Dr Chris Hobson, Chief Medical Officer at Orion Health, discusses how the planned delivery of a shared care record opens the door to improved health services across Ireland by alleviating pressure on overburdened clinicians.
Medicine is one of the most rewarding career paths, but current workloads are relentless. The imperative to prioritise the needs of patients while battling slow legacy technology leads to clinicians working overtime, struggling to come to terms with hard-to-use technology. The combination of factors strains their physical and mental health as a response – exacerbated by the continual expectation to do more with less.
Clinician burnout is a significant problem across healthcare organisations. Reports show that it is increasing, with nearly half of senior doctors in Ireland reporting high burnout levels, and it is not just the clinicians who are experiencing burnout but also patients and their caregivers.
One of the main contributors to this pressure is the obstacles caused by difficult-to-use digital systems and bureaucratic processes that do not contribute to helping the care of patients. A recent study found that 58% of clinicians reported feeling burned out1 and a further study in the British Medical Journal found that Hospital doctors in Ireland have higher burn-out measures than their international peers.
Pioneering progressive ways to develop and use information technology could ease this situation.
Better access to more timely information will reduce clinician stress:
The same study found that 80% of clinicians cited Electronic Health Records (EHR)2 as contributing to their burnout due to limited information availability and difficulty using even the information they can access.
An EMR often contains only a summary of a patient’s history created from their hospital medical record, and it is now widely understood that it does not provide a complete picture of a patient. For example, it may not include previous test results, diagnoses, or data from touchpoints with other services such as mental health organisations or specialist treatment centres. In Ireland, it is also unlikely to include the GP medical record data, such as repeat medicines for long-term conditions or allergies and alerts captured in the community, and this data is often not available from other sources at the point of care.
The limited external data available in an organisation’s EMR means that clinicians often have to spend a significant amount of their time with a patient asking them to repeat their health history or re-ordering tests and investigations that have already taken place. Patients deserve better than this, and so do those involved in delivering their care. In this age of digital revolution, this extra admin work is unnecessary and laborious and delays treatment and discharge – factors that undoubtedly contribute to feeling overwhelmed, frustrated, and mentally and physically exhausted.
Another study found that clinicians spend 49% of their work hours on clerical tasks and interfacing with the EMR, and only 33% of their time performing clinical work.A Shared Care Record (SCR) adds real impact and value. This works alongside an EHR, pulling data from all the relevant health and care settings, creating a comprehensive longitudinal view of their care. Clinicians and care providers can see a complete history of a patient’s interactions with other services, test results, diagnoses, medications, care plans, allergies and more, enabling them to make better decisions on their ongoing care.
One study found that clinicians spend two hours on clerical or EHR-related tasks for every hour of clinical work. An SCR can improve this ratio by ensuring that the correct data is readily available in the right place at the right time.
How a Shared Care Record can alleviate clinician burnout in Ireland:The Health Information and Quality Authority’s recent report found that although there are some very successful examples of Health Information Technology deployments in Ireland, including the National Electronic Referrals programme and the National Integrated Medical Imaging System (NIMIS) nevertheless, Ireland continues to lag behind other European countries.
Reports point to a range of deficiencies and sub-optimal use of information. In particular, there are gaps and limitations in health data’s coverage, scope and granularity, especially in primary care, community care, social care and population health.Additionally, the literature confirms that accessing a shared care record is a critical part of an overall shared care delivery strategy and contributes to significant improvements in Primary Care engagement.
The government of Ireland recently announced the planned implementation of an SCR across HSE healthcare settings. An SCR in Ireland could collect and record care information and a patient’s history, painting a complete patient journey across all HSE-relevant touchpoints. This would have the potential to significantly alleviate clinician burnout by providing ready access to a comprehensive view of high-quality patient data, digitising care coordination and transfers of care, and enabling better-informed decisions at the point of care. It could also provide real-time feedback and alerts to help identify potential issues and facilitate communication and collaboration among care team members. An SCR has the capacity to deliver a seamless transition between population-level care and individual care.
Standard office-centric EHR/EMR use strongly correlates with physician frustration, time-wasting and poor physician satisfaction. In this study almost two-thirds of the physicians agreed or strongly agreed that EHRs add to the frustration of their day (64.2%). Frustration with the usability of EHRs was the most commonly cited HIT-related stress measure in almost every specialty, with the highest prevalence among emergency physicians (77.6%). Difficulty completing essential forms without the necessary information at hand is just one example of a challenging task arising from lack of an SCR.
An SCR helps address these issues significantly by easing the burden of finding comprehensive information and organising it to facilitate physicians’ ability to find the right information as and when they need it. The SCR will also address the issue of EHR usability by delivering the right data at the right time, allowing clinicians to make informed decisions more efficiently.
The opportunity for Ireland:Looking internationally, there is a mixed tapestry of SCRs in place across other nations, that have grown up over years or even decades. In many cases, they are now using severely outdated technology that does not support population health management. The opportunity in Ireland coming at this afresh is to partner with an SCR supplier that can deliver not only today’s ambition to join up information but also a platform capable of harnessing the patient data within the SCR for population health management in the future.
For the SCR programme to be successful in Ireland, getting the digital nuts and bolts right is essential. Naturally, there needs to be a cultural shift and process changes toward working effectively in a shared care practice model. Moving to such a model requires focused and engaged clinicians. The right supplier will need to work closely with clinicians and programme leads, approaching the project compassionately and empathetically to understand healthcare providers’ challenges across HSE fully. By engaging with stakeholders correctly, you pave the way for strong user adoption and faster time to value for the SCR. Once this exciting new SCR programme is in place, Ireland will have all the ingredients necessary to become an international SCR exemplar.
We can create the future of care:Simply put, to reduce the burden on HSE’s clinicians, patient data must be available in the right place at the right time. It must be comprehensive and readily available to the people delivering care.
Additionally, HSE and the SCR supplier should foster innovative ideas as the SCR evolves and delivers on the promise to alleviate burn-out for staff by better managing the population’s health.
