As someone who has spent years focusing on improving patient outcomes, I’ve seen a distressing shift in the work of physicians, one that is no fault of their own. The job has become less and less focused on patients, and more and more preoccupied with the back-office beast of modern healthcare—the electronic health record (EHR)—and the attention and time it requires. Ultimately this takes away from caring for patients. Even in the outpatient setting, the need to use EHRs is slowing down treatment. As healthcare policy and practices have evolved in recent years, it has become increasingly difficult for doctors to focus on what matters most—the patient. Administrative and data-entry tasks have gotten more time-consuming and at times seem all-consuming. Regulatory compliance is unnecessarily laborious. Keeping current with the latest medical research is a constant struggle. More than three-quarters (78%) of physicians experience periodic feelings of professional burnout, a jump of 4% from 2016, according to a 2018 survey by Merritt Hawkins. Contributing factors include loss of clinical autonomy, diminished time with patients, and the administrative burdens of updating EHRs. 78% of physicians experience periodic feelings of professional burnout. EHRs are digital versions of a patient’s paper chart, containing all their medical and treatment histories. They also serve as a communication channel, an electronic prescription platform, and a mechanism for documentation to support billing and compliance. To maintain EHRs, doctors must chalk off countless hours for data entry to satisfy the requirements of pharmacy benefit managers, insurance carriers, and other documentation, including entering quality and performance metrics. For every hour a physician spends with a patient, they must spend two hours on EHR-related clerical work, according to recent studies. I frequently work in the evenings at home taking care of these chores. The EHR burden has pushed burnout rates up more than 10% since 2011, according to one study. No wonder, then, why 1 in 50 physicians in the U.S. plans to leave medicine altogether within two years, according to a 2017 survey by Mayo Clinic Proceedings. While advanced technologies such as machine learning and artificial intelligence (AI) are no panacea for what is driving so many doctors out of the field, emerging applications and other time-saving technologies offer hope. Here are three areas where I think technology can improve physicians’ lives. Streamlined Workflow Clinical decision support (CDS) systems were conceived as software tools that could link physician observations with EHRs, and theoretically help streamline doctor workflows in real-time clinical care. But because these systems are so closely intertwined with EHRs and because of the clunky nature of EHRs themselves, many CDS implementations create more problems than they solve. For example, some continually issue alarms and alerts, the majority of which are for insignificant issues but require manual processing by doctors. The data overload can impede decision-making, cut more into patient time, and increase physician errors. Primary care providers receive an average of 77 EHR notifications per day, according to one study by the Journal of the American Medical Association. Yet critical alerts, such as test results, can often get lost in a sea of other messages across CDS systems. Physicians spend more time documenting what they’re doing than they actually spend seeing patients. Recently, after completing a pre-op exam for one patient, I spent an hour trying to get past a hard stop in the system, which was buried in the EHR. Eventually I had to call an IT person to solve the problem. Machine learning applications and AI won’t solve all of these issues, but they can significantly reduce much of the data “noise.” For example, emerging machine learning tools can predict critical situations before they happen, which helps to lessen the “alert fatigue” doctors experience when working with CDS systems and EHRs. Three Johns Hopkins hospitals recently set up a machine-learning-based system that constantly scans EHR, lab tests, notes, and radiology tests of every admitted patient. If a patient crosses a threshold for having a high likelihood for developing sepsis, the system sends an alert to just the most relevant providers. Developed by Dr. Suchi Saria, the system refreshes every 15 minutes with calculations done by machine learning in the cloud. That doesn’t just reduce burnout; it can save lives. Intelligent Dictation Dictation is another area that is finally getting a much-needed upgrade with an assist from AI. In the past, physicians would dictate notes into recorders and send them out for transcription. But dictation quality was often spotty, and the expansion of required EHR documentation only slowed the process. Poor dictation quality meant doctors would have to edit transcripts for accuracy, adding to their workload. To make things easier for doctors, Johns Hopkins recently began using an AI-enabled speech recognition platform called Dragon, which is built into its CDS systems. Transcription now happens in real-time and with improved accuracy. This is saving doctors valuable time and allows them to focus more on patients. Automating Clinical Records Using AI to complete clinical documentation tasks is an especially promising capability, according to the American Medical Association. While scalable AI applications haven’t yet emerged, the promise is that these tools will be able to analyze a physician’s unstructured, “free-text” clinical narratives, extract relevant information, and fill in the appropriate structured data field on a chart. Natural-language processing is an area of AI that helps computers understand and interpret human speech and writing. Experts think it has great potential for dramatically slashing the administrative burden on physicians. Looking ahead, I realize there’s no silver bullet for physician burnout. Practicing high-quality care requires a human touch. That will never go away. The great irony today is that artificial intelligence may prove to be the force that helps bring that human touch back to the forefront of medicine. Source
