April 25, 2017

Protecting the Core of Physician Practice in a Time of Technological Change

In March 2017, 150 people from around the world gathered at Brown University’s Alpert Medical School for a weekend to participate in “The Patient, the Practitioner, and the Computer: Holding on to the Core of Our Healing Professions in a Time of Technological Change,” an international conference exploring the impact of the electronic health record (EHR) on the patient-practitioner relationship – primarily sponsored by the  Physicians Foundation. Betsy Toll, MD, Clinical Associate Professor of Pediatrics and Medicine, Warren Alpert Medical School, Brown University, discusses the findings from this conference.

The United States is experiencing a growing epidemic of physician burnout and professional dissatisfaction with more than 50 percent in the profession reporting feelings of burnout. A leading cause of physician burnout? The electronic health record (EHR).

While many studies have examined the pain points of EHRs including complex software and documentation requirements, few have tried to answer the question: How has the EHR affected the relationship between patients and practitioners? At a unique conference in Providence, Rhode Island, we aimed to do just that.

In March, 150 people from around the world gathered at Brown University’s Alpert Medical School for a weekend to participate in “The Patient, the Practitioner, and the Computer: Holding on to the Core of Our Healing Professions in a Time of Technological Change,” the first-ever international conference exploring this subject – primarily sponsored by the  Physicians Foundation. We built the conference around four themes: (1) What We Want: Aspirations. (2) What We Have: The Current Landscape. (3) Where We Want to Go: Future Directions. (4) The Big Picture: Healthcare Stakeholders and Government.

Preceding the conference, a half-day practitioner wellness session conducted by national mindfulness-in-medicine leaders Ronald Epstein, MD and Michael Krasner, MD, focused on specific tools and strategies practitioners can use to manage fractured attention, mental fatigue, and typical frustrations arising from EHR use. This event set the stage for the conference itself – exploring how to use technology to improve (rather than detract from) the patient-practitioner relationship.

At the conference, we invited speakers from all over the world to present 15 minute talks, during which they shared personal experiences and research about human connection and communication, attention during EHR use and effective integration of computers in clinical care. Their diverse backgrounds allowed conference participants to consider each theme from several angles.

Over the course of the weekend, the United States’ EHR experience was compared and contrasted with that of other countries. Speakers from Canada, the United Kingdom, Denmark, Portugal, Israel and Australia described EHR development and implementation in their respective nations, emphasizing that the change from paper to EHR has been challenging everywhere.

However, it was clear the United States has had a particularly painful transition since many commonly-used EHR systems were designed for billing and regulation, rather than patient care. This has led to excessive documentation – a problem many other countries have not experienced. 

Overall, participants were fascinated to hear the international perspective, finding that it broadened their understanding of some of the challenges of the United States EHR while offering practical solutions and ideas for addressing roadblocks. They were intrigued by innovative ideas about teaching EHR use, involving patients more directly in their care, and delivering care in teams.

Finally, the conference brought home the need for improved communication and advocacy by all stakeholders, starting with patients and practitioners. This will help practitioners to return their full attention to patients while leveraging the many benefits of technology for the care, education and safety of all involved. Restoring connection and communication between patients and practitioners to the center of care will, in turn, increase the satisfaction and wellbeing of both.