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Health information technology certainly has been an important tool during the pandemic, but it has also contributed to clinician burnout, several speakers said Wednesday during an online session at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).

"When we think about any advances in virtual care or digital health and their impact on our life, it goes beyond the EMR [electronic medical record]," said Isil Arican, MD, director of ambulatory EHR services at Stanford Children's Health in California. "Even the working hours are not the set working hours anymore, because we have all of these tools -- email, Slack, Teams, and people message us and ask things at any time of the day ... So there's an issue with being able to disconnect in all of the digital domains."

"In addition, I think in healthcare, there are a lot of shifting paradigms in the past year especially, to introduce new tools to add additional burden on the day-to-day work," she continued. On top of regular in-person visits, "patient care has now evolved into Zoom and then other virtual visits and virtual meetings with our colleagues, and there are also wearables -- there's a huge influx of data coming into our systems."

Combined with additional regulatory and billing requirements, as well as patients who expect information to flow to them faster, "all this creates a lot of additional tasks and burdens on all of us," Arican said.

Blessing ... and Curse

This added technology has been both a blessing and a curse, said Jenifer Lightdale, MD, vice-chair of pediatrics at UMass Memorial Children's Medical Center in Worcester. "When I started in medicine in the mid-'90s, I had a little analog pager that just was a couple of digits; then it became a PalmPilot -- I think I used to have a PalmPilot, the pager, and the phone ... and now it's all one device, and that's wonderful."

However, with patients able to reach clinicians through a portal and expecting a quick response, "it's hard to remember all the patients. Even if all the information is right there, and I can get in and use an app to get into the electronic health record, it's still exhausting, and I think that toll on clinicians is still just being understood," she said.

Lightdale also warned the audience about the sneaky downside of technologies like virtual visits: "Initially, you're like, 'Oh I like this,' and then you start realizing you're not eating, you're not going to the bathroom, you're not standing up; it is really quite exhausting," not to mention providing some technical support to patients who need it, she said. "I think it has its place moving forward, but it's exhausting and thinking that it's easier is a mistake."

The loss of personnel is another issue providers are wrestling with, said Emily Oken, MD, MPH, professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute in Boston.

Oken, who recently switched from a part-time internal medicine/pediatrics practice to research and education, said that "one of the things I noticed as I was transitioning away from practice was that the institution was making huge financial investments in EMRs and in technology, and in parallel -- possibly as a result -- we're kind of shedding people and resources, and thinking that 'Oh, you don't need a nurse to call in prescriptions because this goes directly to the physician' or 'We don't need as much secretarial support because everything's electronic.'"

But with that loss of people comes a loss of institutional knowledge about the patient population, Oken continued. "In my setting, we had these long-standing nurses who really knew that when this particular patient called, we better get her in because she has a serious condition and we need to see her, and this other person maybe just needs some calming and reassurance, and a conversation over the phone will suffice. And so that increasing technology in combination with the loss of people makes it really hard on providers."

Problems With EMR Design

Although having to work longer hours is associated with burnout, "the magnitude of this correlation is small, and the aspects of EMR use and design are more likely drivers of the burnout that has been found," said Arican. "Some of them [include] the lack of alignment with workflow, and insufficient training in some things like inbox messages and how to handle them."

Some filters can be used to minimize the number of actions that clinicians need to take, "but how efficient we are able to create them in an electronic format and how much burden is actually being shifted to physicians is a very important part of it," she explained.

Stanford takes a multidisciplinary approach to dealing with provider burnout, she noted; in addition to looking at data "we're doing a lot of in-person observation to see what they struggle with, and talk to them and come up with some ways to help them ... It can be different from person to person because it can be different from specialty to specialty, and the person's overall comfort level with technology also contributes."

Getting Clinicians to Accept Help

But it can be hard for clinicians to accept that they need help. "I always say when you come to a clinician with data about them, it's important to recognize that they are going to go through a grief process," Lightdale said. "They are absolutely going to be first off in denial, and then they'll be very angry at you, and I actually tell people to embrace the anger because after that is when you're more likely to actually get towards acceptance."

But you also need to emphasize that you're collecting the data because you want to help them, she added.

One of the side effects of the technology overload is that people leave, said Oken, naming herself as a case in point: "My institution had a homegrown EMR that was pretty well refined to work pretty well in that setting, and we adopted a national commercial EMR, and the amount of time and energy and money and effort that was spent on implementing this new EMR just wasn't worth it to me, given that I was a part-time provider.

"I was 20% in the clinic and I swapped that out for 20% education time, and my quality of life improved dramatically," Oken said.

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