New group hopes to focus efforts to trim clinician burdens
The National Burden Reduction Collaborative aims to get more than a dozen large, influential organizations to coordinate efforts on impactful initiatives.
Clinician burden – like many things in life, particularly the weather – is what everyone talks about and no one seems to be able to do anything about.
Howard Landa, MD, wants to change that narrative.
Landa – chairman of the Association of Medical Directors of Information Systems – had an informal discussion last year with Tanya Tolpegin, CEO of the American Medical Informatics Association, and Vimal Mishra, MD, director of digital health for the American Medical Association. That meeting became the catalyst for the creation of the National Burden Reduction Collaborative.
The new initiative aims to take the many threads of discussion around clinician burden and weave it into a manageable yet actionable strategy.
NBRC draws together more than a dozen major healthcare organizations, federal agencies and standards organizations to define and work on ways to measure and then mitigate clinician burden. The goal is to move beyond talk to action, Landa says.
A coordinated push
Organizers reached out to organizations that already had voiced concern about clinician burden to meet at AMIA’s annual meeting to determine agreement on steps that had the biggest potential for impact.
“We’re all working on burden reduction, but we don’t get very far with it,” Landa says. “Some organizations have tools, others were promoting tools or standards. We started reaching out – ‘Would you be open to getting together for a day? Could we help each other?’ “
The meeting brought together representation from representatives from national organizations that have clinician burden reduction as a key component of their missions. The organizations presented the range of projects that they’re pursuing, which then were winnowed down to five joint projects, with specific organizations taking responsibility for ascertaining feasibility, impact, measurability and the benefits of extensive collaboration.
Initiatives include:
- • Determining whether better clinician training regarding documentation can help reduce burden, jointly being led by AMDIS and KLAS Research.
- • A working definition of clinician burden, and metrics that accurately measure it, as well as defining what constitutes documentation essential to effective medical care, all being managed by AMIA.
- • Establishing and promulgating a unified, automated approach to prior authorization, a process that drains time from both physicians and their staffs, which will be supported by HL7.
Another pursuit that has arisen for NBRC is how to better rein in messages, some of which are natural to the inpatient setting but also the increasing number that clinicians field directly from patients.
Landa knows the challenge will be moving from discussion of burden, and the causes of it, to reach consensus on ways to reverse the trend.
“We’re all great at talking,” he notes. “Now we have to do some work. It’s a collaborative, so we have to agree on a direction that everyone wants. It doesn’t work if it’s not coordinated.”
No simple answers
Clinician burden – the potential for burnout – is a complex challenge that can’t be solved by one organization or one player in the industry.
Documentation burdens have grown because of the need to substantiate charges, Landa notes. That push in the mid-1990s preceded the rise in development of EHRs, which were designed, in part, with the intent to ensure that they captured documentation to support billing.
Other factors, such as quality reporting, have added more verbiage to clinical notes, but added little value for clinicians – who not only have to write more documentation, but have to wade through it to find what they need, Landa contends.
“Everybody talks about creation (of clinical notes), but no one talks about consumption,” he explains. “Right now, it’s just verbal vomit. We’ve talked about it for years, going back to the SOAP (Subjective, Objective, Assessment, Plan) note, where I can look at the assessment as a clinician and just look at the rest of it at my leisure.
“And nursing notes used to be simple and concise. Now they can be a flow sheet with a thousand rows – there’s no way to look at (information) in a consistent way.”
Messaging from patients rose exponentially during the pandemic, and physicians face pressure to respond to messages coming through portals, and via email and texts. “Our docs are spending time answering questions, which is non-revenue care, or spending their evenings doing asynchronous care,” Landa says. “Some are ‘fractional quitting,’ only carrying a partial caseload so they can do all their messaging before they go home.”
Technology needs to evolve to better support patients and take the load off clinicians, he contends. “The portal has to evolve to a new digital front door – it should send the patient to an advice nurse,” who can suggest next steps in a patient’s care journey. Technology can “do video teaching, digital care and more, lessening the load on a physician’s in-basket. The portal is the entrée to that.”