday to response to messaging can decrease stress related to the need to respond and decrease demands that currently are pushed to the end of the day. These enhancements are not only good for the provider but also for the patient as they allow for improved communication and engagement. It is interesting to note that most providers and staff are advocates for EHR’s as they understand the improvements in care that they can provide, however, stress comes with the increasing demand that EHR’s bring (Budd, 2023).
Harris, D. A., Haskell, J., Cooper, E., Crouse, N., & Gardner, R. (2018). Estimating the association between burnout and electronic health record-related stress among advanced practice registered nurses. Applied Nursing Research, 43, 36–41.
Budd, J. (2023). Burnout Related to Electronic Health Record Use in Primary Care. Journal of Primary Care & Community Health, 1–7.
