The Potential of SMART on FHIR Solutions to Mitigate Physician Burnout

Jan 21, 2022 |

Over half of the physicians and nurses in the United States have reported symptoms of physician burnout and it’s estimated to be costing the US healthcare system $4.6 billion due to reduced hours, physician turnover, and expenses associated with finding and hiring replacements.  The COVID pandemic has further compromised an already fragile and overstretched workforce.  Electronic health records have been acknowledged as both a contributor to burnout as well as recognized as a vehicle for exacerbating the underlying business drivers for burnout such as requirements and regulations for prior authorization, documentation, quality reporting, and reimbursement.

The Data Tsunami in Healthcare

Clinicians are facing an exponentially growing data tsunami with the adoption of solutions for Remote Patient Monitoring, Artificial Intelligence, Precision Medicine and Social Determinants of Health.  They spend much of their day toggling, scrolling, and spelunking into multiple information silos to access data that will help them take care of their patients.  Health systems are challenged to stitch these environments together with native EHR functionality thus much of the data is in disjointed silos.  Clinicians are forced to bear enormous task interference and cognitive burdens to interpret a meaningful narrative out of all the bits and pieces.  Many people define healthcare as essentially a knowledge and data processing discipline.  And yet, it is also a discipline that is most effective when the patient experiences a caring and connected relationship with their clinicians.   This relationship, which is also a social determinant of health, is undermined when clinicians are too burned out and overloaded to create that caring connection.  Further, the promised improvements in quality from patient engagement tools may go unrealized if clinicians find accessing them too difficult.

Imagine a world where a clinician can launch a Behavioral Health app, seamlessly embedded in the patient chart, that assembles patient-reported PHQ9s, medication history longitudinal graphs, dispensing data, laboratory data, and decision support recommendations into a single, longitudinal view with intuitive visualizations.  The HL7 FHIR standard is potentially a major enabler since it incorporates real-time interoperability with (a) support for embedding SMART applications into FHIR-enabled EMRs and (b) support for cross-platform CDS.

Rescued by SMART on FHIR

What does FHIR enable? The development of cross-EHR platform applications that can integrate into rather than disrupt clinical workflows that typically happen in the EMR. The art in this craft is the creativity that goes into creating elegant SMART applications that can produce high-value clinical insights applicable to the context in which they are used. The 5 rights of CDS apply (the right information, to the right person, in the right intervention format, through the right channel,at the right time in workflow) but these solutions typically need to go well beyond that in order to support key factors such as usability (presentation), utility, actionability and graceful EMR workflow integration. In our experience, to successfully create such SMART on FHIR apps (we call them Sapphire® Facets),  it has been essential to leverage our team’s expertise in clinical data representation standards, data deduplication, decision support, clinical workflow design, and particularly, the diverse vendor approaches to implementing FHIR.

The healthcare industry sorely needs platforms that are interoperable with EHRs to craft thoughtfully curated and integrated visualizations and workflows that improve the quality of life, efficiency, and effectiveness of everyone on the care team.  Clinicians and their support staff will greatly benefit from solutions that anticipate their needs and cull the data tsunami for the data and knowledge most relevant to supporting their ability to optimize patient engagement and clinical outcomes.

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