Information overload and physician burnout: a KevinMD panel discussion [PODCAST]

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Welcome to a special episode of The Podcast by KevinMD.

In this 60-minute episode, I partner with DrFirst, a pioneer in health IT for over 20 years. We bring together physicians with different backgrounds to explore information overload and physician burnout.

Dr. Sameer Badlani is chief digital officer, M. Health Fairview, a major health system in Minnesota. He is also adjunct faculty at Carnegie Mellon University.

Dr. Colin Banas is chief medical officer, DrFirst. He was an internal medicine hospitalist and served as the chief medical information officer for VCU Health System in Richmond, VA.

They share their stories and discuss the following questions: Based on your roles as physicians and as leaders in health IT, what are your insights into what is contributing to clinician burnout? How did you look at it differently when you became a tech leader? Did your perspectives change? Does tech sometimes contribute to burnout? How can tech best help burnout? What advice do you have for docs? For other IT leaders?

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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Transcript

Kevin Pho: Hi, and welcome to a special episode of The Podcast by KevinMD. In this 60-minute episode, I partner with DrFirst, a pioneer in health IT for over 20 years. We bring together physicians with different backgrounds to explore information overload and physician burnout. Dr. Sameer Badlani is chief digital officer at M Health Fairview, a major health system in Minnesota, and Dr. Colin Banas is chief medical officer at DrFirst. They share their stories, and we discuss information overload and physician burnout. As always, you can earn one hour of Category 1 CME by clicking on the CME link in the show notes. And now on to the show.

From KevinMD, I’m Dr. Kevin Pho, and this is The Podcast by KevinMD. Welcome to The Podcast by KevinMD, where we share the stories of the many who intersect with our health care system but are rarely heard from. Here’s your host, Dr. Kevin Pho.

Hello, and welcome to the KevinMD and DrFirst webinar on information overload and physician burnout. It’s been there for some time, and not aggravated by the pandemic. DrFirst, a pioneer in health IT for over 20 years, is bringing together three physicians with different backgrounds to explore this issue and share their unique perspectives.

My name is Kevin Pho, founder and editor of KevinMD. I’m also a practicing primary care internal medicine physician in Nashua, New Hampshire. Joining me on this webinar today is Dr. Sameer Badlani. He is chief digital officer and executive vice president for technology services at M Health Fairview, a major health system in Minnesota. He is also adjunct faculty at Carnegie Mellon University. Also, we have Dr. Colin Banas, chief medical officer for DrFirst. Dr. Banas was an internal medicine hospitalist and served as the chief medical information officer for VCU Health System in Richmond, Virginia.

So one of the things that we do want to mention is that we have a lot of different perspectives on this call. Dr. Badlani is a chief digital officer at a major health system, with a background, of course, as a clinical physician. Dr. Banas transitioned from a physician to CMIO to a leader at a thriving health IT company. And of course, I’m a practicing internal medicine physician, and through the physician authors at KevinMD and on my daily podcast as well, I listen to and share the stories of the many who intersect with our health care system but are rarely heard from.

So what I’d like to do today is really start by just sharing our stories so the audience can know us a little bit better, and then we’ll get right into the panel discussion. So I can certainly go first. Once again, my name is Kevin Pho, and I’m the founder and editor of KevinMD. I’ve been practicing primary care for almost 20 years now, and I’m proud of the platform that I started back in 2002. It’s really a platform where physicians can share their stories of what goes on behind the scenes and talk about some of the rewards, joys, and frustrations of practicing medicine, and it’s really charting the evolution of digital health and social media.

And I combine that with my clinical duties as an internal medicine primary care physician, and it’s been so gratifying, not only seeing patients in the exam room but also influencing them outside of the exam room. As we know, more and more patients are going online, especially during the pandemic, to research health care information. And I do think it’s more important than ever for every clinician to also go online, so we can help guide patients through this digital health landscape.

And next, I want to introduce Dr. Sameer Badlani. Perhaps you could share your story and journey to where you are today.

Sameer Badlani: Thank you, Kevin. It’s wonderful to be on this panel with you and Colin. So I started my journey as an internist. I was faculty at the University of Chicago. It was a wonderful experience, practicing medicine and teaching medical students and residents, and I happened to have a fellowship in informatics. I use that terminology because there wasn’t a grand plan when I went for that fellowship. But the health IT wave hit my career at the right time. Meaningful use stage 1 became a big deal, and I realized a lot of my fellowship training applied directly. That led to wonderful opportunities: first to be the CMIO at the University of Chicago, then chief health information officer at Intermountain Healthcare, then roles at Sutter Health, and finally, now, chief digital officer at M Health Fairview.

I get to combine technology, design, and transformation, and work on the intersection of health care and technology in service of the patients we serve, and also in service of the employees and the clinicians and the nurses who proudly take care of patients at M Health Fairview. So it’s very satisfying. I do enjoy teaching a lot, so I still do some at Carnegie Mellon, and I’m very grateful to them for that opportunity. I also advise startups and VCs on new product and company development.

Kevin Pho: And Sameer, you made that transition from a clinical role into a technology role. Tell me some of the challenges you faced in making that transition and some of the challenges that you’ve overcome.

Sameer Badlani: Well, the first one was convincing my mother that I hadn’t given up on a wonderful career and that I would be able to feed myself. So that was definitely the first challenge. The second one was at a personal level, trying to tell myself, “I’m still a clinician.” Our identities as clinicians, I know you and Colin get that. For a very long time, we desire to be doctors, then we spend a lot of time becoming doctors. And then after 15 years of practicing, approximately, to say, “I’m going to take my career in a different direction,” felt like a very interesting and bold move.

But it’s been very gratifying, Kevin. Everything I do is in service of health care. Earlier, if I got something right, I’d maybe help 5,000 patients, because I was on the transplant service. Now if I get something right, many more thousands, maybe a million patients, can benefit from that. So the scale of what I can impact has definitely increased, and that’s very satisfying.

On the other hand, I used to say I’ve stopped practicing clinically. But these days, as many of us experience through social collaboration tools and social media, I now have friends and family, and their relatives and their friends and families across the world, reaching out to me, especially in COVID times, for all kinds of second opinions. So I somewhat jokingly, but mostly seriously, say I now have a global concierge second-opinion practice that’s pro bono. So I still get to contribute to helping people on their wellness and health care journey, and that’s tremendously satisfying.

Kevin Pho: Wonderful. And next, we have Dr. Colin Banas. He is the chief medical officer at DrFirst. Colin, can you briefly share your story and journey to where you are today?

Colin Banas: Yeah, I love how Sameer put that phrase about the timing of the health IT boom intersecting with career aspirations. So, much like Sameer, I went to VCU Health to do my residency training, actually, and didn’t know what I was going to do when I grew up. So I stayed on as faculty as a hospitalist, but I also immediately pursued a master’s degree in health administration, because I wanted to do more. I didn’t know what that more was, but there was something there.

I had a couple of roles, things like medical director of care coordination and utilization management. But really, as luck would have it, what came across my desk was an opportunity to contribute to our electronic medical record and provide clinical input. This was well before meaningful use, actually. We were already well adopted on a pretty major EMR, but we recognized that there wasn’t a lot of clinical input. The doctors, the nurses, everyone was sort of boxed out of how to make this thing better. And so my colleague and I actually formed what we called the Office of Clinical Transformation. We got some approval from the dean and some money and actually grew an informatics program, sort of from the ground up.

From there, I was second in command for a number of years, and then, as my mentor and colleague moved on, I became the chief medical information officer, and I did that while practicing hospitalist medicine for a good 10 years. And then finally, within the last two and a half, three years, I transitioned over to the vendor side to try to make an impact at scale, as Sameer was mentioning, from that side of the fence. So you have a pretty diverse panel of physicians who have done other things aside from just clinical medicine. It should be a good conversation.

Kevin Pho: So as a practicing physician, I often don’t know what goes on on the vendor side. You’ve been working for DrFirst for a while now. So what’s something that you’ve learned while working for DrFirst that you didn’t know while you were at VCU?

Colin Banas: I’m surrounded by good people. I think a lot of times the vendor side can get a bad rap for chasing profits or trying to push sales. But I am at a company where genuinely everyone has an altruistic sense of making the product better, because it makes patients better. And so, and I used the air quotes earlier, it is not the “evil empire” of the vendor at DrFirst. It is a wonderful company to work with. Honestly, I started as a consultant with the company and quickly realized that I was enjoying it, and that’s why I made the permanent transition over to become the chief medical officer.

Kevin Pho: Wonderful. All right, so let’s jump into our webinar here, and the title is “Information overload and physician burnout.” We know that the burnout statistics are approaching 50 percent. Fifty percent of clinicians are experiencing symptoms of burnout today, and that was even before the pandemic, and who knows what that number is after the pandemic. Physicians and other clinicians have been facing challenges with burnout, and of course, it’s only getting worse.

So our first question today is: Based on your roles as physicians and leaders in health IT, what are your insights into what is contributing to clinician burnout? Sameer, why don’t you take this question first?

Sameer Badlani: Sure. A lot of times we hear statements like health IT or electronic health records contribute to physician burnout, or are singularly causing physician burnout. I’ve had that expressed to me many times over the last almost 15 years. I would say yes, you could say partially the work associated with using an EHR can be pointed to, but it’s not the singular cause of clinical burnout. That’s something that I have personally experienced and have had to manage through.

One of the things that I like to point out is that the EHR is the window through which we surface all kinds of compliance, documentation, and quality improvement requirements to our clinicians. So if those requirements were on paper, would we say that paper is the reason why we are facing burnout? So we have to separate a gap in the usability of EHRs, which is definitely something to work toward, and then also the fact that the EHR is used as a methodology to surface different kinds of requirements that we clinicians face in practicing medicine in America, which often don’t exist in other countries and which have contributed to the clinical burden. So that’s one aspect.

The second thing that I firmly believe has caused burnout in clinicians is this creation of shift work. Both Colin and I were hospitalists; he’s still a hospitalist, sorry, Colin. One of the things that I found interesting from my training days to my practicing days is the loss of the physician lounge culture. That was the place where senior physicians met with junior physicians. You met with your friends. If you were on a weekend call that nobody liked to do, you probably waited 15, 20 minutes, had a cup of coffee, and then you moved on. So the social fabric of the physician community, and the mentorship and support model, I think really started disappearing when we turned medicine into a shift model.

And I’ll be the first one to say that I fully understand and support why the shift model was created. It’s a non-trivial gap that that particular modification to our work schedules created. But it also had the unintended consequence of really starting to degrade the social fabric that was a support system for many of us physicians. I look back to so many fond conversations with doctors who were at the cusp of retirement when I was in my first or second year of being faculty, as an attending. So that’s the second area that I think is an issue.

The third one that contributes to physician burnout is that we’re going through this tremendous evolution in how health care is being delivered, and physicians, nurses, and other care delivery people, and in this case I’ll put the entire clinical care team under the microscope, have become the human glue that allows patients to receive some semblance of continuity of care. Every day I’m surrounded by clinicians and nurses and care team members who go above and beyond to make things work. So we have compartmentalized aspects of health care in ways that I think have led to all the pressure being put on clinicians.

And that’s what leads to the information overload. You as a clinician have to see this, you have to see that report, you have to see those results, and that consumes time and often takes you away from the interaction that’s so sacrosanct between a clinician and a patient. Those are the things that, in my mind, if I were to break it down, have really contributed to the burnout.

Kevin Pho: Sameer, one of the things that you mentioned in your first point is that you want to separate the EHR from some of the other pressures that may be contributing to burnout. So what are some examples of these other pressures outside of the EMR that you’re talking about?

Sameer Badlani: Yeah, so I’ll start with one that I’m very passionate about and focused on, which is meaningful use. Meaningful use as a construct is fabulous. The idea that we want to create a carrot-and-stick program that promotes the use of information technology and analytics in health care, that’s a great idea. Meaningful use stage 1 was perfect. It gave us a lot of incentive to get going. The requirements were at a low level, so you were not prescribing how the EHR was used in every health care system; you really wanted to get people to a starting point.

I think as a country, we started losing the plot at stage 2 and definitely lost it at stage 3, because it just became full of checkbox medicine. You had to do 10 percent of this, 15 percent of this, and 80 percent of this. And people like Colin and me were put in this unenviable position of selling that federal requirement to our clinical colleagues and trying to sugarcoat it as something that makes their clinical practice better.

So there is a concept in information technology, which I hope I describe correctly, which is time to value, or agency of value. If I am entering information into the system, how quickly do I get value back from the system? And what meaningful use did is it created a divide that became longer and longer. You just keep putting in information, and you don’t see the value out of it immediately, or somebody else sees the value, because now they’re able to hit the checkbox to say this activity was completed. And I think that really started causing people to think of the EHR, or the act of entering information, as a wasteful activity. That could have been avoided if people had slowed down between stage 1 and stage 2, taken stock, and said, “Well, how do we want to proceed now, given what we have learned as we try to do such a massive implementation?”

I’ve had conversations where, when I try to debate the value of stage 2 and stage 3, the response I get is that at least now you can tell who all the smokers are in your system. You have that data. And I had to laugh, Kevin, because if that was what we achieved after spending billions of dollars and so much clinician time, well, that’s really not a good value proposition.

Now, EHRs have tremendous value. When I was leading the implementation in the early phase at Intermountain, I had a community doctor tell me, “I’m a general surgeon. I’m out in the community, and today I had to take care of a kid with a head injury, way outside my area of expertise. But just to know that I could pull up an order set that was created by experts in the system, and then I could get the kid started on the appropriate treatment and ship the kid off to the tertiary care center, what a relief.” And I could see the joy in that clinician’s face, because all of us want to do a good job for our patients, and I could see that joy there.

Those are examples of why EHRs are amazing. And we are now undoing, I think, some of the unintended consequences of stage 2 and stage 3. And that’s why, honestly, I took a pivot in my career. I just couldn’t take it anymore, and I really wanted to be able to move the needle with my colleagues a little bit myself as well.

Kevin Pho: Colin, I’m going to ask you the first question. Based on your role as a physician and health IT leader, what is your insight into what is contributing to clinician burnout?

Colin Banas: Well, I think Sameer’s answer was so spot on, and there are so many things that I could echo verbatim. I really love the notion, and the way that he phrased it, in terms of these other requirements that we are using the electronic record to satisfy. So there are financial requirements. There are regulatory requirements. There are quality improvement requirements. And I think it did get away from us. The system was designed perfectly to get what it was designed to get, which is: Help me do my billing, help me document in such a way that I can defend these things and hopefully avoid a lawsuit. It’s almost like the care portion of it was sort of toward the tail end, when really it should have been flipped the other way.

That being said, I still don’t know anyone clinically practicing who would flip back to paper. I just don’t, because the benefits still outweigh any of the potential downsides. So I do think there are these multiple pressures that all of our clinicians are facing, just outside of the desire and the need to provide the highest quality of care. And then I think COVID just threw kerosene on the fire in terms of the volume that was being forced through the system and that our clinicians were being asked to see.

I think a lot of times the working conditions, and access to things like PPE early on, and just little things that we had taken for granted for so long, were now front and center, and it just sort of had this compounding effect. And you are seeing the Great Resignation of 2021, in terms of folks who are deciding possibly to retire early, or shifting their careers to something with a little less burnout, I guess, is the best way to put it.

And you’re also seeing it in other specialties in medicine, like nursing, for example. There are massive nursing shortages, requiring a lot of shifting of resources and traveling nurses to a variety of places, which ultimately affects things like morale and affects the quality of care. So I do think it’s, of course, multifaceted, as Sameer pointed out, but it definitely does not fall on the lap of technology.

Kevin Pho: Colin, when you talk to other physicians, either in a clinic or in a hospital, can you share a story, case study, or example of some of these regulatory burdens on physicians and how they can potentially lead to their burnout?

Colin Banas: Yeah, I think things like medication reconciliation, for example. It’s a great, necessary, and wonderful thing, and we need to do it perfectly every time, because if we don’t, that’s how patients get hurt. But it’s also become a check-the-box requirement in the eyes of some. And so there are things like the Joint Commission requiring certain things to be documented upon every single admission that lead to these massive digital forms with lots of checkboxes or lots of macros, and folks just end up sort of going through the motions.

I love the term “unintended consequences,” because there are things that happen as a direct result of digitizing some of these things, and those are things that we didn’t see coming. And I love the notion of trying to undo some of the potential harm that was done in the past five years from a regulatory perspective, so that we can get back to the quality care of medicine.

Kevin Pho: So I certainly agree with what both of you are saying. From my perspective, I think the biggest thing that’s leading to clinician burnout is really a loss of autonomy. You both talked about the regulatory burden that a lot of physicians have. Not only do we have 15 minutes in the exam room, for me as a primary care doctor, to see patients, but we also have to do all these checkboxes and do documentation. And if you look at some studies, for every hour we spend with patients, we spend another two hours on an EMR doing these regulatory requirements.

And I think a lot of physicians, especially now, are feeling that loss of autonomy. They’ve trained so hard. They work so hard, and they don’t get the tools or the time to give patients the best care they possibly can. That leads to a term that some of us are familiar with, moral injury: that we don’t have the tools to give patients the care they deserve. And I think that also is a pretty big contributor to burnout.

So let’s talk next about the second question. As both of you transitioned to becoming health tech leaders, did your perspectives on burnout change? Colin, I’m going to have you take this question first.

Colin Banas: Yeah, I went from experiencing it to being blamed for it, back to some of that EHR discussion that we had before. No, when you take a leadership role, you need to take a step back and a more holistic view of your team and of your organization. And I think, thankfully, in the last three to five years, burnout has become an important topic, almost a necessary focus, for health systems and for all practices, quite frankly.

And so being on the leadership team, and being able to be part of the solution that addresses, measures, and then hopefully implements fixes to address burnout, it’s a big change. It’s a big change from being, like I said, on the front line, in the trenches complaining about it, to having responsibility for it.

Kevin Pho: So you said in the beginning, Colin, that some of you in the vendor space were being blamed for the burnout. Are there any misconceptions that you want to clear up with the clinician audience who may be listening to this?

Colin Banas: Yeah, I think there are tremendous tools. So let me back up a second. When I said being blamed for it, I was referring to my CMIO role at an academic health system. From the vendor perspective, I think we have a tremendous opportunity to impact things like burnout. And that’s where we can shift the conversation into things like advanced intelligence and automation. I’m not a big fan of the term artificial intelligence, so I keep trying to shift it over into AI equals advanced intelligence.

But I do think that from the vendor perspective, we’re uniquely positioned to take stock of where the individual pain points are and then apply technology and automation, so that we can free up the clinicians to do the meaningful things. There’s this concept of cognitive burden that I think is particularly appropriate when it comes to all of the things clinicians are trying to manage when caring for a patient, especially when doing it through the lens of an electronic medical record. And a lot of those things do lend themselves to thoughtful automation. So I think that’s where we’ve seen a tremendous pivot in the industry within the last three years.

Kevin Pho: And we’ll certainly talk about some of those solutions later on in the webinar. But Sameer, I want to get your input on this question. As you transitioned to a health tech leader, did your perspective on clinician burnout change?

Sameer Badlani: It did, and I think it’s similar to what Colin expressed. I became aware, and self-aware, of the opportunity and the tools we had access to to mitigate some of this. The first one, in my mind, was me starting to learn, as part of my digital focus, this concept of design. And I realized that as much as I love blaming the regulatory impact for the burnout, we collectively, as the clinical community, looked at this amazing technology of computers and everything else that comes with it and said, “Make it work exactly like how my paper world was.”

And in my mind, that was a very bad mistake in hindsight. That is where we basically said success for the EHR is if it behaves like the paper that I have been using for 15 years in my clinic. So that’s a fundamental flaw in my mind. And thankfully, now the concept of design is really having its renaissance moment in health IT, where people are realizing it’s as important as architecture, and it’s as important as cybersecurity. That would be the first thing I would put forward: Really design the workflow and the computer click flow to be there to achieve the outcome, and the experience that is good for our clinicians at the same time. So that’s one.

The second thing is the suite of new technologies. I also don’t like saying artificial intelligence, Colin. I like to use the term augmented intelligence. So the combination of AI, automation, and ambient technologies creates opportunities that will allow a clinician to use their toolkit differently, and that will give them more time and more autonomy to do the work they need to do.

And then the third big space that has been part of my journey as a health care executive, unrelated to technology, is that, thankfully, the concept of access to health care and the job of health care are evolving. Earlier, we used to say access to health care is when you come to my clinic, sit in front of me, and we conduct our business. Now it’s going to a website, using a chatbot, or doing an e-visit, where there is asynchronous interaction and you get guidance if you need a test for a UTI or a URI. That’s something that my organization was able to configure to respond to the COVID crisis in the first wave. I have no clue what year we are in, Kevin. So full disclosure to my colleagues listening: I have time dystopia going on most of these days.

So in the first wave, we were able to convert that chassis into being able to provide asynchronous care to 2,000 patients a day, without a physician being involved in it, or a patient having to leave the safety of their home, not just the comfort of their home. And that’s a great example of how you have to put this whole idea of access to health care on its head, so that when I am asking a patient to spend time with me, it is for the most appropriate and the most necessary reasons. That will allow for enough time so that we can really take care of our patients. Everything else should be virtual. Everything else should be asynchronous. That’s where we are pushing very hard, and we saw some of that happen in COVID.

The second aspect I mentioned was this whole concept of what the job of health care is for our patients, and I think that’s finally starting to be looked at differently. Earlier, it was: You come to my clinic, you have knee pain, and as long as I get you in on time, you don’t have to wait for me, parking doesn’t cause you too much trouble, and you don’t vomit when you see the bill for the parking, and you go away with a reasonable response to the knee pain, we all high-five each other that we did a great job.

A retailer or a banker would never think like that. They would say, “Hey, Kevin came to my clinic, and if all I did was take care of his knee pain, I failed in my job.” Because what we have to now look at is the entire health care needs of a patient. So if somebody needs a colonoscopy in 10 days or 10 months from now, let’s schedule it while you are there. If you needed a hemoglobin A1C and it’s close to three months, or you are overdue, you’re in my clinic. Why don’t I take care of that for you now?

So when we close more clinical and quality gaps in every interaction and make it count, that’s a wonderful opportunity, because the goal of health care should be to provide a wonderful experience and a great clinical outcome from a safety and quality perspective, but then also to focus on the wellness of the patient. That’s where I think health care is having its rebirth in my mind: That is health, and technology will be essential for that. So now we are going to pivot from “You have to do the EHR because it’s a requirement” to “The EHR and all these other technologies are fundamental to the new way of thinking about delivering health care.” So that gets me very excited.

Colin Banas: Yeah, Sameer, that brought up another thought for me too, in that we’ve also seen a shift, a welcome shift, toward elevating the ability of others on the team to do things, which I think is long overdue. Of course, coming up, everything had to be documented by the physician. Everything had to be ordered by the physician. If it didn’t get done in that certain way, it didn’t happen. And now, not only from COVID but also just from natural evolution, you’ve seen other team players be able to contribute, which again is welcome, and this is the way to get better outcomes.

So you’ve got pharmacists who are able to do complex medication management and even order things in certain situations. You’ve got teammates who can offload some of the things like message center or message inbox responses, or renewals and things like that. And so I think the distribution of responsibility toward more of a care-based model was long overdue and is very welcome. In tandem with technology application, I think that’s where we’re going to start to see real transformation in the delivery of care.

Kevin Pho: So, Colin, I certainly concur with that. I think especially in my primary care setting, the team-based approach is emphasized, and we now have accountable care organizations and patient-centered medical homes, where the physician is the leader of the team and you have a whole group behind that physician to do a lot of the population care management and do things like prescription refills and care coordination, like you mentioned.

Sameer, one of the things that you mentioned was user interface. One of the issues that I hear a lot, of course, is that it takes a lot of clicks to do something on an EHR, and user interface always is a complaint of the clinicians I talk to. So where do you see the biggest improvements in terms of the user interface of current electronic health record technology?

Sameer Badlani: They’re coming in two flavors, Kevin. One is that informaticists of this generation are doing a better job than I think I did in my time of really redoing the click flow to match the workflow, and there is a strong focus on how many clicks you can take out, and on trying to follow the so-called Amazon one-click shopping methodology. So how do we prevent our clinicians from taking the scenic route for everything, and have them focus on the shortest path to getting that work done?

Some of it was that the methodology to implement EHRs 15 years ago was: Wow, look at this amazing tool set. You can do it that way, or you can do it that way. And now even most of the big vendors in the EHR space are saying, “No, this is the foundation, or this is the basic build, and we want you to stick to the straight and narrow.” So there’s recognition in trying to focus on the cleanest way of delivering that work.

The other aspect is that there is a lot of new technology being tested and developed out there that aims to put somewhat of an interaction layer between the EHR and the clinicians. There’s a lot more hype than delivery at this point, but it holds promise that pieces of it may trickle down into the way we think about the usability and the interface of EHRs, and that will definitely help with some improvement.

And then the other thing is this ambient technology. How can we use this voice recognition technology that’s become essential in our houses through Siri and Alexa, and arming and disarming your home security system through voice? That can be used to interact with the electronic health records. So there has been a boom in companies, and I can think of at least five in my mind right now that are doing amazing work in their own way in attacking this problem of the user interface with different ways of leveraging ambient and non-ambient voice-based technology. So that holds a lot of promise for what needs to be done.

I would stress that we always have to first go back to the design element and the job to be done, as Professor Christensen would say in his book about workflow and achieving success in business, because if we use these amazing technologies to fix a bad baseline state, that’s not going to get as far. You always have to go back into the ecosystem and fix the bad workflow, so you can take exponential advantage of these new technologies.

Health care is a great example. We had the most amazing wave of electronic computerization of health care, and then the fastest-growing employment subcategory was scribes. We have to pause and say, “Wait, something really went wrong here,” that in the journey to digitize health care, the fastest-growing segment was human scribes. That tells us there’s a fundamental, deep flaw here, and it’s multifactorial, like we have discussed. So I’m really excited about these ambient technologies and voice-based technologies, but let’s make sure we take the time to go back and use design and workflow and industrial engineering to fix that problem first.

Kevin Pho: Sameer, one of the things that you mentioned in your last response was how a lot of electronic health systems try to replicate paper systems. That leads into my next question: What are some other ways tech can sometimes contribute to burnout? So Colin, I’m going to have you answer this question. How does tech sometimes contribute to burnout?

Colin Banas: Yeah, I think it’s back to the concept of cognitive load, or cognitive burden. As I mentioned, I came out of my training back in 2005. We were on a digital system, but we were still using paper for documentation. And the mission every night when I was working in cardiology, in the ICU, was: Oh my God, I have to run around and gather records so that I can present on rounds the next morning. What did the last cath report show? What was the last ejection fraction? How long ago was the echo?

And I remember distinctly breaking into the cardiology department. It wasn’t really breaking in, but you had to do some trickeration to get into this massive file room to start pulling these files, and then you would write it all down so that you could be prepared on rounds the next morning.

And of course, now that’s completely flipped, right? We went from scrounging to find any semblance of records to almost being inundated by records, depending on your setup and your geography. And so now there’s this concept of: OK, now you’ve given me too much. How can I separate the signal from the noise? How can I get the most relevant to float to the top? And then how can I apply automation to all of this data that is coming to me so that I can have actual meaningful information to do my job?

And so I do think it’s what we asked for. We asked for interoperability. We asked for legible and digital records, and so, of course, there’s a tsunami of data that eventually ensued. So in that sense, it is a problem of our own making. And it’s a good problem to have. I would rather have too much data than not enough data. Don’t get me wrong. I do not want to go back to breaking into the cardiology department and scrounging through massive file rooms.

In fact, one of the most satisfying moments in my career was when we completely boxed up those file rooms and shipped them off to digital storage, never to be seen again, and then repurposed that space for clinical care. That was what this was all about when we started this journey. And so, back to the original question, it is a bit of a problem of our own making, but it’s a problem that is solvable with a lot of the technologies and techniques that we’ve been discussing here.

Kevin Pho: So let’s talk about some of the solutions technology can give us. We’ve talked about some of the problems in terms of regulation and some of the potential issues that technology can bring to clinicians that can contribute to burnout. So let’s flip the script here and talk about solutions and how tech can help with burnout. So, Sameer, let’s talk about some of the solutions that you think of.

Sameer Badlani: Sure. I’ll try to again divide it up into three categories. The first one is the ability to provide access to care and access to wellness information without directly, synchronously interacting with patients. We first started using a third-party system at Fairview and then transitioned to our native EHR capabilities for interoperability reasons. Nothing was wrong with that third-party vendor per se. And that’s a great example of technologies that act as digital extenders of clinical care teams. That’s something that I’m very excited about.

And COVID allowed us to really take bits and pieces of these POCs, or existing assets that we had, and really develop them into a full-blown solution within two to three weeks of realizing that we were in a lockdown stage and had to do something different. So there is that asynchronous care, and then, within the ecosystem, we leveraged telehealth in ways that I for sure couldn’t have imagined pre-COVID. In my mind, it was a very linear thing: The patient is somewhere else, you’re somewhere else, get on a video call, and let’s get on with the visit.

And then now there’s also post-diagnostic care, where we use technologies where patients get signed up on an app, and that has a preset set of questions and daily check-ins. Based on those results, a clinician or a care team member gets involved or doesn’t get involved, and the patient can ask for more information. So it’s the entire ecosystem of pre-diagnosis, diagnosis, and post-diagnosis that is now being done in ways that could not be enabled if we did not have that set of technologies. Now the focus is how to build more automation into it.

The second set of technologies is around augmented intelligence and artificial intelligence. One of my previous roles was chief data and analytics officer at Sutter Health. My biggest realization was that success was not building the biggest Hadoop or HANA cluster and churning out data science. Success was how to get all of that used in health care delivery, to the benefit of the clinicians and nurses and the patients. And that was a big exercise in humility, to realize that data literacy is almost more important than the fancy algorithm that you have been building behind the scenes.

So how do we take all these amazing data analytics and insights and automate them so that, again, as Colin mentioned, it’s not more information for you and me to look at? It’s being taken care of behind the scenes. If the system tells me that Sameer should get a hemoglobin A1C every two months versus every three months, make it happen. Don’t tell me that. And then once you get that result, take care of those results and analysis when you are done there.

And then the third set of these technologies is in what I would call the larger patient engagement or consumer engagement space, where we all experience our lives very differently now. Things like OpenTable six or seven years ago were an outlier; now they have fallen behind. There are so many other digital ways of doing our living, and all of us, clinicians and patients, bring those expectations when we come to health care. That is a high bar, and we need to use technology differently, because in other places, it is technology that’s causing those abilities to manifest themselves.

And that’s what I’m really excited about. How do you use a combination of design, segmentation, automation, and augmented intelligence to really create an experience that is good for the clinician and wonderful for the patient, and where the convenience of that experience, or the high quality of that experience, is matched with high-quality and safe care as well?

Kevin Pho: Colin, what are some opportunities for tech to help with clinician burnout?

Colin Banas: I think it’s that signal from noise. I think it’s anything that we can do to bring the relevant to the top and hide the irrelevant, which is constantly shifting. It’s contextual, but I think there’s tremendous opportunity. And of course, as Sameer has alluded to earlier, health care is a decade behind other industries in doing some of these things, providing these services or experiences.

At DrFirst, we pride ourselves on being able to do this sort of thing related to medications, because getting medications wrong, as I mentioned before, is the way patients get hurt, and it’s also a way that error gets perpetuated throughout the system. It’s called the prescription cascade. If you guys don’t take it off the med list, inappropriately, it gets added to the admission, it gets prescribed again at discharge, and it just cycles throughout.

And so there’s tremendous opportunity, even in things that we’ve considered routine, something like med rec. We’ve been talking about med rec for two decades. We still haven’t really gotten it right. And so there’s tremendous opportunity to apply these technologies in things like that and then have measurable outcome success.

Kevin Pho: Wonderful. I’m going to transition to our final question, which is really just a general question: What kind of advice do you give to clinicians and other health IT leaders? So I’ll take this question first, because this is a topic that I talk a lot about on KevinMD and on my podcast. As we mentioned before, 50 percent of physicians are experiencing symptoms of burnout, and this is a perpetual solution. And I’m happy that not only is this more a part of the conversation, but I’m seeing more and more health systems take this seriously.

A lot of the solutions that they give, resilience classes, yoga, to me don’t really get to the root of the problem, and we’ve discussed some of those problems today. It’s really problems with workflow, problems with loss of autonomy. And on my social media sites, I think it’s important for a lot of clinicians to get together, because as difficult as it is for some physicians, you have to know that other doctors are going through the same thing. So there are a lot of physician Facebook groups online where people can talk about what they’re going through, and perhaps workarounds and solutions that can help.

I think one of the themes that I like to push on my site is that we clinicians are more than our degrees, right? I think sometimes we need passions outside of the exam room. Now, if our passion is 100 percent clinical medicine, then more power to that physician. That’s wonderful. We need more doctors like that, but that can’t be true for everyone. So I talk to a lot of doctors whose passions sometimes are outside the exam room.

So I take a look at myself, for instance, in my story. I see patients two and a half days a week, but the other times, I’m on these webinars with you fine gentlemen, doing podcasts, doing online social media work, and exploring that intersection between health care and social media. And having that passion outside of the exam room keeps me going. I’ve been doing primary care for 20 years, and I see so many other primary care doctors who have to leave clinical medicine. They have to retire early because they’re just doing it full time, and it’s simply not feasible to see 30 patients a day, five days a week.

And I think it’s very difficult to do primary care full time. I think there was a study I read where, if you had to do all the recommendations that are recommended by the various medical societies and guidelines for every patient, it would take something like 22 hours of the day, or something like that. So I think that we do need to use technology, like Colin said, to help include more of the team members to help us out, whether it’s medication reconciliation, prescription refills, or doing inboxes. And like you, Sameer, I think we do need technology to help improve the user interface. We need things like ambient AI technology to help us document. We need to design electronic health records with fewer clicks and better integration with our natural workflow.

I think that technology has certainly helped us. I certainly will not go back to a paper record, but I think there’s so much opportunity that’s out there still, and we’re still nowhere near realizing it. So, Sameer, what kind of advice do you have for either physicians or other health IT leaders?

Sameer Badlani: I think it’s very similar to what you expressed, Kevin. It took me a long time to realize my identity is not that of a doctor; my identity is that of the human Sameer. And the first change I made was that I stopped introducing myself in every setting as Dr. Badlani. I am just Sameer. If people ask me what I do, then I go into what I do. So really decoupling my profession from me as the human was the first step, and finding other ways to find joy and purpose in life was definitely a proactive task I did.

I shared earlier my passion for teaching. The class where I realized I have a deep passion for teaching was in 2007, when I was still a fully practicing clinician, faculty at UChicago. That class had nothing to do with medicine. I fought tooth and nail to be able to teach basic financial hygiene to young doctors, and it became one of the most popular classes at the University of Chicago. Again, it had nothing to do with health care, but the joy I felt discussing a basic finance mindset and how to plan for retirement and basic things, nothing advanced. I’m not a certified CPA or a financial planner, but just having that as a conversation with young students was amazing.

And then, at the end of one of those classes, a young med student came and told me, “You know what, I was going to become a neurosurgeon, because I was afraid that if I did not make that level of income, I would not be able to pay off my medical school debt and be able to have a reasonable life. But what you have taught me is that I can do any branch of medicine and still have a very reasonable life, and more, and pay off my medical school debt. So I’m going to go and do psychiatry.” And to me, there’s nothing more satisfying in that moment as an educator than that somebody is now choosing their true passion, and hopefully that individual is experiencing less burnout than they would have.

What COVID taught me is to really focus on family time and my personal time. I think clinicians love giving, and we just keep going and going, taking care of our family, our parents, and everybody else, except we don’t make time for ourselves. And the biggest thing I’ve done differently since the start of COVID, and since I first had my real burnout moment, is to make time for myself. What that means for me is doing absolutely nothing. I don’t have great hobbies, and I’m not a sporty guy or anything like that. It’s just finding time to do nothing, relax, and just take it easy.

You’ve been hustling for a very long time to get into med school, then in med school and residency, and so on. Take the time to live your life. And I really compliment you, Kevin, on what you have done with the podcast. I always wanted to do something like that. I don’t know whether I will, but it’s really good to see people like you do that.

Kevin Pho: Well, thank you so much for listening, Sameer. Colin, what kind of advice do you have for other clinicians and/or other health IT leaders?

Colin Banas: Yeah, I love that notion of strength in community that you brought up. So go find your community. Often that is with coworkers, but a lot of times it’s definitely outside the four walls. I also like what Sameer brought up. I call it the hero complex. Don’t be a hero. I used to just pound 70, 80 hours a week and think that everyone was respecting me because of how hard I was working, and I’d even show up to work under the weather. It’s just dumb. It’s not healthy. It’s not healthy for your team. It’s not healthy for your patients, or for your colleagues’ patients. It’s just dumb, and it took me a long time to figure that out.

And I guess the last thing I would say, just as general career advice, is that I got where I am today because I got involved. I was interested in things. I put myself out there to participate in committees and to go pursue other forms of education. I mentioned a master’s degree. I also got an informatics certification, things like that. And it’s just these organic experiences of being involved that led to these branches in my career path.

I bet I’m a lot like both of you. I didn’t set out to become a CMIO, or a CMO of a vendor health IT company. It happened organically because I made myself available. And so I always say that to my students and interns and residents: Get involved, because that’s where the real opportunity is.

Kevin Pho: Well, thank you so much to you both for sharing your stories, your time, and your insight. This concludes the KevinMD and DrFirst webinar. Thank you so much for listening.

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