To see all of the feature stories in the Burnout in the Age of COVID-19 series, click here.
hief information officers are under immense pressure every day. They must keep the central nervous system of a hospital or health system up and running at peak performance 24 hours a day, seven days a week, 365 days a year. That is not an easy task in the best of times.
Add to that all the demands of working through a deadly pandemic, with patient volumes increasing, information systems needing to be optimized (and often reconfigured for new clinical tasks) and much of a hospital’s IT workforce working remotely.
We spoke with six healthcare CIOs from across the country – New York to Hawaii – to learn how they’re managing these pressing demands on a day-to-day basis. They discuss the aspects of their jobs that cause them stress and can lead to burnout – but also offer plenty of actionable tips for their peers about how to combat stress and meet the challenges of a demanding job.
Remote workforce challenges
David Chou, chief information officer at Harris Health System in Houston, Texas, said the need to suddenly support a virtual workforce has been a big source of stress during the COVID-19 pandemic.
“Healthcare IT departments have been tasked with standing up solutions such as virtual desktop infrastructure, virtual health and many other solutions to support a remote workforce in a matter of weeks,” said Chou. “While technology solutions are proven, cultural adoption takes time.”
“Healthcare technology teams include established professionals, and they should be trusted to complete their tasks without being in a particular location.”
David Chou, Harris Health System
CIOs and IT departments are leading the charge by implementing the new solutions and driving workforce change management, he said. Traditionally, healthcare providers have never frowned at a remote workforce culture. These organizations have to adapt by allowing telecommuting, a different style of working and a new style of management, he added.
“There is a lot of pressure on the CIO and the IT staff to execute the remote workforce solutions and plan,” Chou said. “In this instance, during the pandemic, healthcare IT adapted exceptionally well, showing its agility.”
Reporting COVID-19 statistics
Kris K. Wilson, CIO at Hawaii’s Hilo Medical Center, reported that one of her primary areas of concern and stress today is properly reporting COVID-19 statistics.
“As new laboratory analyzers were introduced for COVID-19 testing, new tests orders were created,” she said. “We went through several iterations of orders and continue to refine order sets as additional guidance is released. Each order needed to be added to our evolving COVID reporting, and then we had to figure out how to reduce duplicates between presumptive positives, our rapid tests, tests done in the community and revisiting patients.”
It seemed easy in theory to Wilson, but proved difficult to clearly validate each patient and determine if their reason for hospitalization was COVID-related.
“Next we had to alter our reports for patients that eventually ‘recovered’ from COVID yet remained in our facility,” she explained. “Over the course of three months, the information requests from multiple governing bodies continued to change. Sometimes we had to manually count data points in our EHR and PPE in our central supply to ensure we had the correct information. Each requesting entity had a different form of submission ranging from email, fax and web entry. This was not only stressful, it was incredibly time-consuming.”
A chaotic environment
Today, the healthcare environment is extremely stressful for all members of the healthcare workforce due to COVID-19. The daily stress of change and uncertainty continue to escalate, said Theresa Meadows, RN, chief information officer at Cook Children’s Health Care System in Fort Worth, Texas.
“Prior to COVID-19, healthcare professionals already were experiencing high levels of stress that had led to burnout,” she said. “There are many factors that contribute to this stress. The first area of concern that can lead to high feelings of stress is an ever-changing, chaotic environment. Unsuccessful change management can lead to creating stressful environments.”
“Don’t be afraid to deliver the same message multiple times. In some instances, people are not ready to receive the information the first time they hear a message, so repeating the same message at a later time can help with adoption.”
Theresa Meadows, RN, Cook Children’s Health Care System
Many organizations do not have good process and communication to ensure new initiatives are successful, she contended.
“The stress from lack of change management can manifest itself in many ways,” Meadows said. “Many employees and clinicians become negative and try to reject the change. Many will look for reasons why the change will not be successful and focus on what could go wrong. Many studies have shown that ineffective change management will increase stress and contribute to burnout.”
Standing up telemedicine services
The nature of the pandemic and the subsequent loosening of regulations gave rise to a massive wave of telemedicine. Setting up new or additional telehealth services was a source of stress for Wilson of Hilo Medical Center.
“We already were using telehealth for behavioral health consults and tele-nephrology, but these were done in separate platforms outside of our EHR,” she explained. “In order to receive the same reimbursement as a face-to-face visit, we were required to use telehealth software embedded in our EHR through their integrated patient portal. This was a new process for our facility and our EHR vendor.”
Setting up the integrated portal application and the hardware needed to use telehealth was fairly straightforward for Wilson and staff.
“However, signing patients up to use the patient portal so we could schedule visits caused frustration and confusion,” she said. “Many patients in our system were new to patient portals or reluctant to sign in. There also was an initial delay in orders for web cameras, microphones and laptops that limited implementation timelines.”
Decisions that can “scare us to death”
The pandemic has caused a lot of healthcare professionals to put more thought into the decisions they make. COVID-19 adds an extra dimension to what might otherwise be ordinary decisions.
Leonard T. “Skip” Rollins, CIO and CISO at Freeman Health System in Joplin, Missouri, says he tries hard to be sure he’s making the right decisions at the right times.
“Build a strong support system: I am so lucky to have a very strong support system, my boss is great and partners with me frequently to evangelize our plans and initiatives.”
Leonard T. “Skip” Rollins, Freeman Health System
“I am a lot of things, but a worrier is not one of them,” he stated. “I do everything I can to keep my job in perspective – when we CIOs cannot do that, it will take its toll on us. Being a CIO in the healthcare space is very difficult right now. We are expected to make decisions every day that scare us to death, we know where the soft spots are and the concerns we all have about what could happen.”
Bridging the gap between technology and patient care is challenging – sometimes the gap is manageable, but other times it’s so wide CIOs cannot see the other side, he said.
“Those of us who make the leap to the other side experience both success and failure,” Rollins observed. “These leaps are the first steps of true innovation in the industry. I am a very strong believer in pushing the envelope when it comes to healthcare technology.
“COVID-19 has provided an opportunity for many organizations to push a lot of initiatives forward,” he explained. “Many meaningful gains have been made in so many areas. In some cases these advancements have exposed paths to solving many other challenges.
“The days of hiding in your office and spitting a cloud of technical acronyms is long gone,” he added. “Our customers are knowledgeable. They are IT savvy. They understand how technology can be applied and expect the IT organization to stay in the fast lane. I say bravo to our customers for pushing us and giving us the courage to jump the gap and be innovators.”
Disciplined resource management
The application of IT provides nearly limitless opportunity to optimize the delivery of patient care and the business processes of healthcare organizations. The resources to develop, deploy and maintain IT, on the other hand, are finite.
“Constant tension exists between the desire to ‘do everything’ and the discipline required to only commit to appropriately resourced work that is well aligned with the organization’s highest priorities,” said Elizabeth Lever, CIO at the Institute for Family Health in New Paltz, New York, one of the largest Federally Qualified Health Center networks in New York State.
“Prioritizing time and energy for professional development activities and supportive relationships can serve to prevent job demands from translating into stress.”
Elizabeth Lever, the Institute for Family Health
“This requires ongoing conversations with both clinical and administrative leadership in the organization,” she said.
It is a demanding and potentially exhausting task to maintain disciplined resource management in response to a complex and constantly evolving environment, she observed.
“We must respond almost daily to changing regulatory requirements, updated accreditation standards, developing standards in patient care, emerging business needs, technological developments and requests from the user community – all of which require changes in our electronic health record, billing and tracking systems,” she said.
“These tasks, particularly in times of significant and unexpected changes in the environment, can deplete the energy required to solve other complex problems. We are constantly juggling between immediate needs and long-term problem-solving.”
Effective leadership with emerging technologies
The healthcare industry is beginning to apply several newer technologies that are potentially as disruptive to the delivery of healthcare as the introduction of the electronic health record. Lever of the Institute for Family Health worries.
“I am particularly concerned about the rapidly expanding application of machine learning and artificial intelligence, which present entirely new risks and ethical considerations,” she said. “As with many technology-based improvements, early case studies have identified the potential for such technologies to inadvertently perpetuate health disparities along racial and socioeconomic lines.
“CIOs need to develop the necessary knowledge and governance processes to both implement improvements and prevent unintentional harmful consequences of the application of such technologies, particularly as regulations that support patient safety are matured,” she continued. “Lack of familiarity with emerging technology can contribute to a discomfort with leveraging such innovations.”
Subsequently, opportunities for adoption and the associated benefits are missed, and the critical leadership role of the CIO can be compromised, she added.
EHRs, telehealth and staff management
Bob Sarnecki, CIO at Children’s Hospital of Alabama in Birmingham, discusses three stressors of particular note during this pandemic year: electronic health records, telehealth and staff management.
“The EHR is probably at the top of my list this year,” he reported. “With a contract renewal coming up in September 2023, we are evaluating our vendor against other EHR vendors on the market. Any transition is a multiyear effort, with a significant impact on our project portfolio, capital and operational costs, and organizational culture and workflows.”
“We tried to identify projects that would help to ‘de-stress’ the hospital, and made those a higher priority.”
Bob Sarnecki, Children’s Hospital of Alabama
Sarnecki’s executive team is very supportive of the study, and they are up for the challenge, he said, but reconsidering an EHR is a decision no one takes lightly. Internal to IT, the team has been reviewing the effect on its current projects and systems. It is an exciting time, but also very stressful, he said.
“Telehealth also has taken a lot of our focus,” he added. “We have spent time collaborating with and learning from local hospitals, trying to create a platform that combines ease of use with high functionality, so we can transition our patients between telehealth and traditional ambulatory encounters as needed.”
Children’s Hospital of Alabama chose Zoom as its telehealth platform. While it had the basics of the platform functional within a few days, it has built out a great deal of API-based interfaces and system interoperability to make it easy to use for its clinics and patients.
“While we have seen our ambulatory encounters beginning to return to normal levels, we have been excited to see that the number of daily telehealth encounters is approaching volumes consistent with some of our busier clinics,” Sarnecki added.
His third primary stressor of 2020 has been staff management, both within the IT department and throughout the hospital.
“About two years ago, we designed internal policies and procedures to facilitate remote work, but we only saw them implemented during inclement weather,” he said. “COVID-19 changed that dramatically in March, but not just for IT. Hospital-wide, new ways of staff management, social distancing and patient care needed to be imagined and implemented almost overnight.”
He said it has been great working with so many innovative and collaborative departments, all challenged with new ways of thinking for their staff and for the children the organization cares for.
“Zoom figured prominently in patient and staff communication, but sometimes in ways that were unpredictable. For example, allowing COVID-19 patients to communicate with their nurses face-to-face was obvious, but using a Zoom session to address visitor restrictions, board meetings and even allowing nurses to communicate with the families took much more thinking,” he said.
Rapid advancements, consumerism
Contributing to feelings of high stress are rapid technology advancements and the impact of consumerism on the delivery of healthcare, said Meadows of Cook Children’s Health Care System.
“Over the last five years, the rate of adoption of new technology, specifically the EHR, in the healthcare environment has led to increased stress with staff and clinicians,” she said. “Many studies have shown the maturity and rapid deployment of the EHR have contributed to burnout. Now with COVID-19 and the rapid adoption of telemedicine, the practice of medicine has changed once again. Clinicians must learn to adopt new techniques to interact with patients and families.”
“Our laboratory is not owned or operated by the hospital, so it has been critical to maintain constant communication and to confirm result messages were passing from the lab vendor EHR to our EHR in a timely manner.”
Kris K. Wilson, Hilo Medical Center
In April 2020, virtual visits increased from 19% to 28% of outpatient visits at Cook Children’s. Industry studies have shown that 80% of consumers will continue to have televisits even after COVID-19 subsides, she said.
“Consumers expect to have access to healthcare anytime, anywhere,” Meadows said. “The expectation that I can receive care via telemedicine is the new normal. This rapid change creates concerns with clinicians that quality of healthcare can be impacted. In addition, if payers do not continue to reimburse for virtual health, we also will be impacting the livelihood of many physicians. This reality also creates additional stress for organizations.”
Tips to combat burnout
So those are the issues and technologies that are causing healthcare CIOs to feel the heat of working in the age of COVID-19. But these CIOs have been successfully warding off burnout and here share numerous tips for their peers to employ in their efforts to avoid burning out.
Lever of the Institute for Family Health said that CIOs must shape their jobs to fit themselves.
“Especially in roles where there is a high degree of independence, there are many opportunities to shape a job to fit you and increase engagement in the process,” she said. “Termed ‘job crafting’ in the field of industrial and organizational psychology, employees can intentionally determine the tasks completed, along with when and how they are completed; choose the relationships to develop; and frame how to think about workplace contributions.”
Lever shapes her job every time she delegates a task. By delegating a task, she is shifting her responsibility from completing the work to supervising the completion of the work.
“When I intentionally assign work to a member of my team that will stretch or assist in that team member growing skills, I also commit to providing the team member mentorship and coaching as necessary to ensure we are successful together,” she explained. “I find it particularly meaningful to create a workplace culture where individuals have opportunities to develop skills and independence.”
Intentional delegation achieves more than the reassignment of work. It serves as a tool to: shift the specific tasks one completes toward those one enjoys most, develop professional relationships with the team one supervises, permit team members to expand their skills and confidence, and create significance in one’s professional experience, she added.
“There are ways to shape your job as simple as identifying a time of day at which you most effectively engage in certain types of work and scheduling accordingly,” she said. “Though everything about a job is not flexible, the way we think about our work is in our control. My team practices tying actions we take to the support of our mission: to improve access to high-quality, patient-centered primary healthcare targeted to the needs of medically underserved communities.”
This exercise, she added, gives different meaning to even routine IT work like creating a new user account for the electronic health record – connecting any task to a personal value set can help make it more meaningful.
Get a good report writer
Wilson of Hilo Medical Center puts that one plain and simple.
“Have a good report writer on your team who understands clinical workflow,” she advised. “Our report writer is really good at pointing out information that was potentially missing or counted as duplicates. She also is very familiar with our EHR so she could cross-reference and validate reports on her own. This was especially helpful for any reports that were tied to strict deadlines and potential funding.”
Another Wilson tip: Remain in constant communication with one’s laboratory services.
“Our laboratory is not owned or operated by the hospital, so it has been critical to maintain constant communication and to confirm result messages were passing from the lab vendor EHR to our EHR in a timely manner,” she said.
“We also deemed COVID-19 testing as a critical result, so all positives were called to the unit and the verbal receipt of the test was documented in the EHR. This was important because inpatient bed placement and precaution orders were executed in a timely matter to maintain emergency room flow.”
Identify and develop needed resources
CIOs are well versed in obtaining critical resources and the challenges that come with allocating and managing those resources. It is important that CIOs also can effectively develop the resources they need for themselves as an employee, said Lever.
“Prioritizing time and energy for professional development activities and supportive relationships can serve to prevent job demands from translating into stress,” she suggested. “According to the job demands-resources model,” which measures occupational stress “resources are needed and serve to offset the potential stress of demanding jobs.
“Professional development opportunities and supportive work relationships are two types of resources that may be less directly related to the accomplishment of specific tasks, but contribute positively to the overall experience of work and can increase engagement and motivation,” she added.
Many professional development opportunities are available at little to no cost: Joining interdisciplinary project teams, chairing committees, presenting and publishing on work, and so forth.
“In addition, I recommend identifying a professional development activity that is entirely self-directed, ad-hoc and able to be worked into a busy day,” Lever advised.
“I have made it a habit over the last several years to keep a book of essays on management or leadership on hand. Stepping away from my desk for 20 minutes with an article to read and on which to reflect serves as one of my go-to methods of introducing a dose of professional development into my work. Even in the most demanding times, I can find 20 minutes for this task.”
Similarly, developing supportive relationships takes time and intentionality but costs little else, she added.
“Supportive relationships can take the form of ongoing professional coaching, identifying specific skills to develop over time,” she explained. “Supportive relationships can be developed out of collegial relationships, as well. To develop supportive relationships, I make it a habit to ask others for feedback on job performance and for advice. I also practice providing constructive feedback and am willing to provide advice in my areas of expertise.”
Lever has found that making it a habit to ask for feedback on specific, concrete performance or tasks offers the opportunity to develop professional relationships in which she effectively can seek feedback and advice on more abstract performance areas, such as successfully navigating leadership challenges posing ethical questions.
Reevaluate the project portfolio
Sarnecki of Children’s Hospital of Alabama said one step he and his team took to decrease stress was to reevaluate their project portfolio.
“With hospital revenue profoundly impacted by COVID-19, this is one that every CIO has had to face this year,” he remarked. “We tried to identify projects that would help to ‘de-stress’ the hospital, and made those a higher priority. In general, they were projects that improved interoperability and integration – especially helpful when staffing is down – as well as projects that improved communication.”
Internally, for example, IT at the hospital has been deploying a smaller, $2,000 platform that will allow staff to create more video conference rooms, creating video conferencing carts, and deploying system changes that promote workflow changes that are eliminating reliance on specific locations, including text-based notification for families who are social distancing outside the waiting room.
“Our instructional systems and technologies group, responsible for much of our computer-based training, has been working to transition much of our education to web-based, and we have a small ‘TV crew’ that captures our conferences, CME and grand rounds training meetings,” Sarnecki added.
The need for a doc champion
Having a physician champion for IT can go a long way for helping reduce a CIO’s job stress, advised Wilson of Hilo Medical Center.
“We built a COVID-19 screening tool and implemented a scoring system early in the pandemic,” she said. “As new guidance was released, we continued to update our documentation. Our chief medical officer was instrumental in gaining compliance, ensuring appropriate documentation, and ordering COVID-19 and antibody testing.”
Another tip from Wilson: Be sure to prioritize tasks for the team.
“It felt like we were moving and shifting to put out a new fire every day,” she recalled. “We were supporting more employees working remotely, moving departments from one station to another, building COVID-19 pods, and deploying telehealth equipment. On top of this we still have our normal help desk operations, projects and system maintenance to uphold.”
Setting the priorities for the day helped everyone remain focused on the tasks at hand without feeling overwhelmed, she said. Although it was hard not to feel the uncertainty of the pandemic, she added.
One of the ways Sarnecki of Children’s Hospital of Alabama has been trying to combat stress has been to practice “visioning.”
“Developing a CIO’s vision for an organization, a department or even an industry requires strong skills in defining a vision and an executable plan to make that vision a reality,” he explained. “The stress of organizational needs, especially in a pandemic, puts a lot of pressure on you to respond in the moment – also a good skill, but all too often, it can become the principal way of addressing a challenge.”
Take the time to have ideas, truly define goals and develop a comprehensive plan for getting there, he added.
“The pandemic has provided some very interesting ways to practice visioning,” he said. “For me, nothing beats getting outside, to work, walk or run. But I’ve also spent some time having some 30-minute, one-on-one conversations with my team, talking about three topics: What is good in the department? What do we need to preserve? What is not good and needs to be changed? And finally, what do you want to do in your career?”
Sarnecki has found that the conversations he has had from these three questions have provided great ideas for things staff could envision, and helped to identify unique skills and talents that will help him and his team get there.
“I’ve discovered some amazing skills in my team, from former television production to illustrators, writers, construction workers, etc.,” he noted. “If you knew you had those types of people on your staff, wouldn’t it change what you envision, or how you would get it done? What would happen if those people led small, agile teams assigned non-traditional projects?”
Clear, concise, frequent communication
A top tip from Meadows of Cook Children’s Health Care System is that, in times of extreme stress, it is important to have clear, concise, frequent communication with key stakeholders throughout any change.
“These messages should be tailored to specific audiences,” she advised. “For example, we create leader messages that help leaders discuss difficult topics with their teams. We allow the leaders to ask questions and seek clarification prior to sending out communications to all staff. Allowing leaders time to digest a message before it is shared with staff allows them to prepare for questions they might receive.”
Consider offering communication through multiple modalities, she added.
“This includes face to face, video messages, written messages, Zoom meetings and more. For difficult messages, it may require multiple communication points, and not a single message. Don’t be afraid to deliver the same message multiple times. In some instances, people are not ready to receive the information the first time they hear a message, so repeating the same message at a later time can help with adoption.”
Time management and time away from work
Meadows offers another tip to avoid burnout: Work on time management.
“Plan your day so you can address the most critical things as early in the day as possible,” she advised. “Once the day gets started, it is really easy to lose focus on what needs to be completed without a plan. It’s OK to say no. There are many high-priority things that can occur each day. It is important to understand the limits of what you can take on each day.”
CIOs typically have a hard time saying no to requests, she observed. As a result, CIOs must work on determining the best use of their scarce resources, she said, and sometimes that means saying no to others.
“On another note: Take time for yourself away from work,” Meadows stressed. “This can manifest itself in many ways. It could be 15 minutes each morning prior to the start of your day. It could be through an exercise routine. Using your vacation time is very important. Everyone needs to unplug from work to rest and recharge.”
Meadows has a few routines she uses. She has a 45-minute commute each day to and from work. She likes to use this time to decompress. This includes listening to audio books, sometimes listening to music, sometimes talking to friends on the way home. On really tough days, she may drive in silence and think about how to improve the next day.
“I also like to block from 6:00 p.m. to 10:00 p.m. as ‘no work time,'” she said. “This is the time I spend with my family. I try to protect this time so I can focus on things that are most important. No matter what you choose to do, it is important to take care of yourself so you can be the best at work.”
Promoting work/life balance
Work is not a place that employees go to, but rather an output of their effort to advance the organization, said Chou of Harris Health System.
“This has to be the new motto for CIOs – and it should be a motto that leaders can use to promote work/life balance,” he advised. “Healthcare technology teams include established professionals, and they should be trusted to complete their tasks without being in a particular location. If leaders do not trust their employees, then they probably should not have hired them.”
IT employees working remotely miss informal communication and water cooler chats. CIOs should use existing collaboration tools in their portfolios, such as Microsoft Teams, WebEx Teams and Facebook at Work, to create a water cooler group to drive employee discussions, he suggested.
“Studies have shown that remote workers increase their average workday by 8.2%, equating to an additional 48.5 minutes daily,” Chou said. “Healthcare CIOs should focus on cutting down meeting durations to allow for breaks and thinking time.
“Currently, many organizations have their video meetings set for 30- or 60-minute sessions,” he explained. “The recommendation is to reduce meetings to 15 or 45 minutes to accommodate quick informal check-ins while the 45-minute session replaces the 60-minute.”
Find time to play
This tip is especially appropriate to Sarnecki of Children’s Hospital of Alabama.
“Working in a children’s hospital reminds our team daily of the need to find some time to play,” he explained. “Stress is especially difficult for children. As a department, we look for the opportunity to ‘play with technology.’ Our department has helped to provide families and children with ways to remain connected, and we are working on ways to provide the chance to see Santa this Christmas through the hospital WiFi and a green screen.”
The time commitment is limited, but many of the IT staff have skills and technology interests that give them a chance to combine the “techie things” they like to do at home with the needs of patients, he said.
“We know, for example, that very few children will get to see Santa in person this year, underlining the need for a ‘tele-Santa’ solution that our team is building and testing remotely,” he said.
Staff needs to find some time to play, as well, Sarnecki the CIO added.
“In our department, we have had several individuals use video conferencing capabilities to set up small groups that meet virtually to exchange ideas for teaching their children at home, meet with one another to share hobbies or interests, and even practice videoconferencing,“ he said.
“Right now, everyone is stressed, and technology provides one of the best ways to combat the feeling of isolation. Experiment with what works best for your technology and with your culture. Form new friendships. Don’t just preserve the ones you enjoyed before.”
Four final quick tips
Rollins of Freeman Health System wraps things up with four quick tips for CIOs to avoid burnout in the age of COVID-19.
“Stay informed,” he advised. “The hardest job of the CIO is staying aware of everything going on in the industry. It is virtually impossible to read everything, attend the webinars, listen to podcasts and stay in touch with your vendors. I often refer to this as watching a wall of televisions. You must keep up with all the shows, but cannot get so focused on one thing so much that you miss something on another show. It is tough and it’s something you have to work really hard at to keep up.”
Don’t get too proud, Rollins warned. Don’t fall in love with one’s decisions. Remain flexible and willing to relook at decisions and strategies, he said. Revisiting strategies can be career-limiting, but it has to be done to stay in step with the mainstream, he said.
“Build a strong support system. I am so lucky to have a very strong support system. My boss is great and partners with me frequently to evangelize our plans and initiatives,” he said. “My IT leadership team is very strong and knowledgeable. I trust my support system and delegate to my leaders. If you don’t have a team you trust and believe in you have to fix that problem. They have to believe in you and you have to trust them to get stuff done.”
Finally, Rollins advised, “Trust yourself.”
“Above all, you must believe in yourself and trust your instincts,” he concluded. “If you don’t believe in your ideas, it’s hard to convince others to believe in them. I very strongly believe in my abilities. Your confidence is a very strong tool to have. Projecting that confidence positions you in a place to succeed.”
Next up in our feature story series on burnout in healthcare in the age of COVID-19: Physicians talk about stress, and how technology can increase – and decrease – stress levels.