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Centre for Addiction and Mental Health, Toronto

Combatting clinician burnout through engagement

Centre for Addiction and Mental Health

Clinician burnout is an issue across the world – and it’s on the rise. While the COVID-19 pandemic is the prime cause for the condition currently, electronic health records (EHRs) have previously been cited as a factor. This is still the case, but there are methods to accelerate the reduction of EHR burden, as demonstrated at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Burnout is a significant issue as it can impact the quality of care and efficiency of practice – having direct consequences for patients – while also affecting clinicians’ wellbeing, including greater emotional exhaustion and depersonalization,1 as well as substance use, insomnia and depression.2 These factors can contribute to a decline in overall professional behavior and increased turnover.

KLAS found that since the onset of COVID-19, a third of clinicians globally report that they feel burnt out at any given time.3 However, this is far from a new phenomenon, as the number was still a significant 25% before the pandemic began. This pre-COVID-19 figure is consistent with CAMH’s findings among its own physicians – 26% of physicians reported feeling burnt out4 – although the current level is anticipated to be more due to the pandemic, virtual fatigue, etc. This would follow the trend among Ontarian doctors, with 29% reporting persistent symptoms or complete burnout in 2020 and 34.6% in 2021.5

It was with these figures in mind that CAMH sought to optimize a key contributor to physician-reported burnout – their EHR, which is based on Cerner Millennium® and known locally as I-CARE. To achieve this, they developed a three-stage process of engagement, inspiration and change to reduce possible impacts of the EHR. This was developed alongside physicians, as they are the ones experiencing the issues, so they are best placed to help address the burden.

Discovering and implementing fixes

Engagement surveys carried out by the Physician Engagement Strategy team found that of the 26% of physicians feeling burnt out, 75% of them cited I-CARE as a key contributing factor. When asked for specifics, it emerged that half of the challenges could be remedied through either quick fixes – creating new templates, including certain reports with summaries, etc. or future changes, like linking the EHR directly to billing or creating a free-text search option.

With this guidance in hand, Cerner and CAMH were able to work on these requests together. Within four months, all the quick fixes had been implemented, and after a year, 36 of the 47 longer-term changes were in place, highlighting the transformational benefits of collaboration.

Understanding existing functionality better

Optimizing I-CARE wasn’t the only way that physicians believed that they could improve their experience – 34% of issues raised came down to gaining further education about the system. The largest concerns surrounded searching for documents and results, using global auto-text, and forwarding discharge summaries and consult notes.

Some of these were remedied through peer education videos that were accessible through a physician portal, a regular monthly newsletter with tips, tricks and updates, and further education on the benefits of using speech recognition technology for clinical documentation.

This latter innovation has subsequently proven its worth. Six months after the education sessions, 80% of users agree that it’s easy to set up and use, 69% believe that it uses less time than other documentation methods, and 75% indicate that it integrates well with existing I-CARE workflows. Overall, 85% intend to continue using speech recognition technology to satisfy their future documentation needs.

In addition, feedback on the SWAT initiative – the agile approach used to identify and address CAMH’s EHR-related issues – was extremely positive, with 72% of participants agreeing that the main objectives were met, half believing that their proficiency with I-CARE had improved following the process, and 75% suggested that they would recommend the methodology to colleagues for future improvements.6

Taking pre-emptive action

It’s possible for managers to be proactive to optimize usage too, in order to positively impact clinician burnout. By using Lights On Network®, they can check EHR usage metrics for all users, including patient load, time spent on I-CARE – including after hours – and whether the system is being used efficiently, e.g. could the speech recognition technology be used more effectively to reduce input burden?

Understanding how physicians are using I-CARE through the metrics available in the back-end data can help the CAMH team understand where to best focus their efforts on improving the usage and experience of the system. In the CAMH study,4 physicians reported that the workload related to EHR use is high, with 30 minutes spent documenting on each patient and eight hours using the system after-hours. As a next step, the CAMH team will be using Lights On Network to explore the opportunities for further supporting physicians and optimizing the system.

This is potentially important, as CAMH’s study found that users who had low satisfaction with the EHR to begin with were more focused on usability issues and unintended consequences on patient care. Those with a higher opinion were more likely to find workarounds or customizations that would give them a better overall experience.

The process undertaken at CAMH shows the importance of physician and healthcare IT leadership working together to achieve their goals – as well as working closer with the clinicians themselves. Techniques otherwise employed in project management for coordination and iterative progress, e.g. implementing annual surveys so that the organization can work towards meeting clinician needs and reducing burnout are to be used going forwards, so that the working environment remains agile to user needs.

Engaging with physicians, being inspired by their suggestions and implementing relevant changes that are making a real difference to factors that contribute to burnout isn’t the end of this story. The pandemic has made everyone acutely aware of how under pressure all clinicians are – nurses, allied health practitioners and beyond – so CAMH is taking the learnings from the physician study and using them as inspiration to apply to other clinicians within the healthcare continuum.

This dedication to focusing on positive outcomes for all clinicians – and, in turn, those they care for – truly shows that CAMH is a leader in Canada.

1 – Canadian emergency medicine physician burnout: a survey of Canadian emergency physicians during the second wave of the COVID-19 pandemic
2 – Exploring the impact of rural health system factors on physician burnout: a mixed-methods study in Northern Canada,3%2C4%2C5%5D.&text=A%20previous%20study%20from%20Canada,among%20family%20physicians%20%5B9%5D
3 – Clinician burnout 2021
4 – The influence of electronic health record use on physician burnout
5 – Ontario’s doctors report increased burnout, propose five solutions,the%20OMA%20today%20found%20many%20causes%20of%20burnout
6 – EHR SWAT teams: a physician engagement initiative to improve electronic health record (EHR) experiences and mitigate possible causes of EHR-related burnout

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Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.