Physician Burnout! A disturbing trend

Burnout1

Since my last post about my late Grandfather, I didn’t have the motivation to write; but then I thought about all of the times he encouraged me to write, it reminded me to follow my passion, so here I am with my thoughts again, this time on the disturbing trend of Physician Burnout.

Physician BurnoutOver the last 7 years since the time of the “Great EMR Implementations”, we have always discussed physicians retiring because they did not want to learn technology and use the EMR. I put it down to older physicians not keeping up with the times. I’m not so sure about that anymore.  The reason being that one of my friends who is a physician went through a very visible burnout episode that surprised everyone recently. She said that she was working until the middle of the night trying to keep up with documentation and it finally became too overwhelming for her to take. This surprised me tremendously. This wasn’t something that happened to younger, more savvier physicians…or so I thought. IBurnout2n a June 29th, 2017 article in the Harvard Business Review, points such as loneliness at work is also a factor that is identified as the reason for burnout (it doesn’t discuss physician burnout in particular though). Similarly, in a June 22nd article in Time Magazine, titled “Doctor’s on Life Support”, it starts by saying that “Doctors are stressed, burned out, depressed, and when they suffer, so do their patients. Inside the movement to save the mental health of America’s doctors“. The  signs of stress are evident. IT departments can and should do more to collaborate with clinic practices and primary care and specialties to help develop efficiency within the every day use of technology. Technology “A-Teams” should be identified to work with their physicians, understand the challenges that they are facing, whether in the EMR, wireless “dead zones” in clinics that drop the connection, old laptops and PCs that need to be updated, that sometimes may mistakenly be attributed to an EMR deficiency or other areas where the process can be smoother for the physician and/or clinic staff.

All of us as Healthcare Information Technology professionals needs to bear in mind that we need to do all we can do reduce and eliminate physician burnout and improve the processes for the physician so that we can enable them use technology for better, faster and more efficient patient care. The burden of EMR documentation should be lessened and, at the end of the day, it will be the patient that will gain and the quality of care will increase with a happier, less stressed, care provider.

 

An intuitive Payer-Provider Solution that “Cares to Connect”

Sometimes I have the opportunity to connect with interesting people that want to provide better healthcare collaboration like myself. Recently, I was introduced to such an individual in Suresh Kumar, the founder of a solution called “vCareConnect”.

I recently asked him about how he came up with his entrepreneurial initiative. Below is my interview with him.

Ajay: Suresh, thanks for sharing some of your thoughts with me and the readers of Healthcare Interoperability. How did you start this concept of Care Coordination?

Suresh: One of my neighbors is a caregiver for her 75 year old Mother. Her Mother had had a mild stroke and had to be taken to the Emergency Room. She shared with me how, during this event, she had to share the same information over and over again with different people and most of the providers were not aware of the care prescribed by other physicians for her Mother. That’s when it struck me. Why can’t the healthcare experience be like going on Amazon.com?  In an “Amazon experience” the buyer provides the information only once, completes their purchase with many sellers within the “Amazon ecosystem” without having to re-enter their information and the fulfillment department knows everything about the order and optimizes shipping to reduce costs. Granted in that model, it is possible to be well coordinated as a seller is in that ecosystem. In healthcare, we cannot get all of the healthcare systems under one umbrella. That was the genesis for the solution which I named, “vCareConnect”; a care coordination platform that provides transparency to the patient, provider, caregiver and care manager, enabling collaboration.

Ajay: So what is your concept of care coordination?

Suresh: Coordination means different things to different people, here is how we describe coordination, it is the ability to clearly communicate to provider, patient, caregiver and care manager on what care is needed for the patient, when is it needed and how to organize to ensure patient receives the care.

Lets say, as a scenario, I am on a visit to Florida and I fall sick. I should be able to quickly share my medical record with the provider  so that they can see the Care Plan I am on and medications I am taking. After I get back from my travel to Florida, I should be able to revoke provider access if I want to do so.

Ajay: That is an interesting concept, but what’s unique about vCareConnect?

Suresh: Another key part of the platform is a greater inclusion of caregivers. Caregivers play a key role in influencing patient behaviors and we believe this is an aspect that’s not been explored enough to improve patient engagement. Say if I am lagging behind on my blood pressure testing, if my wife knows about it she will certainly influence or prompt me to get it completed.

Unlike traditional careplans  our solution helps provider/care manager communicate care tasks in an easily understandable, daily task-like fashion. Our multi-modal communication tool-set delivers the information via the channel the patient prefers (such as online, through a smartphone app or a regular landline/mobile telephone call). What we are trying to do is providing tools to a team based care approach to  ensure transparency and communication among all of the stakeholders in the care process.

Ajay: That’s awesome to hear. Have you had any early successes in your entrepreneurial pursuits?

Suresh: Fortunately, we have had a chance to pilot this product in a rural population in India and have had some success in decreasing the  miscarriage rate and improving deliveries at the local government facilities from 20% to 35%. We were also able to save the patient population around $140,000.

Ajay: Suresh, thanks for sharing your experience and your entrepreneurial adventures with us. I look forward to your success and your continued advocacy for better patient care through healthcare information technology!

Suresh: Thanks Ajay.

Suresh Kumar is the founder of vCareConnect. He is a technology leader and has worked in technology consulting and advisory for 15 years. As a Senior Enterprise Architect and management consultant, he has provided services to organizations such as Blue Cross Blue Shield of Illinois, Wellpoint and Cigna. He was the Operations Director for Transunion Healthcare’s Analytics Product managedcare.com and has worked for consulting firms such as Booz & Co , Deloitte and Capgemini. Suresh currently lives in Illinois with his family.

Suresh Kumar-Founder of vCareConnect

 

 

Thought Leadership – Empathy’s involvement in Patient Engagement

 

Earlier this year, I had introduced you to “lifestyle philosopher” and Oxford University Professor, Roman Krznaric and his work on empathy’s role in our world today. He has released a new animation which is an amazing video that is part of this post. Hopefully, it is as insightful for you as it was for me. I interviewed Roman on some of his thoughts about empathy and it’s role in healthcare as well as other areas that were relevant to our world today. Here, below is that interview.

Roman, thanks for your time to answer some of my questions. How did you get involved with the concept of empathy?
I used to be an academic teaching and researching political science. But about a dozen years ago I had an intellectual awakening when I came to realize that societies and politics didn’t simply change through new laws, institutions and policies but through changes in the way people treated each other at the individual level, especially through empathy. I define empathy as the art of stepping imaginatively into the shoes of another person, understanding the feelings and perspectives, and using that understanding to guide your actions. It’s a fundamental skill that almost all of us have, but we rarely fulfill our empathic potential, or work hard enough to harness the power of empathy to create social transformation. 
How do you think that empathy can help healthcare, both there in Britain and here in the US, where healthcare is a very politically charged topic?
It’s interesting to me that the origins of public healthcare in Britain can be traced back to an important empathic shift during the Second World War. Over a million children were evacuated from big cities to rural foster homes to escape the German bombs. And one of the unintended results was that relatively well-off rural folk suddenly had relatively poor city children thrust into their homes, and they could see the extremes of urban poverty with their own eyes: it was a moment of empathic understanding and awakening. There was huge public outcry and the government took immediate action, improving public health care for children, giving free meals in schools, vitamin supplements and other health care. This mass meeting of strangers was, in effect, the beginnings of the British welfare state – and it happened right in the middle of the war when resources were extremely scarce. There is a lesson here: that empathy sensitizes us to health care inequalities, and can spur social and political action to alleviate it.
Of course, healthcare reform is a very politically charged topic in the US, since it is so closely associated with the Obama administration. It was also Obama who started talking about America’s ’empathy deficit’ in the lead up to the 2008 Presidential Election. The American right then started critiquing the concept of empathy because of its links to Obama. Despite all this political complexity, I think empathy remains essential to the issue of healthcare. Why? The historical evidence points to the fact that empathy opens the door of our moral concern for neglected or marginalized social groups, and laws, rights and public policy wedge that door open, helping to universalize that moral concern. Healthcare, like other key areas of public policy, is one where we should be shining the light of empathy, trying to understand how different parts of society experience the public health system (or lack of it), and equally how they are impacted by the structure of private health care. It is only through empathising that we gather enough evidence, from enough points of views of different citizens, to design truly effective and socially just health care systems. Otherwise good healthcare becomes the privilege of a few, rather than the right of the many. 
The US is undergoing a sort of renaissance in healthcare information and technology. What do you see as the role of empathy in this area (more usage of smartphones, tablets and laptops vs. human interaction)?
 
One way to think about this issue is to look at the new wave of ’empathy skills training’ for doctors that has become popular in the last few years. Doctors are often criticized for being too clinical and emotionally detached from their patients. In 2010, doctors at a Boston hospital took part in an empathy skills program in which they were advised to pay greater attention to the changing expressions on their patients’ faces (for instance whether they showed anger, contempt, fear or sadness), to take note of voice modulations, and to make simple changes such as facing the patient rather than their computer screens during a consultation. After just three one-hour training sessions, doctors who went through the program showed vastly improved empathy levels. Their patients said these doctors made them feel more at ease, showed greater care and compassion towards them, and had a better understanding of their concerns. The doctors too could see the benefits. After spending a day putting the program’s methods into practice, one hospital doctor reported that while it was initially difficult to empathize with the patient while simultaneously making her diagnosis, eventually it ‘became fun’ and embodied the kind of personal interaction that had initially drawn her into medicine.
Now, what does this tell us? It would seem to suggest that it is person-to-person interaction that patients are after more than anything, and that this is the key to bringing more empathy into the sphere of healthcare. All the technology in the world doesn’t substitute for having a real human being treat you, look you in the eye, and hear your personal story.
 
That might make me sound pessimistic about the possible role that technology might play in empathic healthcare. Yet I also believe that if we get smart about using technology, it can help bring about an empathy revolution in healthcare. OK, almost everyone would rather have the doctor look at them rather than at their computer screen during a consultation. Yet just imagine if basic video technologies like Skype became a standard way for your doctor to visit you in your home to give post-treatment or post-operation check ups and advice. We need to learn to bring a little more intimacy into the way we use technology, especially social networks.
 
Do you foresee any upcoming empathy deficits?
 
The evidence is pretty clear that the US in a period of long-term empathy decline. A well-known study (Scientific American, December 23rd, 2010) revealed that US empathy levels are down nearly 50% in the last 40 years, with the steepest decline occurring in the past decade. So the empathy deficit is growing. At the same time we see rising levels of narcissism – around 1 in 10 Americans now exhibit narcissistic personality traits. There is also growing evidence that social networking technologies are exacerbating narcissism and contributing to empathy decline. There is a question about whether these trends are going to continue. I’m glad to say that there is a growing movement trying to address these problems by teaching empathy in schools. The most effective program, called Roots of Empathy, began in Canada and has now reached over half a million children worldwide.
 
Will we see more of these animations in the future? I think it is a great tool to get your message  across in a simple, entertaining and informative way.
My animation about empathy, The Power of Outrospection (produced by the Royal Society of the Arts in London) makes the case that empathy can be a powerful tool for social change. It’s fascinating how popular the animation form has become – this particular one has had over half a million views – and is evidence of the shift towards visual learning. I think we need to tap into our multiple intelligences when communicating ideas. For some people books are the most powerful, for others it will be animations, blogs or going to talk with a real live human being! Personally I plan to pursue all these communication routes in the future, including the animations – luckily for the world someone else does the drawing, since my drawing skills are in need of serious work!
Thanks for your time on this interview. Hopefully we see a much more empathetic world as we move forward in the 21st Century.
RomanKrznaricRoman Krznaric, PhD, is a writer on empathy and social change based in the UK. His latest book is Empathy: A Handbook for Revolution (to be published in the US by Penguin in November 2014). He advizes organizations including Oxfam and the United Nations on using empathy as a tool for social transformation and public policy. He is a founding faculty member of The School of Life, and founder of the world’s first digital Empathy Library. Website: www.romankrznaric.com Twitter: @romankrznaric

Healthcare’s sign of the times – Big Data, Analytics and Patient Profiling.

To profile or not to profile.Analytics and Big Data are in everything now. They are used for online couponing to analyze your buying patterns, in your (sic) email  and what your likes and dislikes are, in your browser with pop ups and in your social media. It has been in healthcare by the industry leaders, but was going to get more penetration as soon as the industry realized that they would have to get to know their patients through Patient Engagement initiatives as part of Meaningful Use Stage 2 where it is mandated that 5% of patients view, download and transmit their own health data, healthcare provider organizations who are concerned about that percentage of their patient population, can leverage analytics to help drive that engagement. Now that predictive modeling is the hot button topic of our healthcare IT times, I have given a lot of thought towards patient profiling and how that will progress over the years through better ways to collect, transform and present patient engagement data.

Building an enterprise data warehouse within a healthcare delivery organization brings together the many disparate systems that hold data become integrated into a single source of truth for operations, clinicians and the consumers of the data or analytics. The ability and focus now by many in the healthcare ecosystem that the way to progress is through the process of integration of disparate data, much also from legacy systems where the data was never was never clean and easy, but organizations now think that having this data will give them an edge in a newer, more cost conscious care delivery ecosystem

How much of a risk are you really and how effectively can a care dlivery organiation manage their costs and quality of care when dealing with a patient that may have the likelihood of hospitalization and possibly be re-admitted in the near future and a risk to the organization, especially for an ACO?

Physicians have the opportunity to prevent these patient readmissions utilizing profiling techniques that currently, may be exactly what large CPG or retail organizations already do well. Making sure that the ED (Emergency Department) as one of the most expensive locations for care that an organization has the ability to be increasingly efficient without losing the high quality of care that it requires to be for the community. Being able to keep patients away from using the ED’s facilities and be able to have regular ambulatory visits by identifying their conditions or health characterists early on and leverage newer technologies such as tele-health (Ohio HB 123 was recently passed here in Ohio covering just that topic and effective 5.20.2014) can lower the costs for an ED and make the delivery of care more efficient and target care for specific, previously identified patients more pro-actively.

Profiling can allow a physician to help lower the cost of medications that a patient is prescribed by reviewing and substituting equivalent, lower costs medications for the patient based on the information at hand. Medications account for one of the highest areas of healthcare costs today.

I sum up today’s blog post by reminding everyone that whether you work for or are a healthcare provider, a vendor, a professional services firm or a consumer of healthcare services, you have your work cut out for you. My encouragement goes out to everyone as I know and have seen how busy your day to day lives are and I have also seen how EMR teams, reporting and analytics teams and functional managers are tasked with many times doing the seemingly improbable tasks of getting all of the work effort completed in the short time frames that they have and somehow, it all comes together. For those of you in a state (clue, NC) the South East coast, United States who I know have gone Big Bang at all locations with everything live this past Friday morning with your EMR, my hats off to you, for you are one of those teams that have worked countless hours to make the seemingly impossible, seem doable. Collaboration and good team dynamics is the key. Don’t forget that!

Oh, and if you are viewing this from an XP machine after April 8th, well, you better unplug your computer from the internet because Microsoft has stopped supporting XP. Talk to your IS&T team if you are in an organization and think about options for a different platform.