Death by a Thousand Clicks Part 3: The Cost of Extra Clicks

This is our third part of a four part series looking at the Fortune Magazine article “Death by a Thousand Clicks.”

Part 1

Part 2

Part 4

Physician burnout is nothing new but now there is a higher level of awareness and it has taken on a much more prominent level of concern since the rush to EHR technologies.  Articles are written every day about how the EHR was supposed to bolster patient care, but many instances are cited in which just the opposite has occurred.  On top of that, the EHR has been blamed for a ballooning of physician retirement due to disillusionment related to the EHR.

In 2018 a Merritt Hawkins survey indicated that 78% of physicians showed signs of burnout. Burnout is real and has been labeled a “public health crisis” by prestigious organizations like Harvard School of Public Health.

The underlying issue is that physicians spend too much time doing tedious, small value tasks in the EHR that sap their energy and focus.  I am not a physician, but I understand the correlation between too much time spent on low value tasks and too little time spent on high value tasks.  My frustration and fatigue skyrockets when I do things that are mindless and do little if anything to help me attain my goals or my company’s goals.  I am never as unhappy as when I am kept from important work.

If you believe what you read in articles, physicians send half their day with their noses buried in the computer screen.  They spend less then half their time listening to and looking into the faces of their patients.  Then, on average, physicians spend 1.5 hours every night in what is called pajama time updating patient records.

I wonder how healthcare organizations go about advertising for new physicians.  How about this for an advertisement?


One of the irritations often cited by physicians is “alert fatigue.”  This happens when well-meaning alerts constantly appear on the screen.  Alerts are a great idea because they help point out potential problems like prescribing one drug that will react badly with a drug already prescribed for the patient.  However, if you get dozens of such alerts, one naturally becomes desensitized.  Scott Keeney wrote in a recent Internet post:

 “A patient has constipation and is already on a stool softener (for example, docusate). I add a stimulant or osmotic laxative – a common thing to do.  The EHR alert pops up that the patient is already on the stool softener.  I click “OK,” and another pop-up box appears that makes me click my justification for adding another constipation medication.  I have to select from multiple choices including “Not applicable” to “Disagree with this recommendation” to “Treatment Plan Requirement,” whatever that means.

You may say: “What’s the big deal?  It’s just two clicks.”  Well, these extra clicks add up and increase the time I spend interacting with the EHR.  Additionally, the more interactions I receive, the more I become numb to important ones.”

Hal Baker, a physician and the chief information officer at WellSpan, a Pennsylvania hospital system said, “Physicians have to cognitively switch between focus on the record and focus on the patient…  [t]exting while you’re driving is not a good idea.”  But physicians type into the computer, converse with their patients, and apply their diagnostic and treatment skills, all at the same time.  The American Journal of Emergency Medicine study says that on average, a physician experienced approximately 4,000 clicks in the EHR every shift.  It is virtually impossible to get every one of those clicks correct.

Extract is doing its part to reduce the time physicians spend searching for important clinical data in the EHR.  Extract’s HealthyData document and data handling platform specializes in automating all of the documents coming to the hospital or clinic.  HealthyData finds and extracts important discrete data and files this information in the patient record where the physician expects to find it, when they need it.  Contact us today for more information or a demo of the platform.

About the Author: David Rasmussen

David Rasmussen is the President of Extract. With 30 years’ experience leading software companies, David is driven by the challenge to consistently find groundbreaking ways to solve customer problems. David finds it rewarding to hit the customer’s target and create a great team, build a solid infrastructure, and emerge with a strong value proposition.