Op-Med is a collection of original articles contributed by Doximity members.
Digital engagement solutions have been helping providers boost patient experience, improve the health of populations, and lower the cost of delivering care — the Triple Aim for optimizing health system performance as outlined by the Institute for Healthcare Improvement.
But to meet these three goals, providers need to address a serious and growing problem: physician burnout.
As a practicing physician myself, the pressure to see more patients in shorter encounters is stressful enough. But on top of this, the amount of administrative and documentation burden has increased, adding to already long hours, and a concerning national trend of provider and staff burnout.
Physicians, especially primary care physicians, are exhausted. Increasingly, the Triple Aim is being re-examined as the Quadruple Aim, with the added goal of reducing burnout and making work life better for healthcare professionals.
Patient Engagement — Just Another Headache?
Automated digital patient engagement platforms, such as HealthLoop, are a relatively new breed of technology, coming onto the market around 2011, and achieving broad market adoption more recently. Such platforms automate remote guidance and telemonitoring, both before and after healthcare encounters, by leveraging the relationship the patient has with a healthcare provider or a team of providers, and automatically guiding the patient through an episode of care.
Leadership at hospitals and practices have been increasingly promoting these solutions, in part, because they recognize that high-touch follow up promotes enhanced patient experience, improved patient satisfaction ratings, increased referrals, and reduced hospital readmissions.
Healthcare providers themselves, however, already burdened with a workflow that has no additional bandwidth, have not been as quick to embrace these new systems. Many believe that they simply don’t have time to interface with patients outside of the hospital or clinic.
Furthermore, many feel betrayed by and harbor negative digital health associations with the last new digital health tool implementation to which they were exposed — the new EMR rollout — which involved large workflow changes, steep learning curves, and large increases in documentation time that detracted from face-to-face time with their patients.
But not all digital health solutions are created equal. Some have had design approaches coming from administrative-centric perspectives. Those digital tool vendors, however, with employees that come from healthcare, and that design from the healthcare provider and patient-centric perspectives, develop their solutions from the workflow of their users backwards. So, in fact, physicians who have adopted such user-centric digital engagement solutions find that they offload a great deal of administrative work from those whose very jobs it is to provide direct patient care.
Digital health tools that enable the frontline staff to end phone tag with patients and switch to asynchronous communication, and that facilitate each member of the care team to practice at the top of his or her license and not be burdened with work below that level, can in fact lessen the administrative burdens on those providing direct patient care.
The Burden of Emails and Phone Calls
In addition to their direct patient care duties, physicians must carve out some time in their days, time that is often squeezed into the interstices between patient encounters, to respond to phone calls. While that has long been the practice, the amount of time available has been squeezed, and phone tag makes the process ever more inefficient. More recently, however, providers have acquired increasingly large inboxes of emails from patients and colleagues to also manage.
One would think that adding another stream of patient communications, such as those delivered through automated patient engagement platforms (in the cases when two-way communication features are selected by the practice) would exacerbate an already overburdened system. In fact, however, such platforms enable front-line staff to handle most inquiries from patients that previously would have come in through clinic phone lines or into the physician’s email inbox. This shift from synchronous phone communications and email communications into digital engagement platforms which distribute the work across the full care team creates new efficiencies that have not previously been possible.
Following an encounter such as a hospitalization or an elective surgery, patients are often asked to return for a follow-up visit to ensure they are recovering properly. In the gap between the discharge and the follow-up appointment, we have often assumed that no news is good news; namely, if we didn’t hear of any problems from the patient, that everything must be “on track.”
Unfortunately, no news is simply no news, and most physicians know of patients who had potentially avoidable readmissions or complications that occurred between encounters. Unfortunately, physicians cannot “check in” on patients every day to monitor them until the next face-to-face encounter.
Or can they?
In fact, we cannot scale the physician’s face-to-face time, but using technology, we can scale the physician’s outreach, creating automated remote digital encounters coupled with telemonitoring. These virtual check-ins run in the background throughout the day while the physician sees his or her patients in clinic, and surfaces only those patients who need attention today, first to the frontline staff, and then up the chain if appropriate.
Furthermore, physicians who engage with patients via automated digital check-ins are finding that quite a few of the follow-up face-to-face visits become unnecessary. Why is this? It’s because patient progress and status is maintained and known at such a granular level, that often, the follow up face-to-face visit is simply redundant. And when a handful of follow-up visits are scratched off the calendar, a slot opens for a new patient, and so does opportunity for new revenue.
Dealing with Shorter Appointments
Physicians didn’t go through four years of medical school so that they could push pencils, fill out forms, and do administrative tasks. And they didn’t go through many more years of residency so that they could spend more time documenting in an EMR than time spent time with their patients. Physicians need tools that work for them; not against them.
This is one of the reasons many physicians resist adopting new solutions — they are already crushed for time, and want to spend the time they do have providing high quality care.
Automated daily engagement with patients outside of the encounter means that the face-to-face visit, often limited for time, is continued post-visit with a digital dialogue in which many of the most repetitive questions posed, can be anticipated, and answers can often be provided before they are even asked by the patient. Most physicians are quite aware of how often they provide the same “routine” advice time and again to each patient. That’s because the physician has “seen the movie” before. But often, the patient has not. This may be his or her first time experiencing a procedure or the management of a diagnosis.
Imagine, however, technology taking on the burden of telling the same information over and again. Studies have found, in fact, that when information is broken down into bite-sized pieces this way, rather than served as a bolus in an after-visit summary or a large set of discharge instructions, that patient comprehension and retention improve.
Face-to-face visits may be getting shorter, but automated longitudinal follow up means that the full episode of care is richer than ever.
Our Healthcare System Does Not Need Burned-Out Physicians
Our country’s healthcare system is dysfunctional and already under tremendous strain. The last thing we need are physicians who are burning out. Some of the most intelligent, empathetic professionals in the world are beginning to wish they had chosen a different line of work.
Automated engagement with patients outside of the care setting does not add to a physician’s workload; in fact, it helps with the extending the physician-patient relationship, and enables a more effective use of all-too-brief face-to-face appointments.
Physicians who use HealthLoop report a net promoter score (NPS) of 47. By way of comparison, one study asking physicians of their views of their ambulatory EHRs found NPS scores for all EHRs less than zero, except one, which came in at a whopping score of 5. Compare this to top consumer brands such as Southwest Airlines, with an NPS score of 62. Can you imagine a digital healthcare tool that is simply delightful for providers to use? This is what can be accomplished when design is user-centric.
It should not just be healthcare administrators who are embracing new engagement technologies. Physicians have reason to be every bit as enthusiastic. While the practice of medicine has become more demanding than ever, well-designed technologies can and should alleviate hard-working healthcare providers, and give them room to Achieve the Quadruple Aim, and find joy in the important work they do.