For those who have been intimately involved with health information technology, particularly Electronic Health Records over the past decade, the speed of adoption and change in practice workflow has been breathtaking. This is not just a North American phenomenon — it has happened in similar fashion across the Western World and in many parts of Asia. A number of third-world countries are also jumping on the bandwagon and are using mobile technologies and telehealth applications to reach remote communities, particularly in communities in which it is difficult for providers to provide care to patients. Whereas just 10 years ago, it was not uncommon to visit dominantly paper-based clinics and find paper systems in hospitals, this is now the exception rather than the norm.
What has not kept pace with the speed of change is the ability to balance all of these new changes with life and family needs to ensure that clinical practice remains rewarding and sustainable. In fact, the pendulum appears to have swung too far towards the technology. Based upon data that has been collected over the last three years through the AmericanEHR satisfaction survey, I can confidently say that many physicians are feeling overwhelmed by technology and the need to spend more time charting after hours than they had ever done before in their paper-based practices. The life/work imbalance is in part due to the rapid adoption of technology, but also due to other factors including the usability of the EHR solutions and how well they fit into the clinical workflow. As the Meaningful Use program proceeds to Stage II and Stage III, how does one balance the workload with the requirements to collect and report more information and in greater detail? Some physicians may be dropping out of the Meaningful Use program; for example, AAFP News Now recently reported that of the 11,578 family physicians who attested to Meaningful Use in 2011, only 9,188 did so in 2012 — a 21 percent drop in participation.
Here are some tips to achieving a balance between work and life in these challenging times:
- Acknowledge the learning curve. No matter how tech-savvy you might be, there is always a learning curve for new technologies and processes. Some clinicians have unrealistic expectations when implementing an EHR that it will be simply a process of switching the same workflows and processes from paper records to an EHR. Nothing could be further from the truth. If you are resistant to change and not willing to take advantage of the features within the EHR that require workflow adjustments, you set yourself up for a difficult transition. Accept that you will need to slow down for a period of time when you implement your EHR and that it may take anywhere from six weeks to three months to get over the hump of implementation.
- Reiterate your goals and objectives when you initially decided to implement an EHR. In the heat of EHR implementation and early use, it is easy to forget why you made the change in the first place. If you had higher goals, revisit them from time-to-time and remind yourself why you are making the transition. For example, improved medication management and safer clinical practice, better management of patients with chronic diseases, or the ability to measure improvements in quality and performance through your EHR. If you did not create a mission statement, it is good to do so as this will provide an anchor for clinicians and staff who are going through a rough patch.
- Recognize there are some things that are out of your control. It is easy to get frustrated because either certain features are absent or do not work properly in the technology tools you are using. For example, the inability to share information between your EHR and that of your colleagues or your local hospital system. If an information exchange has not yet been implemented or your system is not yet configured to work with the exchange, you have no way to change this scenario. Accept that your technology has certain limitations and focus on the parts that you can use by optimizing them to the maximum level.
- Leave the work at work (as much as you possibly can). Remote access is a double-edged sword. While it does allow you to access your patient records (or other technology-based diagnostic tools) from home or while you are on vacation, this can significantly impact your home/life balance. Getting into the habit of sitting on your computer on weekends or evenings and working from home can make you physically present, but mentally absent during times that you should be spending with family. Consider designating a specific time of day or period of time on weekends to remote access and then keep to that schedule.
- Take maximum advantage of time-saving features in your EHR. Have you optimized your EHR so that it can do some of the work for you, particularly with respect to repetitive tasks such as recalls, reminders, and performance reports? Many EHRs allow users to set up automated reports and reminders that can be sent to your inbox, reducing the necessity to manually check for this information.
- Reward yourself and your staff from time-to-time. As care providers, we often forget how challenging the care delivery process can be. Rewards can be as small as an in-office social get together when achieving certain goals, e.g. all physicians using E-Prescribing or a specific group of patients that has achieved certain treatment goals.
- Practice, Practice, Practice. Getting better at using your technology will reduce the amount of time you have to spend after-hours to do work that could be completed during the work day. If you have to repeatedly ask for help from colleagues or have to muddle your way through specific features, it will significantly impact your ability to achieve the sought after work/life balance.
- Invest in training and take the time to learn how to use your EHR and technology most effectively. Your EHR vendor is continuously improving their product. Take the time to learn new features, particularly because many of these will be related to improvements in achieving Meaningful Use. If you cannot take the time to attend training, identify someone within your practice who can be the practice champion and ensure they receive regular training that can be shared with the remainder of your clinicians and staff.
- Provide feedback to your vendor(s) regarding features that will improve quality of care and make your life easier. If there is something that would significantly reduce your workload, share with your vendor or take your suggestions to your EHR user group. There may be stronger support than you initially anticipated.
Do you have any suggestions about changes you have made that have improved your work/life balance? Share your thoughts below.