On the Record: The Diagnosis of Administrative Burden

By: Leyna Hoang, Biological Sciences, ‘27

There is a secret that is not taught to medical students that they will soon face when they graduate. The number one cause of physician burnout in the United States is not the stressful situations, the emotional toll, or even the difficult patients, but rather the hidden evil: the administrative physician burden. 

While many physicians enter the field to do what they love by seeing patients, they are rather buried with mindless busy work that prevents them from doing the job that they signed up for. According to a study done by Palo Alto Medical Foundation Research Institute, it was discovered that for every hour of seeing patients, an additional hour of desktop medicine, “activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results” is required [1]. As a result, many physicians reported that “that administrative duties negatively affect their ability to deliver high-quality care” [2]. 

How did administrative work become such a big problem? The electronic health record (EHR) is the major problem and it typically falls under the phrase “tyranny of technology.” It is important to note that the EHR does provide many benefits and it has great potential to be a tremendous asset to efficient and effective medical care. Although many believe that EHR will save money, reduce stress, and get rid of paper, the opposite is revealed. The number one complaint from healthcare professionals is that EHRs have poor usability, which “correlates with poor performance in terms of safety” [3]. Since the EHR is not something typically taught in school, physicians face a learning curve when using the EHR, introducing the possibility of mistakes. This has led to as many as 400,000 injuries per year from medical errors that occur due to the EHR [3]. Apart from the mistakes of physicians themselves, the system itself is not always 100 percent reliable at recognizing inaccuracies. The EHR failed to detect up to 33 percent of medication errors as well [4]. Not only is this administrative burden harming physicians through burnout, it also directly affects the patients through their physical health and the patient-doctor relationship. . The EHR strains the patient-doctor relationship because doctors must shift their focus towards entering patient responses in a computer, as opposed to engaging in conversation with the patient.

The EHR needs to be improved for the mental health of future and current physicians as well as the wellbeing of patients. Some possible solutions are supporting team-based care to not put the burden on one specific person, promoting coordination to help track referrals to make care less costly and more patient-centered, and improve overall communication to keep the purpose of the EHR on the patient’s needs [5]. This change will make care less costly and more patient-centered because it will reduce the amount of repeat tests and will make diagnosis more straightforward because of the clear and concise patient record. Ultimately providing faster and better treatment to patients. Making these small changes will completely transform healthcare and evolve the EHR to be as beneficial as it was created to be. The EHR can truly be a powerful tool and change the workload of physicians for the better. As a result, the administrative burden will decrease and physicians can continue to do what they love and save lives. 

References

1. Tai-Seale, M., Olson, C. W., Li, J., Chan, A. S., Morikawa, C., Durbin, M., Wang, W., & Luft, H. S. (2017). Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine. Health affairs (Project Hope), 36(4), 655–662. https://doi.org/10.1377/hlthaff.2016.0811  

2. Rao, S. K., Kimball, A. B., Lehrhoff, S. R., Hidrue, M. K., Colton, D. G., Ferris, T. G., & Torchiana, D. F. (2017). The Impact of Administrative Burden on Academic Physicians: Results of a Hospital-Wide Physician Survey. Academic medicine : journal of the Association of American Medical Colleges, 92(2), 237–243. https://doi.org/10.1097/ACM.0000000000001461  

3. Communication, M. and. (2023, September 11). When electronic health records are hard to use, patient safety may be at risk. University of Utah Health | University of Utah Health. https://healthcare.utah.edu/press-releases/2023/09/when-electronic-health-records-are-hard-use-patient-safety-may-be-risk#:~:text=%E2%80%9CPoor%20usability%20of%20EHRs%20is,performance%20in%20terms%20of%20safety.%E2%80%9D  

4. Communication, M. and. (2023a, July 5). Electronic Health Records fail to detect up to 33% of medication errors. University of Utah Health | University of Utah Health. https://healthcare.utah.edu/press-releases/2020/05/electronic-health-records-fail-detect-33-of-medication-errors  

5. American Medical Association . (2014). Priorities to improve electronic health record usability. American Medical Association . https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/member/about-ama/ehr-priorities.pdf