Switching to Electronic Health Records Improves Patient Satisfaction and Eases Physician Burnout – If You’re Prepared
By Delu Vimalesvaran
Data & Analytics Consultant, Slalom, Inc.
Slalom is a CHEF Platinum Sponsor
As with any business, customer satisfaction is key for success. Ensuring customers feel valued, receive services to their expectations, and feel positive employee engagement is necessary to retain a loyal customer base. These concepts also apply to the healthcare industry as patient satisfaction is necessary for financial reimbursements, revenue growth, and maintaining a hospital’s reputation.1 Research comparing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey against Centers for Medicare and Medicaid Services (CMS) data on hospital income margins found that hospitals providing “superior” patient experience saw 50 percent higher margins than others in the market.2
The HCAHPS survey is taken by a random sample of patients and captures many facets of the patient experience: engagement with hospital staff, the hospital environment, communication regarding the care given, and the overall experience. A study at MGH found that “65 percent of patient satisfaction was related with physician empathy” and personal engagement.3 With the patient-provider relationship playing such a key role in overall patient satisfaction, it is important to understand factors influencing the provider experience, such as physician burnout and an overlooked contributor to this: Electronic Health Records (EHRs).
Patient quality of care has generally increased with the advancement of technology in healthcare. EHRs provide the care team with the patient’s full medical history and run background processes that trigger alerts, such as when a medication prescribed may interact negatively with an existing medication or allergy. Automatic checks like this help detect and prevent adverse outcomes. However, the healthcare industry has been slower in adopting new technology, which can be attributed to the fear of an unsuccessful implementation and its impact on critical hospital processes. Patient care teams often have workflows they have fine-tuned over the years to perform their responsibilities within a limited timeframe. Using an unfamiliar interface or a new functionality that will adjust an existing, robust workflow has the potential to fail and cause severe consequences to the patient. The time spent on establishing new processes is often rushed by the immediate actions that must be taken to treat patients.
In addition to variable complexities of interfaces and workflows, EHRs result in a general increase in administrative work, which has in turn increased an already long workday. For every hour a physician spends with a patient, two hours are spent on EHR documentation tasks and desk work.4 The time spent on EHRs amounts to more than $365 billion a year, an amount that could be otherwise spent on direct patient care.5 A 2018 Stanford study found that while providers believe EHRs have their benefits, they feel there are even more challenges to be addressed; challenges related to complicated interfaces, lack of interoperability, and for the system to serve as more than a means of storage.6
Provider feedback on EHRs aligns with feedback from patients that feel a lack of engagement as their providers sit facing their laptops. As providers document notes on their computers during appointments, there is less eye contact and discussion time with patients. The short time a patient is allotted to speak with the provider’s full attention is juxtaposed against the wait time before a provider arrives. This experience overall reduces the ability to build a trusting patient-provider relationship.
While EHRs are responsible for improving patient care and hospital spending, they have also contributed to longer provider hours and strained patient-provider relationships. Hospitals administrations and technology firms are already responding to the difficulties conveyed by providers. There is a move towards leveraging artificial intelligence (AI), machine learning (ML), and advanced analytics in the form of voice recognition software, automation, and enhanced interfaces with better usability, meaning fewer clicks and simpler workflows.
Nuance is an example of an AI technology developed to improve the documentation process in efficiency and accuracy. Nuance’s documentation solution, Dragon Medical One, integrates with EHRs and has built-in tools to give “physicians evidence-based guidance and suggestions at the point of care to improve and speed documentation without disrupting workflow.”7
After implementing at Piedmont Healthcare, providers reported saving hundreds of hours each month, while also seeing 65% more documentation per hour using voice documentation. 8 The time saved allows providers more quality time with patients, while the accurate clinical documentation eases downstream processes, such as reimbursements.
Outside of technological developments to mitigate EHR challenges, there are also steps providers can take to improve patient experience with the system. A 2018 research study equipped an exam room with a patient facing screen to mirror the provider’s computer screen. Patient interviews post appointment indicated a sense of improved engagement and transparency. Patients reported more involved discussions and with more transparency, the opportunity to share updates to their medical history documentation, ultimately allowing for better care.9
The course seems clear, then: when providers share their screen and EHR generated reports, the EHR becomes a positive component of the patient experience that increases interaction opportunities between providers and patients. Patients are more likely to recognize the value of the services provided to them and thus may feel more satisfied.
Of course, EHRs are only a positive component if you are thoughtful about how and when to make the jump. While EHRs have been pivotal in moving away from traditional paper documentation and manual processes, there have been unintended effects that require innovative patient-centered solutions. EHR firms often consult hospital staff to design enhancements, but the focus of these functionalities tends to be mainly on patient care, CMS requirements, and billing.
While these areas are important, ask yourself the following questions to prepare:
- Will the benefit of the functionality outweigh the burden on the end user?
- How might the patient experience be impacted?
- Can any part be automated through AI/ML tools?
- Can usability be eased to reduce training time?
Being mindful of physician burnout and patient satisfaction when implementing changes in EHR software will allow for a more meaningful use of future versions. Hospital administrators, in addition to applying the above questions when you provide EHR and healthcare technology feedback, also consider them when analyzing potential workflow modifications. Patient-centric technological advancements and changes in patient-EHR interactions will improve patient satisfaction and quality of care – but only if you have taken the right steps to prepare your team.
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- Mehta, Shivan. “Patient Satisfaction Reporting and Its Implications for Patient Care.” July 2015. https://journalofethics.ama-assn.org/article/patient-satisfaction-reporting-and-its-implications-patient-care/2015-07.
- Collier, Matthew, et al. “Patient Engagement: Happy Patients, Healthy Margins.” 2015. https://www.accenture.com/_acnmedia/Accenture/Conversion-Assets/DotCom/Documents/Global/PDF/Industries_17/Accenture-Happy-Patients-Healthy-Margins.pdf#zoom=50.
- Heath, Sara. “To Boost Patient Satisfaction, Try a Little Provider Empathy.” 01 March 2016. https://patientengagementhit.com/news/to-boost-patient-satisfaction-try-a-little-provider-empathy.
- Arndt, Brian, et al. “Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.” Sep 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593724/.
- Haas, Derek, et al. “3 Ways to Make Electronic Health Records Less Time-Consuming for Physicians.” 10 January 2019. https://hbr.org/2019/01/3-ways-to-make-electronic-health-records-less-time-consuming-for-physicians.
- Stanford Medicine. “How Doctors Feel About Electronic Health Records.” March 2018. https://med.stanford.edu/content/dam/sm/ehr/documents/EHR-Poll-Presentation.pdf.
- Becker Hospital Review. “Better physician documentation with more patient face time? It can happen.” 12 June 2019. https://www.beckershospitalreview.com/artificial-intelligence/better-physician-documentation-with-more-patient-face-time-it-can-happen.html.
- Nuance Communications, Inc. “Piedmont Healthcare Improves Clinical Documentation, Physical Productivity with Nuance AI-Powered Solutions.” 2018 October 2018. https://www.globenewswire.com/news-release/2018/10/30/1639040/0/en/Piedmont-Healthcare-Improves-Clinical-Documentation-Physician-Productivity-with-Nuance-AI-Powered-Solutions.html.
- Asan, Onur, et al. “The electronic health record as a patient engagement tool: mirroring clinicans’ screen to create a shared mental model.” 20 April 2018. https://academic.oup.com/jamiaopen/article/1/1/42/4980802 .