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    An expert weighs in: How Clinical Documentation Integrity (CDI) could help clinicians avoid burnout

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    Photo of Dr. Natalia Dorf Biderman, M.D.

    • The conversation around COVID-19 and its relationship to physician burnout continues. According to results from a Medscape survey, which polled more than 7500 physicians in eight countries, about two thirds of US physicians said burnout has intensified during the crisis.

      And while COVID-19 has resurfaced the conversation around burnout, it’s been a hot topic among the medical community for a long time. Many clinicians, organizations and leaders have long been exploring not only how to avoid burnout – but how to elevate wellbeing and joy. 

      We spoke to Dr. Natalia Dorf Biderman who practices hospital medicine at Methodist Hospital in Minnesota. Natalia offers a unique perspective on clinical fatigue, given her expertise in CDI and clinician wellbeing. Natalia is originally from Uruguay and pursued a career in internal medicine at Universidad de Valparaiso in Chile. She served as the Chilean medical director in the Maccabiah games – where she met her future husband and, eventually, moved to Minnesota, completing a residency in internal medicine at the University of Minnesota. Since then she has worked at Methodist Hospital and has held different leadership positions. She is currently the CDI medical director and Wellbeing committee chair.

    • Q: What prompted your interest in the topic of physician burnout?

      Dr. Biderman: I experienced burnout for the first time way before the pandemic – about five or six years ago – and I wanted to understand why I was unhappy. I had wanted to be a doctor my whole life. It was in my DNA. As I started exploring physician health and wellbeing, I realized there’s this range to burnout. You don’t have to be totally burnt out or fried. Physicians are extremely resilient; there’s a lot you go through to become a physician and to remain a physician. Individuals in other professions might notice burnout earlier, but a lot of clinicians just keep going – and that’s what happened to me. So since then, I have been involved in many aspects of wellbeing in healthcare both at work and in the community.

    • Q: How did the pandemic impact physician burnout?

      Dr. Biderman: The amount and change of practices and protocols were dizzying. What we knew one morning could easily change in the afternoon. There was also the quantity of meetings and work. On top of these changes, we had questions and doubts about personal safety. How am I going to be? How will my colleagues be? How contagious is this? Do we have enough personal protective equipment? The combination of all these factors was extremely difficult. Now that the numbers are improving and things are less chaotic we are in a place where we can look back and start processing what we have been going through.

    Q: How did you realize your work with CDI could have a positive impact on your work experience and burnout?

    • Dr. Biderman: I didn’t make the connection right away. At Methodist Hospital, I was on an operations leadership team and was asked to work on CDI. I realized I had so much to learn about our regulatory environment and its impact on patients and communities. There’s no question that being at the bedside connected to individual patients brings purpose and meaning to those doing the work. In this work, I realized that being connected to the healthcare system as a whole, also gives me incredible meaning and purpose. I dug into claims-based data, regulatory, public reporting, data analytics. Being involved in this work gives you an overview of the healthcare system and you are able to engage with it in a different way.  The amount and change of practices and protocols were dizzying. What we knew one morning could easily change in the afternoon. There was also the quantity of meetings and work. On top of these changes, we had questions and doubts about personal safety. How am I going to be? How will my colleagues be? How contagious is this? Do we have enough personal protective equipment? The combination of all these factors was extremely difficult. Now that the numbers are improving and things are less chaotic we are in a place where we can look back and start processing what we have been going through.

    • Q: What have you learned so far?

      Dr. Biderman: The more we move into a value-based approach to care delivery, the more we realize each encounter has an impact on the system. In my current position I collaborate with quality, coding, data analytics and clinical teams and help translate those unique patient encounters into meaningful data that accurately represents the complex and quality care we provide. I look at the grey space of the clinical world and the discrete nature of the data world and draw connections between the two. Then, we work to implement education, process improvements and efficiencies that make it easier to do the right thing in real time. In the world of medicine, patient care or a specific encounter is typically not just one thing and it’s frequently not black and white. The longer I have been involved with this work the clearer it becomes that we are trying to translate between two languages. I ask: How do we live with a foot in both worlds?

    • Q: How do you see technology impacting your day-to-day?

      Dr. Biderman: There’s no question that having 3M’s M*Modal technology in our suite of tools is improving the clinician experience for documentation and coding. The language we’re able to use is different because dictation is different than typing. Voice recognition technology allows for a different kind of storytelling. With the CARES Act, all documents within the EHR are released to the patient as they are signed – and that is the right thing to do.  When we’re able to tell a story that lands closer to the patient story – when we can capture why our patients come in to see us and what they’ve told us – it’s a big improvement in what we’re able to communicate. We can use documentation as a storytelling tool, not just for coding or billing.

    • Q: How do you help other clinicians see the value in technology?

      Dr. Biderman: I’m usually an early adopter. I am always looking for tools to make my life easier. It might be why I have always been involved with quality improvement and human centered design. I think technology is here to stay. It saves lives and makes the care we can give safer. So I am always asking myself: How can I make this tool/tech work for me? I use our EHR and other technology tools to pretty high standards and I am always showing other clinicians when I find something exciting or new that helps. In my work with CDI I am always looking for efficient tools or ways to use our technology to our advantage.

    Dr. Natalia Dorf Biderman, M.D. and her husband climbing a mountain in Chile
    Q: How is practicing medicine in the U.S. different from practicing medicine in Chile?

    • Dr. Biderman: In my experience, one of the key differences from many places elsewhere in the world, like South America, is that in the U.S. there is a large percentage of clinicians who work within large organizations and systems. In South America, by far, most doctors work independently. They might work for one healthcare system in the morning, then another system in the afternoon and then they hold their own private clinic; there is agency and wide decision-making rights in that set up. There are many downsides too, don’t get me wrong.

      In South America, there is burnout too – but it might have a different flavor that pertains to workload and hours taking care of patients. It is just different. I also believe there are other compounding factors or cultural differences about work-life balance that don’t pertain exclusively to clinicians. Culturally, the way South Americans engage with work and non-work life is, in general, different. One’s identity is more tied to community and family and not so much to work – so vacations, breaks and get-togethers with friends and family are central to life.

    • Q: Do you think your immigrant experience informs how you practice?

      Dr. Biderman: I believe so. I’ve experienced medicine/healthcare delivery in different ways which allows me to see what we do from a different lens. It gives me the foundation to see how things could be different and, ultimately, for innovation. Diversity matters. When you bring in people with diverse experiences, you create the underpinning for different ways of designing and creating. There’s no question about that.


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