I wrote recently about the ‘hub and spoke‘ configuration proposed by Vijay Govindarajan in his latest book on reverse innovation in healthcare. The idea is to ensure that skills are closely matched to tasks to ensure that highly skilled people are not wasting large quantities of time on low skilled work.
The biggest culprit for this is note taking and various other administrative tasks. A recent study from Stanford University highlights the scale of this challenge in the United States. It found that the clinical notes of American doctors were roughly four times as long as their peers in other countries.
This in turn appears to have a knock-on effect on the enthusiasm of American doctors for the digitization of medical notes. The researchers noticed a clear divide in enthusiasm between doctors in America and doctors in countries like Australia and Singapore for electronic medical records.
The paper argues that doctors in the US are being overburdened with documentation, not least due to medical regulations that mandate such excessive note taking. This results in pulling the doctor away from face-to-face time with the patient.
“Documentation in other countries tends to be far briefer, containing only essential clinical information,” the authors say. “It does not contain much of the compliance and reimbursement documentation that commonly bloats the American clinical note.”
They go on to suggest that this level of documentation is contributing significantly to the extremely high levels of physician burnout in the United States. It’s a finding that was shared in a study I wrote about last year.
The study quizzed doctors on their perceptions of the impact EHR had on patient engagement levels. It found that doctors were often anything but complimentary about them, citing higher levels of burnout and a depersonalization of their work.
“Physicians who are burnt out provide lower-quality care,” the authors said. “What this speaks to is that we, as physicians, need to demand a rethinking of how quality is measured and if we’re really getting the quality we hoped when we put in EHRs. There are unintended consequences of measuring quality as it’s currently being done.”
Being able to simplify the documentation requirements placed upon doctors, or indeed giving them greater administrative support, could go a long way towards not only providing better care, but reducing the burnout of doctors.
Of course, AI technologies could also play a part. I wrote earlier this year about a report from Nuance Communications documenting their work with the Emergency Department (ED) at South Tees Hospitals NHS Foundation Trust.
The paper highlights how clinicians felt that speech recognition technology was 40% faster than writing clinical documentation by hand. When this saving was extrapolated over the course of a full year, it would equate to gaining nearly two full-time clinical staff.
Whether it’s procedural or technological however, it’s increasingly clear that healthcare systems and providers need to do a better job of managing the administrative burden so that doctors can focus on what they’re trained for.