Health IT Summit in Chicago 2014 – “7 Ideas in 7 Minutes” with Sanaz Cordes, MD, COO, healthfinch

1. !
7 Ideas in 7 Minutes
!
Sanaz Cordes, MD, COO
healthfinch: The Doctor Happiness Company

2. Traditional
Primary Care Model
Cannot Survive

3. ½of physicians are
burnt out
ORIGINAL INVESTIGATION
Burnout and Satisfaction With Work-Life Balance
Among US Physicians Relative to the
General US Population
Tait D. Shanafelt, MD; Sonja Boone, MD; Litjen Tan, PhD; Lotte N. Dyrbye, MD, MHPE; Wayne Sotile, PhD;
Daniel Satele, BS; Colin P. West, MD, PhD; Jeff Sloan, PhD; Michael R. Oreskovich, MD
Background: Despite extensive data about physician
burnout, to our knowledge, no national study has evalu-
ated rates of burnout among US physicians, explored dif-
ferences by specialty, or compared physicians with US
workers in other fields.
Methods: We conducted a national study of burnout
in a large sample of US physicians from all specialty dis-
ciplines using the American Medical Association Physi-
cian Masterfile and surveyed a probability-based sample
of the general US population for comparison. Burnout
was measured using validated instruments. Satisfaction
with work-life balance was explored.
Results: Of 27 276 physicians who received an invita-
tion to participate, 7288 (26.7%) completed surveys.
When assessed using the Maslach Burnout Inventory,
45.8% of physicians reported at least 1 symptom of burn-
out. Substantial differences in burnout were observed by
specialty, with the highest rates among physicians at the
front line of care access (family medicine, general inter-
nal medicine, and emergency medicine). Compared with
a probability-based sample of 3442 working US adults,
physicians were more likely to have symptoms of burn-
out (37.9% vs 27.8%) and to be dissatisfied with work-
life balance (40.2% vs 23.2%) (PϽ.001 for both). High-
est level of education completed also related to burnout
in a pooled multivariate analysis adjusted for age, sex,
relationship status, and hours worked per week. Com-
pared with high school graduates, individuals with an MD
or DO degree were at increased risk for burnout (odds
ratio [OR], 1.36; PϽ.001), whereas individuals with a
bachelor’sdegree(OR,0.80;P=.048),master’sdegree(OR,
0.71; P=.01), or professional or doctoral degree other than
an MD or DO degree (OR, 0.64; P=.04) were at lower
risk for burnout.
Conclusions: Burnout is more common among physi-
cians than among other US workers. Physicians in spe-
cialties at the front line of care access seem to be at great-
est risk.
Arch Intern Med. 2012;172(18):1377-1385.
Published online August 20, 2012.
doi:10.1001/archinternmed.2012.3199
A
LTHOUGH THE PRACTICE OF
medicine can be incred-
ibly meaningful and per-
sonally fulfilling, it is also
demanding and stressful.
Results of studies1-3
suggest that many phy-
sicians experience professional burnout, a
syndrome characterized by a loss of enthu-
siasm for work (emotional exhaustion),
feelings of cynicism (depersonalization),
and a low sense of personal accomplish-
ment. Although difficult to fully measure
and quantify, findings of recent studies4-8
suggest that burnout may erode profes-
sionalism, influence quality of care, in-
crease the risk for medical errors, and pro-
mote early retirement. Burnout also seems
to have adverse personal consequences for
physicians, including contributions to bro-
ken relationships, problematic alcohol use,
and suicidal ideation.9-11
Despite the extensive data on physi-
cian burnout, to our knowledge, no na-
tional study has evaluated rates of burn-
out among US physicians. Although there
has been much conjecture about which
medical or surgical specialty areas are high
risk, this speculation has primarily been
based on comparisons across studies of
physicians from individual disciplines, for
which differences in sample selection,
study size and setting, participation rates,
and year of survey administration con-
found interpretation. The literature on
physician burnout is also hampered by a
lack of data about how rates of burnout
for US physicians compare with rates for
US workers in other fields.
Author Affil
Department
Medicine, M
Rochester, M
(Drs Shanafe
and Sloan an
American M
Chicago, Illi
and Tan); D
Orthopaedic
School of M
Orleans, Lou
and Departm
and Behavio
University o
Seattle (Dr O
Author Affiliations:
Department of Internal
Medicine, Mayo Clinic,
Rochester, Minnesota
(Drs Shanafelt, Dyrbye, West,
and Sloan and Mr Satele);
American Medical Association,
Chicago, Illinois (Drs Boone
and Tan); Department of
Orthopaedics, Tulane University
School of Medicine, New
Orleans, Louisiana (Dr Sotile);
and Department of Psychiatry
and Behavioral Sciences,
University of Washington,
Seattle (Dr Oreskovich).
ARCH INTERN MED/VOL 172 (NO. 18), OCT 8, 2012 WWW.ARCHINTERNMED.COM
1377
©2012 American Medical Association. All rights reserved.
Downloaded From: http://archinte.jamanetwork.com/ on 01/06/2014

4. CONFIDENTIAL
Forth-five percent
(45%) of the physician’s
day is spent outside of
face-to-face patient
care.
ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 3, NO. 6 ✦ NOVEMBER/DECEMBER 2005
488
Time Spent in Face-to-Face Patient Care
and Work Outside the Examination Room
ABSTRACT
PURPOSE Contrary to physicians’ concerns that face-to-face patient time is
decreasing, data from the National Ambulatory Medical Care Survey (NAMCS)
indicate that between 1988 and 1998, durations of primary care outpatient visits
have increased. This study documented how physicians spend time during the
workday, including time outside the examination room, and compared observed
face-to-face patient care time with that reported in NAMCS.
METHODS Using time-motion study techniques, for each of 11 physicians,
2 patient care days were randomly selected and documented by direct observa-
tion. Physician time spent on face-to-face patient care and 54 activities outside the
examination room were documented. Data represent 12,180 minutes of work and
611 outpatient visits.
RESULTS The average workday duration was 8.6 hours, and face-to-face patient
care accounted for 55% of the day. Work outside the examination room relevant
to a patient currently being seen averaged 14% of the day. Work related to a
patient not physically present accounted for one fifth (23%) of the workday. The
combination of face-to-face time and time spent on visit-specific work outside the
examination room assessed by direct observation was significantly less than the
2003 NAMCS estimate of visit duration assessed by physician report (13.3 vs 18.7
minutes, P <.001).
CONCLUSIONS Nearly one half of a primary care physician’s workday is spent on
activities outside the examination room, predominately focused on follow-up and
documentation of care for patients not physically present. National estimates of
visit duration overestimate the combination of face-to-face time and time spent on
visit-specific work outside the examination room by 41%.
Ann Fam Med 2005;3:488-493. DOI: 10.1370/afm.404.
INTRODUCTION
P
rimary care physicians have expressed discontent and concern that
face-to-face time with patients is diminishing and that their adminis-
trative burdens are increasing.1-3
Concerns are fueled by data suggest-
ing that shorter visits are associated with lower patient satisfaction4,5
and
possibly poorer quality of care.6
Recent findings from multiple data sources
indicate, however, that the duration of the visit in a primary care setting
is increasing,7
the number of patients being seen during an average week
is decreasing, and the number of hours spent working during the week
has remained the same.8
Specifically, longitudinal data using the National
Ambulatory Medical Care Survey (NAMCS) for the decade 1988-1998
indicate that physician-reported face-to-face interaction time has increased
2.0 minutes to an average of 16.3 minutes per encounter.7
NAMCS data
from 2003 indicate that among general and family physicians, the average
visit duration is 18.7 minutes.9
What could account for the discrepancy between physician perceptions
and national data? Data for the NAMCS are based on physician reports at
the completion of each sampled visit. Gilchrist et al10
showed that com-
Andrew Gottschalk, BS1
Susan A. Flocke, PhD2
1
Case Western Reserve University School
of Medicine, Cleveland, Ohio
2
Departments of Family Medicine and Epi-
demiology and Biostatistics, Case Western
Reserve University, and the Case Compre-
hensive Cancer Center, Cleveland, Ohio
Conflicts of interest: none reported
CORRESPONDING AUTHOR
Susan Flocke, PhD
11001 Cedar Ave, Suite 306
Cleveland, OH 44106-7136
susan.flocke@case.edu
Why physicians are
burning out?

5. Less PCPs
Growing Patient Panels
Traditional Primary Care Model
is NOT SUSTAINABLE!

6. Healthcare today
Who does the work?
Physicians
Staff
Protocols & algorithms
powered by technology
…and tomorrow

7. What Challenges Does
Primary Care Face?

8. Challenge: EMR Workflow
• Optimized for Data Collection
• Does not execute tasks based on
the data

9. Idea #1:
Workflow Automation
Powered by the EMR
•Transform the EMR from collecting data
to executing clinical tasks based on data

10. Example:
Automatic Scheduling
•EX: Patient on tegretol automatically
receives serum level scheduling
message annually —> lab interpreted by
technology —> any additional actions
necessary executed

11. Challenge: Too Many Tasks
for a Physician to
Complete in a Day
• PCP would need to spend 21.7 hours per
day to provide all the recommended
acute, chronic, and preventative care to a
panel of 2,500 patients!

12. Idea #2:
Task Delegation
Physician Staff
Protocols
Algorithms
Standing Orders
(Technology!)

13. Example:
Refill Protocols
•EX: Nurses relieve physicians of this
task by using technology (fueled by
protocols) to process refill requests

14. Challenge: Patient
demand for care exceeds
clinic capacity
• Patients experience delays in getting
appointments with PCPs

15. Idea #3:
Team Based Care
•Using nurses at the top of their license to
provide team based care to patients

16. Example:
Group Appointments
•EX: Nurses provide group appointments
to asthma patients (aerochamber, MDI
use, peak flow, asthma action
plan . . .etc)

17. Challenge: Traditional
PCP Encounter is Reactive
Annual Well Visit
Diagnostics Ordered
Diagnostics Reviewed by MD
Order Sent to Nurse for additional testing
Message sent to scheduler
Patient Notified to get additional test
Test Reviewed by MD
Message sent to nurse to call patient
Nurse calls patient with results

18. Idea #4:
Redesign PCP Encounter
to be Proactive
• Use technology to automate pre-visit
planning to queue up routine diagnostic
elements ahead of the patient encounter

19. Example:
Pre-Wellness Labs
•EX: Annual blood work is ordered and
completed by the patient prior to the
physician encounter so that results are
discussed real time

20. Challenge:
Healthcare is
Asynchronous
• Primary care offices are flooded with
asynchronous requests that use precious
staff resources

21. Idea #5:
Synchronize Care
• Technology-enabled batching &
consolidating of unrelated care elements

22. Example:
Medication Synchronization
Application
•EX: Using technology to synchronize a
patients various medications such that
all refills occur simultaneously

23. Challenge: Primary Care
Not Optimally
Standardized
• Varying treatment plans for the same
patient problem results in staff time wasted
and higher rate of errors

24. Idea #6:
Standardization
• Using technology to implement evidence-
based and best practice protocols/orders to
empower staff and drive efficiency and
quality

25. Example:
Strep Throat Protocol
•EX: Standardized protocol in place
empowering nurses to diagnose queue
up prescription order for strep throat

26. Challenge: Primary Care Not
Optimally Centralizing
Routine Processes
•One nurse may do 10 different types of
tasks per day

27. Idea #7:
Centralization
•Create “hubs” fueled by technology
where staff is executing the same
workflow without interruption

28. Example #7:
Centralized Coumadin
Center
•EX: Hub of nurses using protocols to
manage all coumadin patient across the
organization

29. Thank you!
healthfinch: The Doctor Happiness Company
!
www.healthfinch.com
Madison, Wisconsin
Scheduling Wizard
SynchWizard
Coumadin Wizard
TrackerWizard
LabWizard
RefillWizard
CareGap WizardWellness Wizard