By Philip Marshall, M.D., Co-Founder and Chief Product Officer, Conversa
The healthcare industry is looking for solutions to the serious problem of clinician burnout and its ramifications for the entire system. According to Medscape’s 2019 National Physicians Burnout & Depression Report, 44% of clinicians said they are exhausted by overwork and feel cynical about their jobs.
Burnout isn’t only about clinicians’ satisfaction with work. It also contributes to increased medical errors, reduced patient satisfaction and poor patient outcomes. That’s why addressing clinician burnout has emerged as one of the four pillars of the “quadruple aim,” an industry effort to advance the healthcare system.
The quadruple aim used to be known as the “triple aim” when it was first established by the Institute for Healthcare Improvement (IHI) in 2007. A decade later, the IHI recognized the severity of physician burnout. That recognition led to the institution of a new pillar aim—improving clinician satisfaction—along with pillars advocating for an enhanced patient experience, population health improvements and cost reductions. The fourth pillar was added in recognition of a basic fact: Without improvements in clinician satisfaction, the other aims would suffer.
Doctors are inherently helpers. Ask any physician and they’ll likely tell you they entered the medical field to help people navigate their care journeys and improve their lives. What transpired was something far different. The healthcare system has turned the profession into a complex health data transcriptionist role.
Of the more than 15,000 physicians surveyed by Medscape, 59% cite too many bureaucratic tasks—such as electronic health record (EHR) charting and paperwork—as the major contributor to burnout. Spending too much time at work (34%) and excessive time spent in the EHR (32%) were other top factors. Documenting care in EHRs can take up a significant amount of time in a physician’s day—as much as 50% more time than seeing patients.
A recent New York Times opinion piece noted that the healthcare system relies too heavily on an “endless and free resource”: the professional ethic of medical staff members. The system often exploits a physician’s personal time to maintain the status quo.
This is not dissimilar from what I learned early in my medical career. In 1998 I published a large study of physician attitudes toward the use of the EHR. Kaiser Northwest was the first Kaiser region to implement the Epic Systems’ EHR, and I surveyed all clinicians and interviewed the department chairs to understand their early opinions about how the EHR was impacting their patient care.
Then, just as now, EHR technology exacerbated the problems of burnout, adding hours of non-patient-facing administrative time to clinicians’ schedules. Using automated patient technology can help physicians save time. Often referred to as conversational Artificial intelligence (AI) or “chatbot” technology, these tools help providers stay connected to patients between episodes of treatment, ensuring a continuous conversation.
As part of this ongoing conversation, patients can enable their home health equipment and wearable devices to deliver patient-generated health data (PGHD)—such as symptoms, patient-reported outcomes, biometric device readings and social determinants of health (SDOH)—to providers. AI can analyze this data and help providers make better decisions about which patients require physician attention and who is on track to manage themselves.
But not all chat technology is created equal. With such high stakes, the technology must be built with an intimate feel and understanding for preferred physician workflows. It must also reduce, not increase, provider risk.
Most people associate chatbots as free text or voice, requiring natural language understanding (NLU), a process prone to error. Even when the chats execute perfectly with perfect NLU (which has never been accomplished in any industry, let alone healthcare), the resulting data is not structured and thereby not aggregable, analyzable or able to drive automated processes. The best health chat technology can give patient-reported data structure, allowing it to serve as critical automated business intelligence for physicians.
The results are convincing. In one Conversa pilot project, 82% of physicians said they would recommend the use of health chat technology to a colleague. And 83% reported that health chat technology extended the care they deliver to patients.
Health chat technology isn’t just a time-saving tool for physicians. It can also help patients achieve superior health outcomes. For example, if an oncologist has access to more data —such as side effects, medication compliance or SDOH that may impact recovery—earlier in a patient’s healthcare journey, then that physician can ensure his or her patients are on track with treatment protocols, which has a direct link to lower mortality rates.
The healthcare industry needs more tools to address clinician burnout, and health chat technology is stepping into the gap. By helping automate the data collection from patients, and the education and guidance for those patients who don’t require a physician’s involvement, that can help physicians focus on what they love to do. Then hospitals and health systems can, in turn, enhance the patient experience, drive better outcomes and reduce unnecessary costs.