Strangled to Death by a Mouse

The vitality of the therapy profession that we have come to know and love is dying a slow death–and it’s not by what you think.

If you feel like you’re professionally suffocating,

there’s a reason for it.

You may feel like a patient whose pulse oxygen reading is too low. They might look okay on the outside, but they’re working harder to make it through each day.

You can sense in them something below the surface is not healthy. Unless the patient makes changes, the future looks bleak.

Similarly, the quality of therapists’ work/life is casually being choked to death by electronic documentation. We are spending far too much time looking at computer screens than patients faces–and it’s killing our souls.

Please take a look at these astonishing facts about the stress that the EHR adds to our lives.

90 minutes each day

According to the Annals of Family Medicine, EHR documentation amounts to an extra 90 minutes of work per day.

4,000 Clicks

Approximate number of mouse clicks an ER doctor makes throughout a single shift, according to an American Journal of Emergency Medicine study.

5.9 Hours

Average time (out of an 11.4-hour workday) on EHRs, compared with 5.1 hours spent with patients, according to a 2017 study in the Annals of Family Medicine.

 

The Miracle Cure

Ten years ago, President Obama signed a law to accelerate the digitalization of medical records. The stimulus bill has driven the adoption of EHRs at therapy clinics and hospitals across the United States.

Electronic health records were supposed to be the miracle cure for the ailing U.S. healthcare system. Promoters promised higher quality healthcare, lower costs, patient empowerment, and drastically reduce medical errors.

After investing $36 billion and millions of hours of healthcare professionals time, there is little to show for it. Except that it has radically changed the very nature of therapists work experience.

 

Red Flags

In WebPT’s The State of Rehab Therapy 2019, the top reason for making a professional change is to improve work-life balance, followed closely by increased satisfaction and fulfillment.

Meredith Castin of The Non-Clinical PT, states, “Many therapists were initially attracted to …profession because they’re caring, driven, and conscientious.” They are conflicted when they experience the current climate of unrealistic productivity demands.

Therapists find themselves flittering from patient to patient like a hummingbird in search of life-giving nectar. When these idealistic therapists are forced to complete documentation on top of patient care, it leads to job dissatisfaction and burnout.

 

The Burnout Epidemic

I blame the bloated EHR notes that have doubled in length in the past decade (Epic) for the burnout problem among therapists.

Rehab professionals are leaving patient care in enormous numbers for a variety of reasons. At the heart of the mass migration is the inner conflict felt by therapists.

There is a constant struggle to serve their patients in the way they’ve been trained, to spend quality time with loved ones outside of work, and to get their notes done.

The lifeless repetition, the box-ticking, the endless scrolling, and pull-down menus are burning out today’s therapists and driving increasing numbers into other occupations and early retirement.

Unless we deal with not being able to breath and enjoy our day because EHR is sitting on our chests, we will see the therapy profession, as we know it end up on life support.

I’d love to hear your experience and thoughts in the comments below. If you want to email me, I can reach me at [email protected]

 

14 responses to “Strangled to Death by a Mouse

  1. Ryan McAllister says:

    Paul—I appreciate your thoughts on this. For sure there is an opportunity to make EHR more efficient. However, your goal of improve work life balance and job satisfaction with therapist may be more effective if you address root causes such as increased cost of education, decreased reimbursement, stagnant wages etc.

    1. Paul Potter says:

      I agree with you Ryan on the other root causes of job dissatisfaction and defection among therapists. I wanted to draw attention to the sneaky mouse that is stealing our joy.

      Being more efficient with EHR was not what I was going after but more of ruthless simplification of the ever-expanding, data monster we have now.

  2. Rob Coltman says:

    90 min at the end of each 10 hr day is the norm. (I work four 10 hr days). If it doesn’t get done that night, it’s on the weekend. It is unsustainable and will eventually move on from the profession.

    1. Paul Potter says:

      Rob, you’re getting close to the 11 hr days of the ED docs. How much of your day is spent in front of patients?

  3. JT Monaco says:

    There are two findings that I have observed in regards to ED:
    1) In order to achieve better life/work balance, I have noticed that the documentation is poor and not thoroughly developed in appropriate medical terms for the purpose of time consumption. This can be problematic for insurance authorization, updating progress for a referral source, and might represent lack of professional effort.

    2). Due the excessive documentation, I have observed therapists have used a “standard protocol” for their patients’ injuries in order to save time on their documentation. Usually this leads to lack of progression over the course Rehabilitation, not being able to progress patients towards their goals, and further does not acknowledge the skill level of what a therapist should possess.

    However, I agree with Ryan and his statement that is an effect of the previous concerns he described that current therapists are experiencing.

    1. Paul Potter says:

      Thanks, JT for your insights.

  4. Jeff Yaver says:

    As a PT of over 30 years of experience, I have lived the progression of writing notes on paper to EHR. I have used the same system for the 10+ years and it seems to get more complicated and I am documenting items that no one will ever read. Along time ago, I was involved in educating our PTs in how to streamline care to make it more effective and efficient. I dream of the day where documentation could be more streamlined as well. Thanks for writing this blog!

    1. Paul Potter says:

      You’re welcome, Jeff. Your comments have a ring of truth from a veteran PT. Thanks for your input into the conversation.

  5. Bob Bacci says:

    The requirements of documentation have crushed everyone. The concept that more is better is not true it’s an assumption. Today documentation is an exercise in diminishing returns and in fact more documentation may not improve quality. We need to adopt a GETMO philosophy “Good Enough To Move On”.
    If you are a perfectionist – you have a problem and it robs you of more production. Perfection many times is the enemy of progress! When documenting we need to look for the greatest level of of return based on the time invested. The pursuit of excellence may motivate us to spend more time to documenting…but the pursuit of perfection will steal from you and your family what cannot be replaced – time.

    1. Paul Potter says:

      Bob, your phrase ‘perfection many times is the enemy of progress” points out to me that excellence in quality care and satisfactory documentation are two different things. Adopting your GETMO mindset will help many therapists avoid the spiral of death by documentation. Thanks for contributing!

  6. Richard says:

    Patient’s appointment is 1500

    Best case scenario. Patient shows up to clinic on time.

    They are asked to complete no less than 5-6 forms they don’t understand or which frustrate them(10-15 minutes). 1510-1515

    The physical therapist asks for an additional 2-3 forms because “best practice.” (2-5 minutes at best). 1520

    Patient follows PT to treatment room. Allergies, medications, medical history are reviewed (2-10 minutes). Vitals taken because they are “vital.” (2 minutes). PT asks patient to “tell their story” because “therapeutic alliance.” (10-20 minutes) 1530-1540.

    Physical examination performed. 15-20 minutes. 1545

    Review physical examination with patient and answer questions. 15 minutes. 1600….late for 4 o’clock sitting in waiting area.

    Review and provide HEP…printer not working…10 minutes…1610…Press Ganey scores reflect tardiness…

    Completion of documentation and email authorization forms…15-20 minutes sometime after patients are gone…whoops…forgot some information on auth form….more emails/faxing…

    1. Richard says:

      Whoops…forgot to add depression/suicide questionnaire

      1. Paul Potter says:

        Is the questionnaire the patient or for the PT?

        1. Richard says:

          LOL…I hadn’t looked at it from that perspective while typing up the post. Given the current climate in healthcare and society, I can understand the question :)

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