In this post, I want to share a cool idea used at Mission Health in North Carolina. I recently interviewed Dr. Ron Paulus, CEO of the health system. Three years ago the organization launched “Immersion Day,” when board members leave their corporate meeting rooms to shadow the doctors and nurses in their hospitals. Journalists and legislators are also invited to join. They don scrubs, go through an orientation, sign privacy forms, and spend 9 to 12 hours behind the scenes watching frontline clinicians in their everyday work. They gain insights they could never have gained otherwise. According to Dr. Paulus, Immersion Day helps each side learn how the other thinks. For many board members, it's the first time they've been at the front lines of care. For many physicians, it's the first time they've met a member of the board. (The health system has a second program, appropriately named "Walk a Mile," for senior executives.)
During the Q&A period after a presentation I gave recently on understanding and preventing physician burnout, a physician in the audience voiced her vehement objections to the current electronic health record (EHR) with a simple statement: “We need a revolution.”
In a few words she described her frustrations with the EHR. “It is meaningless—full of fields that we cut and paste from other fields. There are an ever-growing number of pull-down menus and boxes to check, because we are required to document every possible ICD-10 code to make sure the hospital can bill as much as permitted. It leaves me little time to do what I’m there to do: care for my patients.”
Many, many physicians are voicing the same frustrations with the EHR. The negative impact of the EHR is not the only systemic problem fueling physician burnout, but it’s high on the list.
As I drove home from the talk that night, I was struck by how closely the physicians’ experience with the EHR mirrors the central theme of Charles Dickens’ novel, Bleak House. I’m a voracious reader of fiction, although not a huge fan of the classics. But this work made an impact on me that persisted long after I finished my high school English assignment.