Dr. Ann Cappellari says she has heard what she considers horrendous stories about health care providers whose work lives overtook their personal lives, leaving them stressed and burned out.
Cappellari
One was a pediatric nurse practitioner who worked with high-risk patients all day and then spent evenings documenting her care because she didn't have time to log that information during the workday. That nurse practitioner left health care. Cappellari also recalls a physician who spent her days seeing patients and her evenings with her family and then set her alarm for 2 a.m. so she could catch up on documentation before starting a new day of patient care. That doctor moved to a job with a research company.
Cappellari says those care providers are like many in the medical field. "They have this obligation to their patients and to finish their work, but at the immensely high cost of their own personal well-being," says Cappellari, SSM Health chief medical information officer.
Schmidt
To help overwhelmed providers balance their professional and personal lives and to keep them from abandoning the medical field, she and her colleague Dr. Heather Schmidt, SSM Health's system medical director of employee well-being, are leading efforts that make use of technology tools sharpened by artificial intelligence and machine learning.
Mining objective data
Schmidt is based in Fond du Lac, Wisconsin, and has a lead role in the development of a dashboard that tracks metrics shown to be predictors of clinician burnout. "We're starting here in Wisconsin, and then our goal is to be able to very quickly expand across the system," she says.
The metrics for the dashboard come from human resource files and electronic health records. They include such data as how long a doctor has been in practice, how much time a doctor spends with patients, and what time of day the doctor is inputting information into health records.
"This dashboard is really an innovative way to look at well-being, because it's not just relying only on subjective survey data," Schmidt explains. "It's really using that objective data."
She points out that most surveys that are meant to shed light on clinicians' well-being are confidential and anonymous. "And we can't help people when we don't know who needs helping," she notes.
Among those assisting Schmidt in building the dashboard is Xi Hu, a researcher from the Center for Labor and a Just Economy at Harvard Law School. Hu is one of the founders of Atalan, a startup that developed the platform for the dashboard. Atalan says its goal is "to support health systems in improving clinician well-being and retention through evidence-based technology and best practices." The company also has worked with Bon Secours Mercy Health.
First, SSM Health's dashboard will create a broad view of physicians' stress levels within departments and at specific sites to reveal trends and comparisons. The eventual goal of the dashboard, Schmidt says, is to identify individual doctors who are spiraling toward burnout. SSM Health leaders could then offer those doctors evidence-based interventions, such as mentorship, flexible work schedules and training on tools that can reduce the amount of time needed for administrative tasks.
"We're just taking that very slowly and making sure that we're building trust and staying transparent before we go right to that (individual) piece," Schmidt says.
When she first discussed the dashboard with a group of physicians who agreed to champion the project, Schmidt says she worried that it might be seen as threatening because the analysis could get to the individual level. To her surprise, the physicians were eager to have a means to predict burnout. "Most of them said, 'You know what? Actually, I would love it, because then we can actually do something about it,'" she recalls.
Assistive technology
Cappellari is overseeing the use and refinement of tools that tap AI and machine learning to take some of the administrative load off doctors. One such tool is an ambient documentation app, which unobtrusively creates a voice recording of a patient visit and generates a suggested clinical documentation note. The clinician reviews the app's suggested note and decides whether the note needs modifications before it goes into the patient's electronic record.
Over time, Cappellari explains, the app gets better at generating notes that more precisely reflect what the clinician would have documented.
Cappellari says the technology frees clinicians to focus on the patient rather than on the need to log the visit. "You insert this ambient documentation tool and immediately, there's a full face-to-face visit with the patient that the patient routinely comments on," she says.
Another tool SSM Health is exploring expedites the answering of emails from patients. "It reads the patient message, and it says, 'Here is a suggested response,'" Cappellari explains. "And once again, it never goes out until you edit or approve it."
Do no harm
Cappellari says she, Schmidt and the others involved in introducing the new tools to predict burnout or ease stress among care providers are following the clinicians' maxim: First, do no harm. Their intention is not to invade doctors' privacy or prod them to do more, but rather to make care providers' work lives less taxing. "When we talk about this work, it isn't a goal of increased productivity," Cappellari says.
Schmidt adds: "However, I would say that most of us actually want to be more productive. If I could see more patients and document less, I would. I love patients."
Cappellari and Schmidt say the administrative burdens on care providers are part of the reason both of them have moved away from daily practice in their specialty fields. For Cappellari, that was emergency medicine and for Schmidt, family medicine. Schmidt still sees patients in her clinic while Cappellari maintains touchpoints with regular clinician shadowing.
Schmidt says none of the family medicine residents she went through training with have stayed with the specialty. "Either they're doing administration, they're doing leadership, they're doing only virtual visits," she says. "I thought for sure I would be a family medicine doc forever. I lasted five years before I had to start thinking of something different."
'A tough world'
Cappellari says "absolute burnout" was behind her move to informatics. "It's become a harder world, and you're dealing with a lot of people coming in looking to you to help them for a thousand reasons, often beyond their health. And it's just a tough world," she says. "I respect immensely our practicing clinicians, for how they manage in this environment."
She and Schmidt say the hope is that the tools SSM Health is exploring bring in metrics that show a return on investment in terms of identifying and addressing clinicians' stress points. That's important, they note, because the technology is costly and like any other investor, SSM Health wants to see a positive return.
Cappellari says the champions of the new technologies want to be able to tell SSM Health executives, "You put this in, and you made a difference here, and it was incredible value, because now we have retention of that provider. They didn't reduce their schedule. They didn't leave the organization."
Related story: How Ascension is addressing physician burnout.