When you hear healthcare, anywhere in the world, what words come to mind?  

Would you use the words interconnected, unified or synergies? That’s unlikely and it's because healthcare is fragmented, it’s messy and this is pre-pandemic. On the coalface - the clinicians, the humans, on the front line, there’s only so much pressure a person can take. Clinician burnout is a real thing, so what do we do?

In this episode, Pete talks with Dr Travis Bias from 3M’s Health Information System Division about how we can reduce the administrative burden for clinicians to free up more time to care for patients. Pete and Travis talk about this issue of burnout and how it’s impacting clinicians across the world and here in Australia. They also explore the technology that can be used now to improve things for clinicians, healthcare systems and patients. 

Who is Dr Travis Bias?

Dr Travis Bias is the Medical Director of the Clinician Solutions (3M M*Modal) team within 3M’s Health Information Systems Division and is currently based in Denver, Colorado. He is a family medicine physician. Travis has also taught medicine in central Kenya and Eastern Uganda and he has served as a lecturer in Comparative Health Systems and Global Health Diplomacy at the George Washington University and University of California Berkeley Schools of Public Health. 

Within 3M, he previously served in a clinical operations consulting role as a Clinical Transformation Physician Consultant within the Performance Matrix consulting team. Travis has worked in multiple clinical settings, including a small single-specialty practice and he has also done some telemedicine. 

Clinician Burnout

There are two major areas that pose a problem within the health system. First, there is an extraordinary amount of competing demands on the time of doctors. In certain settings, clinicians can feel pulled in several directions. They have to manage urgent patient visits, patient phone calls, charts, electronic medical records, phone calls from the specialists and more. 

Secondly, throughout a clinicians day, there are numerous interruptions that require cognitive task switching, which can negatively impact the doctor's stress level and the completion and quality of work they were doing before the disruption. Many of these disruptions are numerous administrative or clerical tasks that doctors are expected to perform but were not trained for and may not be the best team member to perform. Then there is a layer of new technologies, which in some cases are burdensome to contend with and the number of tasks and clicks throughout the day may become stress-inducing for the average clinician.

Then on top of all that is already happening comes COVID-19, a once in a century pandemic. Therefore, frontline clinicians are understandably stressed, and as such, health systems and their leaders are more focused on improving the work environment of their clinicians in order to better serve patients. 

Over the last fifteen years, the World Health Organisation has been helping to better define the issue of burnout; however, since the pandemic, it has received a lot of attention. Consequently, health leaders are now focused on addressing burnout directly and indirectly. In the United States, there are different wellness initiatives that focus on offering doctors resources for yoga, free laundry services or increased individual resilience training. 

Right now, clinicians want solutions that will indirectly remedy the issue, which includes tools to simplify their workday. Though there are individual challenges that contribute to the overall problem, we need to recognise that burnout is a multifactorial issue. So, there is a need to change the way burnout is spoken about. No matter where you are in the world, burnout boils down to the fact that healthcare workers simply want the time and the tools to do their job efficiently. They were trained to perform at a high level to care for others and when there is a lack of time and tools, like adequate staffing on teams, medications or supplies, it becomes incredibly deflating.

This lack will cause the migration of care workers to other areas of healthcare or outside of the sector entirely. That then, of course, exacerbates existing health workforce issues, shortages, and stress in communities all over the world.

Integrating the Electronic Medical Record within the Hospital Setting

The electronic medical record is where clinicians spend the bulk of their time. The EMR has been great at delivering on its promises to help clinicians retrieve necessary information at the right time, improve quality of care, improve communication between health workers and even improve the communication between them and their patients. In the US, there have been many challenges with the EMR rollout though it was originally thought that the EMR would bring better care. Though the EMR has assisted with improving care delivery, it has applied unnecessary stress on clinicians and taken much of their time with significant data entry demand. 

The EMR’s success is dependent on how it is configured and implemented and how an organisation's leadership supports and directs its usage. 3M is working to strengthen the information collected in the EMR to help clinicians work more efficiently within the EMR. The company intends to make that technology mould to the way a doctor organises their thinking, rather than forcing the doctor to fit within the confines of the EMR.

The goal is to move that technology further into the background so clinicians can focus their attention on building those rewarding and craved human connections with patients. 

Technology to aid with Clinician Burnout

3M’s goal is to address the time and attention deficit by leveraging the latest technology to improve doctors’ efficiency in handling information, gathering documentation and in triaging, some of those tasks to the right healthcare team members. There is information that is crucial to billing and budgeting that comes from the doctors’ reports, so inaccurate documentation can significantly affect the information available to the health system.

3M leverages its natural language processing with a rule-based AI engine, which they use to proactively deploy nudges within the electronic medical record in real-time to help fill gaps in documentation that need filling. This helps to improve physicians efficiency so they can focus on higher-level complex tasks. The engine is built on internationally recognised ontologies, such as SNOMED. 

Over four hundred clinical rules have already been built and early adopters in the US typically roll out about five of those rules per specialty group at any given time. This means that, for example, cardiologists might get the rules that are cardiac-specific, while GPs would get the general rules. These rules are customisable and 3M has adoption specialists that will work with organisations to create rules that better align with local initiatives. These tools are integrated directly into the EMR and work quietly to improve clinician workflow. Additionally, the technology is suitable for bolstering the efficiency of any clinical documentation specialists or coders within the hospital environment.

New and Emerging Technologies

It would be ideal to get to a place where technology is either directly or indirectly augmenting that patient-doctor interaction and that’s exactly what 3M is working toward. The company will build on its strengths from prior work to get to a point where the attention and the visit between doctor and patient are focused on building that human connection that patients crave. 

This is a great point to start with addressing burnout so that we can get to a place where doctors are not tied to the computer screen or technology. They are able to focus on the patient in front of them. The key is to build solutions that make the clinicians’ workday easier.