By Nick Hedges
The use of electronic medical record (EMR) systems by office-based physicians reached 78% in 2021, up from a mere 17% in 2008. Reducing their reliance on paper records makes private practices more efficient and cost-effective, enabling them to improve documentation and revenue flow. But it can also lead to EMR fatigue, for physicians and physical therapists.
Unfortunately, the embrace of EMRs by physical therapy and rehabilitation practices has done little to ease the impact of burnout on physical therapists. A 2020 study by the American Physical Therapy Association (APTA) found that 82.4% of physical therapists experienced burnout, with documentation requirements cited as the largest source of stress on the job.
After years of being promised EMRs would magically transform private practices, how is it that this technology now is responsible for therapist burnout?
EMR or EHR (electronic health records) fatigue can occur when practices deploy inefficient technologies that drive user errors and stress. Two specific phenomena contributing to EMR-related burnout are click fatigue (from repeatedly navigating through multiple digital screens) and alert fatigue.
Using eye tracking and pupillometry (measurement of pupil dilation) to trace signs of fatigue during EHR use, a study at the University of North Carolina at Chapel Hill determined that 80% of participants “experienced physiological fatigue within the first 22 minutes of EHR use.”
Physiological fatigue can manifest itself as diminished empathy for patients, inattention to detail, lack of focus, and an increased risk of error. Left unaddressed, EMR fatigue can lead to lower job satisfaction and performance, impacting staff turnover, quality of care, and patient satisfaction – all of which can threaten the survival of a therapy and rehab practice.
Here are three ways the wrong digital tools put a physical therapy and rehab practice at risk.
Creating stressful inefficiencies
Stress commonly is a precursor and contributing factor to burnout, and a cumbersome EMR documentation process can fuel both. A 2020 Mayo Clinic study linked poor EHR usability to burnout among physicians from all specialty disciplines.
“The finding that the odds of burnout decrease with incrementally higher EHR usability is consistent with previous work suggesting that time spent with the EHR distracts from meaning in work, thus leading to burnout,” Mayo Clinic wrote.
As long as humans are involved, physical therapy and rehab practices will never be able to eliminate 100% of documentation errors. Combine therapist fatigue with poorly designed data entry interfaces, and mistakes are inevitable. Data shows that the number of malpractice claims related to EMRs has grown along with the increasing prevalence of these systems in healthcare.
Poor patient experience
In a 2018 study by Stanford University, doctors report that more than 60% of time devoted to each patient is being spent on the EHR. This hyper-focus on computer screens can cause therapists to become disconnected from their patients – one of the three dimensions of burnout in physical therapy (along with exhaustion and less effective clinical performance).
There’s no going back to paper records; EMRs now are an integral part of patient care. Yet it’s clear these systems may contribute to stress, error, or depersonalization in clinical settings. How can practices maximize the benefits of their EMRs while mitigating risks and staff burnout?
Therapists themselves can do a lot to improve their relationship with technology with some simple strategies. Taking a few breaks throughout the day, for example, can make a difference. Even five minutes away from a computer or mobile screen can be beneficial. Therapy and rehab practices should encourage staffers to take a little time during their shift to listen to music, go outside, or stretch and relax.
If documentation responsibilities can’t wait, staffers still can ease their eye strain by using the 20-20-20 Rule. Give your eyes a break by looking away from your screen every 20 minutes. Focus on an object 20 feet away and continue looking at it for 20 seconds.
What to Look for in an EMR Platform
Clinical documentation requirements have increased in complexity over time. The most reliable EMR systems stay ahead of the changes and streamline the documentation process. Not every solution, however, is optimized to reduce friction in your workflows. Some common challenges include click fatigue, information overload – when staff may make more errors when being bombarded with excessive alerts and complex interfaces – and slow, unreliable systems that are prone to crashes that hurt productivity and can even result in lost revenue.
Therapy and rehab practices should look for an EMR platform that is both patient and provider-oriented. Such a system would include simply designed, intuitive interfaces as well as automation to handle simple tasks that consume chunks of a physical therapist’s day. Automation and an easily navigable interface will streamline your practice’s clinical workflow, allowing therapists to spend more time with patients.
A quality EMR also will be highly interoperable, allowing practices to exchange, communicate, and leverage information shared between two or more computer systems. Interoperability can improve the patient experience by enabling telehealth visits and powering a patient portal.
Finally, therapy and rehab practices should look for an EMR that comes with comprehensive training and support during and after implementation.
Preventing EMR Fatigue
While EMRs have made documentation of records more efficient and cost-effective for therapy and rehab providers, not all EMR platforms are designed with the user’s needs in mind or are fully interoperable. Practices that want to reduce or avoid EMR burnout among staff should look for a fully interoperable system that features automation and user-friendly design to streamline processes.
Nick Hedges is the chief executive officer of Raintree Systems and a 25-year veteran of the technology industry. Raintree is a leading provider of electronic health records (EHR) including patient engagement, scheduling, billing, and practice management, in addition to revenue cycle management (RCM) software solutions for the therapy and rehab industry. It was awarded the 2023 Best in KLAS designation for Outpatient Therapy/Rehab software and services.