Health IT Summit in Chicago 2014 – “7 Ideas in 7 Minutes” with Sanaz Cordes, MD, COO, healthfinch


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Health IT Summit in Chicago 2014 – “7 Ideas in 7 Minutes” with Sanaz Cordes, MD, COO, healthfinch

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Health IT Summit in Chicago 2014 – “7 Ideas in 7 Minutes” with Sanaz Cordes, MD, COO, healthfinch

  1. 1. ! 7 Ideas in 7 Minutes ! Sanaz Cordes, MD, COO healthfinch: The Doctor Happiness Company
  2. 2. Traditional Primary Care Model Cannot Survive
  3. 3. ½of physicians are burnt out ORIGINAL INVESTIGATION Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population Tait D. Shanafelt, MD; Sonja Boone, MD; Litjen Tan, PhD; Lotte N. Dyrbye, MD, MHPE; Wayne Sotile, PhD; Daniel Satele, BS; Colin P. West, MD, PhD; Jeff Sloan, PhD; Michael R. Oreskovich, MD Background: Despite extensive data about physician burnout, to our knowledge, no national study has evalu- ated rates of burnout among US physicians, explored dif- ferences by specialty, or compared physicians with US workers in other fields. Methods: We conducted a national study of burnout in a large sample of US physicians from all specialty dis- ciplines using the American Medical Association Physi- cian Masterfile and surveyed a probability-based sample of the general US population for comparison. Burnout was measured using validated instruments. Satisfaction with work-life balance was explored. Results: Of 27 276 physicians who received an invita- tion to participate, 7288 (26.7%) completed surveys. When assessed using the Maslach Burnout Inventory, 45.8% of physicians reported at least 1 symptom of burn- out. Substantial differences in burnout were observed by specialty, with the highest rates among physicians at the front line of care access (family medicine, general inter- nal medicine, and emergency medicine). Compared with a probability-based sample of 3442 working US adults, physicians were more likely to have symptoms of burn- out (37.9% vs 27.8%) and to be dissatisfied with work- life balance (40.2% vs 23.2%) (PϽ.001 for both). High- est level of education completed also related to burnout in a pooled multivariate analysis adjusted for age, sex, relationship status, and hours worked per week. Com- pared with high school graduates, individuals with an MD or DO degree were at increased risk for burnout (odds ratio [OR], 1.36; PϽ.001), whereas individuals with a bachelor’sdegree(OR,0.80;P=.048),master’sdegree(OR, 0.71; P=.01), or professional or doctoral degree other than an MD or DO degree (OR, 0.64; P=.04) were at lower risk for burnout. Conclusions: Burnout is more common among physi- cians than among other US workers. Physicians in spe- cialties at the front line of care access seem to be at great- est risk. Arch Intern Med. 2012;172(18):1377-1385. Published online August 20, 2012. doi:10.1001/archinternmed.2012.3199 A LTHOUGH THE PRACTICE OF medicine can be incred- ibly meaningful and per- sonally fulfilling, it is also demanding and stressful. Results of studies1-3 suggest that many phy- sicians experience professional burnout, a syndrome characterized by a loss of enthu- siasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplish- ment. Although difficult to fully measure and quantify, findings of recent studies4-8 suggest that burnout may erode profes- sionalism, influence quality of care, in- crease the risk for medical errors, and pro- mote early retirement. Burnout also seems to have adverse personal consequences for physicians, including contributions to bro- ken relationships, problematic alcohol use, and suicidal ideation.9-11 Despite the extensive data on physi- cian burnout, to our knowledge, no na- tional study has evaluated rates of burn- out among US physicians. Although there has been much conjecture about which medical or surgical specialty areas are high risk, this speculation has primarily been based on comparisons across studies of physicians from individual disciplines, for which differences in sample selection, study size and setting, participation rates, and year of survey administration con- found interpretation. The literature on physician burnout is also hampered by a lack of data about how rates of burnout for US physicians compare with rates for US workers in other fields. Author Affil Department Medicine, M Rochester, M (Drs Shanafe and Sloan an American M Chicago, Illi and Tan); D Orthopaedic School of M Orleans, Lou and Departm and Behavio University o Seattle (Dr O Author Affiliations: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota (Drs Shanafelt, Dyrbye, West, and Sloan and Mr Satele); American Medical Association, Chicago, Illinois (Drs Boone and Tan); Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana (Dr Sotile); and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (Dr Oreskovich). ARCH INTERN MED/VOL 172 (NO. 18), OCT 8, 2012 WWW.ARCHINTERNMED.COM 1377 ©2012 American Medical Association. All rights reserved. Downloaded From: on 01/06/2014
 Forth-five percent (45%) of the physician’s day is spent outside of face-to-face patient care. ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 3, NO. 6 ✦ NOVEMBER/DECEMBER 2005 488 Time Spent in Face-to-Face Patient Care and Work Outside the Examination Room ABSTRACT PURPOSE Contrary to physicians’ concerns that face-to-face patient time is decreasing, data from the National Ambulatory Medical Care Survey (NAMCS) indicate that between 1988 and 1998, durations of primary care outpatient visits have increased. This study documented how physicians spend time during the workday, including time outside the examination room, and compared observed face-to-face patient care time with that reported in NAMCS. METHODS Using time-motion study techniques, for each of 11 physicians, 2 patient care days were randomly selected and documented by direct observa- tion. Physician time spent on face-to-face patient care and 54 activities outside the examination room were documented. Data represent 12,180 minutes of work and 611 outpatient visits. RESULTS The average workday duration was 8.6 hours, and face-to-face patient care accounted for 55% of the day. Work outside the examination room relevant to a patient currently being seen averaged 14% of the day. Work related to a patient not physically present accounted for one fifth (23%) of the workday. The combination of face-to-face time and time spent on visit-specific work outside the examination room assessed by direct observation was significantly less than the 2003 NAMCS estimate of visit duration assessed by physician report (13.3 vs 18.7 minutes, P <.001). CONCLUSIONS Nearly one half of a primary care physician’s workday is spent on activities outside the examination room, predominately focused on follow-up and documentation of care for patients not physically present. National estimates of visit duration overestimate the combination of face-to-face time and time spent on visit-specific work outside the examination room by 41%. Ann Fam Med 2005;3:488-493. DOI: 10.1370/afm.404. INTRODUCTION P rimary care physicians have expressed discontent and concern that face-to-face time with patients is diminishing and that their adminis- trative burdens are increasing.1-3 Concerns are fueled by data suggest- ing that shorter visits are associated with lower patient satisfaction4,5 and possibly poorer quality of care.6 Recent findings from multiple data sources indicate, however, that the duration of the visit in a primary care setting is increasing,7 the number of patients being seen during an average week is decreasing, and the number of hours spent working during the week has remained the same.8 Specifically, longitudinal data using the National Ambulatory Medical Care Survey (NAMCS) for the decade 1988-1998 indicate that physician-reported face-to-face interaction time has increased 2.0 minutes to an average of 16.3 minutes per encounter.7 NAMCS data from 2003 indicate that among general and family physicians, the average visit duration is 18.7 minutes.9 What could account for the discrepancy between physician perceptions and national data? Data for the NAMCS are based on physician reports at the completion of each sampled visit. Gilchrist et al10 showed that com- Andrew Gottschalk, BS1 Susan A. Flocke, PhD2 1 Case Western Reserve University School of Medicine, Cleveland, Ohio 2 Departments of Family Medicine and Epi- demiology and Biostatistics, Case Western Reserve University, and the Case Compre- hensive Cancer Center, Cleveland, Ohio Conflicts of interest: none reported CORRESPONDING AUTHOR Susan Flocke, PhD 11001 Cedar Ave, Suite 306 Cleveland, OH 44106-7136 Why physicians are burning out?
  5. 5. Less PCPs Growing Patient Panels Traditional Primary Care Model is NOT SUSTAINABLE!
  6. 6. Healthcare today Who does the work? Physicians Staff Protocols & algorithms powered by technology …and tomorrow
  7. 7. What Challenges Does Primary Care Face?
  8. 8. Challenge: EMR Workflow • Optimized for Data Collection • Does not execute tasks based on the data
  9. 9. Idea #1: Workflow Automation Powered by the EMR •Transform the EMR from collecting data to executing clinical tasks based on data
  10. 10. Example: Automatic Scheduling •EX: Patient on tegretol automatically receives serum level scheduling message annually —> lab interpreted by technology —> any additional actions necessary executed
  11. 11. Challenge: Too Many Tasks for a Physician to Complete in a Day • PCP would need to spend 21.7 hours per day to provide all the recommended acute, chronic, and preventative care to a panel of 2,500 patients!
  12. 12. Idea #2: Task Delegation Physician Staff Protocols Algorithms Standing Orders (Technology!)
  13. 13. Example: Refill Protocols •EX: Nurses relieve physicians of this task by using technology (fueled by protocols) to process refill requests
  14. 14. Challenge: Patient demand for care exceeds clinic capacity • Patients experience delays in getting appointments with PCPs
  15. 15. Idea #3: Team Based Care •Using nurses at the top of their license to provide team based care to patients
  16. 16. Example: Group Appointments •EX: Nurses provide group appointments to asthma patients (aerochamber, MDI use, peak flow, asthma action plan . . .etc)
  17. 17. Challenge: Traditional PCP Encounter is Reactive Annual Well Visit Diagnostics Ordered Diagnostics Reviewed by MD Order Sent to Nurse for additional testing Message sent to scheduler Patient Notified to get additional test Test Reviewed by MD Message sent to nurse to call patient Nurse calls patient with results
  18. 18. Idea #4: Redesign PCP Encounter to be Proactive • Use technology to automate pre-visit planning to queue up routine diagnostic elements ahead of the patient encounter
  19. 19. Example: Pre-Wellness Labs •EX: Annual blood work is ordered and completed by the patient prior to the physician encounter so that results are discussed real time
  20. 20. Challenge: Healthcare is Asynchronous • Primary care offices are flooded with asynchronous requests that use precious staff resources
  21. 21. Idea #5: Synchronize Care • Technology-enabled batching & consolidating of unrelated care elements
  22. 22. Example: Medication Synchronization Application •EX: Using technology to synchronize a patients various medications such that all refills occur simultaneously
  23. 23. Challenge: Primary Care Not Optimally Standardized • Varying treatment plans for the same patient problem results in staff time wasted and higher rate of errors
  24. 24. Idea #6: Standardization • Using technology to implement evidence- based and best practice protocols/orders to empower staff and drive efficiency and quality
  25. 25. Example: Strep Throat Protocol •EX: Standardized protocol in place empowering nurses to diagnose queue up prescription order for strep throat
  26. 26. Challenge: Primary Care Not Optimally Centralizing Routine Processes •One nurse may do 10 different types of tasks per day
  27. 27. Idea #7: Centralization •Create “hubs” fueled by technology where staff is executing the same workflow without interruption
  28. 28. Example #7: Centralized Coumadin Center •EX: Hub of nurses using protocols to manage all coumadin patient across the organization
  29. 29. Thank you! healthfinch: The Doctor Happiness Company ! Madison, Wisconsin Scheduling Wizard SynchWizard Coumadin Wizard TrackerWizard LabWizard RefillWizard CareGap WizardWellness Wizard