The Heat of Administration
The national administrative costs which consume one-sixth of doctors’ time have been well researched and thoroughly documented; they comprise a staggering 25-30% of total healthcare expenditure. This figure is twice that of Canada’s and much higher than member nations of the Organization for Economic Cooperation and Development (OECD) [1]. Even though roughly 60% of these administrative costs can be attributed specifically to billing and insurance related documentation, the remainder can be accounted for by clinical documentation in the complex electronic medical record (EMR). Although EMRs are being developed to be less clunky, more intuitive and with better interoperability with other software, this has not improved the rates of physician burnout in the United States.
Between 2011 and 2014, the proportion of physicians suffering from burnout in the United States increased significantly, from 45.5% to 54.4% [2]. While physician burnout can be caused by a plethora of factors–including emotional exhaustion, lack of meaning or purpose, feelings of ineptitude or moral distress–administrative work is also a contributing factor. A study conducted in 2014 showed that more extensive use of the EMR was associated with an even greater administrative burden and consequently reduced physicians’ career satisfaction [3]. Many physicians articulate this problem by saying that they are “treating the data” and not “treating the patient” as they were trained to do in medical school. In this way, enhancements in technology have compromised the tangible and time honoured doctor-patient relationship in the name of efficiency.
Putting The Patient First
Research has also shown how administrative tasks or clinical documentation on the EMR can adversely impact patient satisfaction scores. A recent pilot study in 2018 found a statistically significant inverse relationship between daytime EMR usage and patient satisfaction score [4]. This is contradictory to the emphasis which was placed on patient satisfaction by the United States Institute of Medicine Report, which coincided with the rapid uptake of EMRs throughout the nation. However, a systematic review in 2016, which examined 53 studies that were primarily scoped to explore patient perceptions of EMR usage, found that there was no change in patient satisfaction or patient-doctor communication [5]. With these two studies in mind, it becomes worthwhile to take a step back and deliberate the utility of EMRs rather than lambasting them as the cause for physician burnout and poorer patient satisfaction scores.
Enhancing the EMR as a Tool
Findings from a study published in February this year reveal that the implementation of medical scribes increased efficiency in the paediatric emergency department without compromising on patient satisfaction scores. Physician feedback on medical scribes was also excellent [6]. Medical scribes are chiefly responsible for assisting physicians with accurate documentation using the EMR. They accompany physicians during routine patient consultations and document vital information, such as patient history, physical examination findings, investigations and interventions performed, and the management plan drawn up by the physician [7]. This live documentation enables and empowers physicians to take back what was initially lost from the implantation of EMRs – focusing on the patient and establishing good rapport [8].
The A.I Scribe
With this in mind, how can technology replicate, or even enhance this experience? Cronix is an interesting company that aims to fix a chronic problem by proposing a superior solution. Whilst the merits of a physical scribe cannot be understated, scribes are not bereft of problems. Firstly, there is the issue of confidentiality. Medical scribes are not medically trained personnel, and patients may be uncomfortable with another individual present in the consultation room who is privy to sensitive and protected health information. Secondly, medical scribes must learn how to filter information and document only what is relevant. Problems can arise when scribes copy wholesale swathes of information what is articulated by the physician, without processing it with higher-order thinking. This requires scribes to be trained, which is yet another time investment that could be considered an administrative task.
Cronix has developed an artificially intelligent voice recognition software which can be implemented into the EMR. This solution precludes the necessity for a physical scribe and is equipped to learn medical jargon on the go. Personally, I am excited about the value that Cronix can bring to the physician’s bedside manner and is hopeful about its future. This medical A.I application has promise in actually enhancing the doctor-patient relationship and enabling Doctors to do what they do best – practicing Medicine.
References
1. Tseng, P., et al., Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System. JAMA, 2018. 319(7): p. 691-697.
2. Shanafelt, T.D., et al., Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc, 2015. 90(12): p. 1600-13.
3. Woolhandler, S. and D.U. Himmelstein, Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction. Int J Health Serv, 2014. 44(4): p. 635-42.
4. Marmor, R.A., et al., The Impact of Physician EHR Usage on Patient Satisfaction. Applied clinical informatics, 2018. 9(1): p. 11-14.
5. Alkureishi, M.A., et al., Impact of Electronic Medical Record Use on the Patient-Doctor Relationship and Communication: A Systematic Review. Journal of general internal medicine, 2016. 31(5): p. 548-560.
6. Addesso, L.C., et al., Impact of Medical Scribes on Provider Efficiency in the Pediatric Emergency Department. Acad Emerg Med, 2019. 26(2): p. 174-182.
7. Miller, N., I. Howley, and M. McGuire, Five Lessons for Working With a Scribe. Fam Pract Manag, 2016. 23(4): p. 23-7.
8. Hess, J.J., et al., Scribe Impacts on Provider Experience, Operations, and Teaching in an Academic Emergency Medicine Practice. The western journal of emergency medicine, 2015. 16(5): p. 602-610.