Telemedicine Offers New Hope For Burnout Reduction During COVID-19

Even before the ongoing pandemic, it seemed clinicians’ stances on telemedicine and digital health were definitive—you either supported the notion that telemedicine is the future or you held fast to traditional medicine practices.

Now, regardless of opinion, clinicians have been forced to pick up telemedicine and incorporate digital health into practices. For some, this challenge has created an added burden while others have been able to adapt more quickly to their new reality.

With physician burnout already a prevalent issue, the prospect of additional burden from using telemedicine combined with the looming threat of coronavirus disease 2019 (COVID-19) could pose a real threat to clinicians moving forward.

With this in mind, HCPLive ® reached out to a group of 3 clinicians in an effort to learn about factors associated with telemedicine exacerbating or relieving burnout as well as what are some of the most common hurdles when trying to integrate digital health into an existing practice. Taking into account every physician’s experience with digital health is unique, we reached out to 2 experts in telemedicine and a physician who has been forced to adopt telemedicine rapidly in the wake of the ongoing pandemic.

Michelle Alencar, PhD, is the chief scientific officer and co-founder of inHealth Lifestyle Therapeutics. An associate professor at CSU-Long Beach, Alencar specializes in obesity medicine and strives to improve integration of digital health into practices to improve patient outcomes by allowing for greater and more effective lifestyle management with telemedicine platforms.

What are some factors or themes associated with telemedicine exacerbating burnout among clinicians?

Alencar: With physician burnout, I think the first thing to understand is it's sort of inevitable at a point. I think that telemedicine provides an added layer for those who are not used to it to add to frustration. I think the last paper that I was reading said that about 50% of providers reported some sort of burnout. If you're going to take somebody who's already burned out, who's having those sensations, having those feelings, and you're throwing them in the deep end of telemedicine—obviously, there's going to be a lot of frustration.

It's so new for a lot of these providers that they haven't even had the chance to go through this in their training—mental training or taxonomy training, for example. Some of the frustrations that can lead to burnout related to telemedicine for me, and my experience with our providers nationwide, is really just breaking the ice. So, how do they apply it?

That's really where it needs to click for doctors to really see the correlation between how it can get really leveraged in their practice. For example, if they have something to package it around. If they have something to package the telemedicine around where patients are getting used to it, it creates a better atmosphere for the adoption among providers.

In terms of frustration, it has to do with technology. More and more EMRs are now coming out with or that have the ability to conduct telemedicine visits. If they are in the environment that they're used to, they're much more likely to adopt it and not relate it to frustration.

If they can overcome that hurdle with a program offering or a technology that's integrated with their EMR, it’s much easier for them to integrate it into their already busy work schedule.

The same thing goes for patients on the patient/user experience side. If they are using a patient portal already with that doctor, adding another layer that has a telemedicine arm isn't so foreign for patients.

My overall response would be, the frustration is related to the technology and the usability of that technology for the provider. If they can overcome that hurdle with a program offering or with a technology that is integrated with their EMR, it’s much easier for them to integrate it into their already busy work schedule.

What are some factors or themes associated with telemedicine decreasing burden among clinicians?

Alencar: I think once they get over that initial technology hurdle, providers start to see the light in terms of how telemedicine can transform their business and transform the user experience of their patients, as well as the lifestyle for themselves. Burnout is almost inevitable in the current landscape. I think the last paper that I was reading said there's going to be a 130,000 physician shortage by 2030 or something like that and that's huge.

When you talk about what that means to patient care and user experience and how care is being delivered telemedicine has to be included—It's no longer an add-on anymore. Now it's a necessity.

These doctors are going to start using it and start leveraging it a lot more, which is great. In my experience, the doctors that have adopted telemedicine see it in 3 major categories. Number one, it really helps them to shorten visit times. When you look at the data of a telemedicine based visit versus an in-person visit, you're looking at an eight minute telemedicine visit versus a 15 or 20 minute in-person office visit, which for a lot of use cases is tremendous. This could potentially lead to less burnout because they're able to really optimize their schedule for that for time management.

The second thing that telemedicine really helps with is flexibility—not only flexibility with the doctors and their schedule, but patients and their schedule because you're able to reach the patients where they're at. So not only does it help doctors manage time, but it helps patients make sure that they can be seen in a timely fashion.

Then the last thing that is really important that a lot of doctors are not doing with telemedicine is leveraging service extenders. So, by leveraging folks that they have in their office—so, office staff already or outside service extenders—physicians are now able to spread their time out by individuals that now are executing incident to their behalf. So, again, this is a big "Aha!" moment for doctors that we work with, realizing "Wow, I could have a separate service being conducted by my staff on telemedicine that is helping my patients get better, but it's also a billable service and it's reaching the patient where they're at". It's a win-win-win.

This is a big piece of telemedicine that's really emerging. I'm hoping and a lot of folks in the telemedicine space are really hoping that this gains more traction, because that's how we're going to reduce physician burnout. That's how we're going to be able to get patient outcome better patient outcomes, and that's how we're going to be able to reach more patients.

What are some of the most common hurdles when adopting telemedicine and how can they be avoided?

Alencar: A lot of it surrounds the user experience. One of the biggest hurdles that these doctors will tell you is they cannot get their patients on the technology. So, circling back to my answer to the first question, the technology is the biggest issue most of the time. The frustration is getting the patients to adopt it and getting them onto the technology. Once they're on the technology, you're smooth sailing most of the time. Then you're dealing with the normal frustrations of technology, which is bandwidth.

Those are the biggest hurdles. What I can tell providers is, number one, provide a very detailed and hand holding experience to get those patients onto the technology that you've decided to select. For us, the best way that we do that is providing an application. A lot of EMRs or other patient interface apps will have an ability for patients to self-schedule, but there may be some patients that need to have a little bit more hand holding to get to download the app and things.

The best case scenario would be to have an administrator in your office call the patients letting them know that their visit is going to be conducted through televisit and they’re going to have to download an application click on a link whatever it is that your technology requires. If they're going to be sitting in a waiting room, then they need to be prepared to do that. Their provider will take X number of minutes to enter the waiting room is a good way for the administrator to get them prepped and, if the administrator, is available to merge the provider into the visit. That's one of the best user experiences that we can that you can provide for those patients.

I would say the biggest hurdles is getting the patient to that first visit. And, circling back on my second answer, if you can couple that with a program offering that gets patients to use technology and using telemedicine ahead of time, it makes the integration of urgent care, sick care visits, and those kinds of things, so much easier to implement and manage.

Geeta Nayyar, MD, MBA, is the chief medical officer for Greenway Health. Specializing in rheumatology, Nayyar is focused on bridging the gaps between clinical medicine, business, communications, and digital health. A member of the Health Information and Management Systems Society (HIMSS) board of directors, Nayyar has received multiple awards and recognitions for her work in the field of digital health.

What are some factors or themes associated with telemedicine exacerbating burnout among clinicians?

Nayyar: When we say digital health and burnout, I think the two things that come to mind are just EHR—it's a burnout associated with the EHR—and the second one, sort of as the dovetail to that, is the clicks. The number of clicks and the excess of inefficiencies created by many of the EHR software out there.

So, again, I hope to see it moving in the right direction. I know that's a big part of what we're trying to do at Greenway, but this has fundamentally been the issue with EHRs and slowing clinicians down just from basic documentation to get through your basic workflow for an encounter.

What are some factors or themes associated with telemedicine decreasing burden among clinicians?

Nayyar: I think those that have had positive experiences have workflows that have been really customized or well thought out for their specialty or per their vendor of choice.

So, I think it's the thoughtful workflow and the technology to support that. I also think usually it's the savvier super champion doctor that's really nailed some of those things and created a lot of those workflows created a lot of those custom templates.

Again, my mindset is on the EHR. I think there are many examples outside of the EHR that can be assets, but for now, just kind of keep it in that EHR lane. That's what comes to mind.

What are some of the most common hurdles when adopting telemedicine and how can they be avoided?

Nayyar: Overnight doctors and providers have had to essentially come up with new workflows and ways to use the technology to solve for bandwidth issues—to offer what I call web side manner versus bedside manner. They're doing the video visit in a different technology, they're documenting in a different technology, and then they're using their phone or their other device if there's any follow up.

So, I think it's been a disconnected implementation for most. For those that were already doing this long before the pandemic, I think they've probably had things move right because they had time to plan and be thoughtful. Now, as we enter recovery stage, you have this piecemeal of brick and mortar plus telehealth and offices are trying to figure out where does each belong and should they should they be together. Everyone is kind of figuring out the workflow that makes sense for them.

William Fox, MD, FACP, is an internist with Fox and Brantley Internal Medicine. Based out of Virginia, Fox has practiced medicine for more than 2 and a half decades but has had to adapt his practice to cope with the ongoing pandemic. Fox represents thousands of internal medicine practitioners who have had to change their practices seemingly overnight in an effort to provide care to their patients.

What are some factors or themes associated with telemedicine exacerbating burnout among clinicians?

Fox: I would say the only thing is that the shift to telehealth has been very disruptive, because it’s not the way we typically run our offices. We’ve had to adjust, and any time you adjust, your level of efficiency goes down.

The efficiency has gone down as we’re learning to adjust to telemedicine. But has it increased the workload? I don’t think so for me, overall.

What are some factors or themes associated with telemedicine decreasing burden among clinicians?

Fox: It’s very convenient for patients. It makes patients feel very safe—they’re not worried they might catch COVID-19 in a doctor’s office. It allows doctors to continue to have contact with patients for their various ailments, during a pandemic in which people don’t want to travel. It allows us to keep our doors open, because it allows us to see visits. We have to see a certain amount of patients daily to keep our practice open.

That contact with the patient allows us to make sure that their medical needs are taken care of, so that they don’t decompensate to a point where they need to go to the ED or hospital.

What are some of the most common hurdles when adopting telemedicine and how can they be avoided?

Fox: There are segments of the population that have troubles using technology, because of their age. There are some who don’t have the equipment because of their socioeconomic status or because of where they live. Those are some of the biggest problems.

The only way to help with that is to improve internet availability for all socioeconomic classes, but some people may still not be able to afford the technology. It’s bigger than a simple answer, because it speaks to disparities in care and poverty.

And of course, the inability to do a full hands-on examination when it’s needed—that’s a difficult thing to work around.