By this time next year, Mayo Clinic will be well on its way to training 45,000 employees across its campuses in Wisconsin, Minnesota, Arizona and Florida to use Epic's electronic health records system. Whether that's a positive or a negative may depend upon who you ask.
Electronic health records have been hailed for years as a way to enhance coordination and improve quality of care, and Mayo was the most prominent early adopter. However, concerns persist about unintended negative consequences that could result in professional burnout.
Mayo Clinic's Tait Shanafelt authored a studylast month in Mayo Clinic Proceedings that further confirmed those findings. In collaboration with American Medical Association, Shanafelt surveyed more than 6,000 physicians across the country before determining that the increased clerical burden — particularly among family medicine physicians, urologists, otolaryngologists and neurologists — led to decreased job satisfaction and an increased risk of burnout.
Those findings aren't new, but they've helped the health care industry zero in on issues first identified by a landmark 2014 study conducted by the American Medical Association and the RAND Corporation.
"We need to find ways to incorporate EHRs, patient portals and electronic order entry in a way that does not increase clerical burden for physicians or reduce their efficiency," Shanafelt said recently of his study. "The national data indicates that computerized physician order entry is a driving factor in the relationship between the electronic environment and physician burnout. CPOE was associated with a 30 percent higher risk of burnout after adjusting for age, sex, specialty, practice setting and hours worked per week."
Though no Mayo doctors were made available for this story, the health care behemoth has already devoted years to tackling those concerns. It participated on a national task force that was created immediately following the 2014 study, while also developing its own User Experience Team in 2015 to assist with the Epic partnership, which is expected to last decades.
Among the most important findings were eight "usability priorities"that were spelled out last year to address the potential for professional burnout. The priorities include: enhance physicians' ability to provide high-quality patient care; support team-based care; promote care coordination; offer product modularity and configurability; reduce cognitive workload; promote data liquidity; facilitate digital and mobile patient engagement; and expedite user input into product design and post-implementation feedback.
Dr. Steve Peters, co-chair of of Plummer Project-Epic Implementation at Mayo Clinic, says that Epic has been responsive to the issues and is building its system to meet Mayo's specific needs, farther noting that Mayo's training strategy is "under development." Mayo Clinic Health System is expected to go live with Epic in the summer of 2017 in Wisconsin, fall of 2017 for MCHS in Minnesota, spring of 2018 in Rochester and fall of 2018 in Florida and Arizona, according to Peters.
A lot of work remains to be done until then, Peters said, but everything remains on schedule, despite the new study's findings.
"The goal is to understand the needs of users, what they need to do their work, and to evaluate how well the new system will meet those needs," Peters said. "Several hundred employees have been interviewed, shadowed, and observed. The User Experience team is collaborating with the rest of the Plummer Project team and Epic to optimize both the system and strategies for training and implementation."
Shanafelt's study listed a number of potential solutions that could ease physicians' clerical burden. They include adding medical scribes hired to follow physicians, delegating order entry to other members of the care team and a return to paper order sheets with electronic entry by clerks, among others.
Finding an equitable solution is critical within the medical field, but especially so for Rochester. It's projected to add around 30,000 health care professionals over the next 20 years through the ambitious $6 billion Destination Medical Center project. Many of those new employees will be physicians charged with tracking electronic health records.
"The specific strategy probably used likely matters less than recognizing that physicians should not be doing this, and finding a practical way to have this task completed by support staff," Shanafelt said.