Presentation on theme: "Jerry L. Halverson, MD Rogers Memorial Hospital WPA President, WMS President- Elect December 5, 2014."— Presentation transcript:
Jerry L. Halverson, MD Rogers Memorial Hospital WPA President, WMS President- Elect December 5, 2014
Privacy Incentives and penalties/ meaningful use AMA/ RAND study
Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy
What factors influence physician professional satisfaction? What are the implications of these factors for patient care, health systems, and health policy? EHRs were found to be a significant dissatisfier
Physicians approved of EHRs in concept and appreciated having better ability to remotely access patient information and improvements in quality of care. However, for many physicians, the current state of EHR technology significantly worsened professional satisfaction in multiple ways. poor usability time-consuming data entry interference with face-to-face patient care inefficient and less fulfilling work content inability to exchange health information degradation of clinical documentation
"Physicians in multiple specialties and practice models noted that their EHRs improved their abilities to access patient data, both in health care settings and at home."
"Physicians and administrators in some practices described how EHRs improved their ability to provide guideline-based care and track patients’ markers of disease control over time. These advantages were predominantly noted in primary care practices."
"Interviewees described enhanced communication through the medical record itself (e.g., by facilitating access to other providers’ notes and eliminating illegible handwriting) and through EHR-based messaging applications (e.g., patient portals). Improvements in between-provider communication were most commonly noted in larger practices, where all providers were on the same EHR."
"The majority of physicians who interacted with EHRs directly (i.e., without using a scribe or other assistant) described cumbersome, time-consuming data entry.”
"Beyond data entry, physicians and their colleagues described EHR user interfaces that, in important ways, hampered rather than facilitated their clinical workflow. Nonintuitive order entry was particularly problematic."
Multiple physicians who entered their notes via keyboard described their EHRs as interfering with face-to-face patient care. Many of these physicians blamed themselves for lacking the ability to type without compromising the level of attention they could devote to patients. These physicians faced a difficult trade-off: divide attention between the patient and the computer, or defer data entry until after leaving the patient, lengthening overall work hours.
Physicians in multiple specialties and a range of practice settings described frustration when health information was not exchanged between EHRs. Even when practices invested in EHRs, faxes were a common mode of communicating patient information between care settings
Some EHR products feature automatic email alerts to physicians. For primary care physicians in particular, this has created a sense of information overload— the unceasing volume of messages reaching them has expanded beyond the number that they believe they can handle diligently
Both primary care and subspecialist physicians noted a mismatch between meaningful-use criteria and what they considered to be the most important elements of patient care.
Some physicians, especially those who owned or who were partners in their practices, reported that investing in EHRs exposed their practices to significant financial risks. In particular, the costs of switching EHRs— which could become necessary due to factors beyond a practice’s control—were of high concern.
Physicians who did not use scribes reported that their EHRs required them to perform tasks below their level of training, decreasing their efficiency.
While some physicians described using templates (or “macros”) to ease the writing of clinical notes (i.e., to overcome data entry problems), many described misuse of template- based notes as a significant threat to both clinical quality and professional satisfaction. Such notes were described as complicating the task of retrieving useful clinical information. This problem was reported by physicians in all specialties and practice models included in the study.
"In our sample, there was no significant relationship between overall satisfaction and the length of time since EHR installation."
"In addition, physicians whose practices reported having greater numbers of EHR functions (with higher numbers indicating more advanced and possibly more complex EHRs) were less likely to have high overall professional satisfaction."
Physicians and practice managers described the cumulative burden of externally imposed rules and regulations as having predominantly negative effects on professional satisfaction. At the time of the study, "meaningful use" rules for EHRs were the regulations most commonly singled out by physicians and practice leaders.
Better EHR usability should be an industrywide priority and a precondition for EHR certification.
To leverage the power of EHRs for enhancing patient care, improving productivity, and reducing administrative costs, the AMA framework outlines the following usability priorities along with related challenges: Enhance Physicians' Ability to Provide High-Quality Patient Care Support Team-Based Care Promote Care Coordination Offer Product Modularity and Configurability Reduce Cognitive Workload Promote Data Liquidity Facilitate Digital and Mobile Patient Engagement Expedite User Input into Product Design and Post- Implementation Feedback
The EHR should fit seamlessly into the practice and not distract physicians from patients.
EHR design and configuration must: (1) facilitate clinical staff to perform work as necessary and to the extent their licensure and privileges permit and (2) allow physicians to dynamically allocate and delegate work to appropriate members of the care team as permitted by institutional policies.
EHRs should have enhanced ability to automatically track referrals and consultations as well as ensure that the referring physician is able to follow the patient’s progress/activity throughout the continuum of care.
Modularity of technology will result in EHRs that offer flexibility to meet individual practice requirements. Application program interfaces (APIs) can be an important contributor to this modularity.
EHRs should support medical-decision making by providing concise, context sensitive and real-time data uncluttered by extraneous information. EHRs should manage information flow and adjust for context, environment and user preferences.
EHRs should facilitate connected health care—interoperability across different venues such as hospitals, ambulatory care settings, laboratories, pharmacies and post-acute and long-term care settings. This means not only being able to export data but also to properly incorporate external data from other systems into the longitudinal patient record. Data sharing and open architecture must address EHR data “lock in.”
Whether for health and wellness and/or the management of chronic illnesses, interoperability between a patient’s mobile technology and the EHR will be an asset.
An essential step to user-centered design is incorporating end-user feedback into the design and improvement of a product. EHR technology should facilitate this feedback.