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Physicians Ask New HHS Head For Health IT Help

Posted on February 28, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The American Academy of Family Practitioners has written to new HHS Secretary Tom Price with a list of areas in which health IT could use a helping hand.  In its letter, the group outlines issues with physician use of health IT that the new leadership could tackle.

According to the AAFP, the top issues policymakers need to tackle include:

  • Lack of healthcare data access undercuts care: Without interoperability, it will be hard for doctors to ensure continuity of care, care coordination and a learning and accountable health system, the group says. It names the Direct protocols as an example of progress on this front.
  • HIT functions are too business-oriented: According to the AAFP, the healthcare industry has spent too much time focused on automating the business of healthcare, particularly documentation. The letter argues that it’s time to flip the focus from business functions to delivery of appropriate care.
  • HIT reduces physician satisfaction: The group argues that current health IT solutions are “extinguishing the joy of practice” for physicians and contributing to physician burnout and frustration.
  • EHR certification standards are undercutting clinicians: The AAFP contends that existing standards for EHR certification are causing problems physicians, as they don’t do much to push vendors to meet user demands or improve their technology.

This is certainly a reasonable summary of issues in physician HIT adoption. And they deserve to be addressed Unfortunately, it’s not likely that that the AAFP will get much satisfaction from HHS, CMS or any other government entity. I’ve reluctantly come to the conclusion that agencies like ONC aren’t going to get much more done.

I do have hope that current waves of technology will allow health IT issues to self-heal to some extent. In particular, as healthcare technology becomes more decentralized, connected and mobile, providers won’t have to manage clumsy, ugly EMR interfaces on the desktop. In part due to some chats with vendors, I’ve become convinced that next-gen HIT solutions will present data via lightweight clients (perhaps even lighter than existing apps) which create an EMR-on-the-fly. One example of a company working on this approach is Praxify which Healthcare Scene recently saw at HIMSS. This lightweight client approach could make existing concerns about HIT usability and architecture obsolete.

However, I’m realistic enough to know that no matter how nifty emerging HIT approaches are, we still have to get from here to there. And as long as clinicians remain something of an afterthought when EMRs are designed – something which despite vendor denials, remains a big issue – we’re likely to keep struggling with today’s HIT issues. Let’s hope the revolution comes before we’ve exhausted our issues fighting current health IT demons.

Yet Another Study Says EMRs Contribute to Physician Burnout

Posted on September 21, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A Mayo Clinic study recently concluded that – surprise, surprise – that physicians who used EMRs were less likely to be satisfied with the amount of time spent on clerical tasks. But from where I sit, while the story certainly deserves attention, it’s also worth considering how this fits into the problem of physician burnout on the whole.

First, let’s review the study itself. To conduct the study, which appeared in the Mayo Clinic Proceedings, researchers connected with 6,375 physicians in active practice, 5,389 of which (84.5%) reported using EMRs. Meanwhile, of 5,892 physicians who said that CPOE was relevant to their practice specialty, 4,858 (82.5%) said they used CPOE technology.

Researchers concluded that physicians who use EMRs and CPOE had lower satisfaction with time spent in clerical tasks and higher rates of burnout, including when the data was adjusted for age, sex, specialty, practice setting and hours worked per week. The bottom line, researchers said, was that this large national study demonstrated that satisfaction with EMRs and CPOE was generally low.

Now let’s take a look at the big picture on physician burnout. One comprehensive take comes from the American Academy of Family Physicians, whose position paper on the subject includes the following definition of burnout: “A syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feeling of cynicism (depersonalization), and a low sense of personal accomplishment.”

The AAFP paper, which points out that the phenomenon has been studied for decades, notes that 45.8% physicians are considered to be experiencing at least one symptom of burnout. According to a recent broad-based study, that there is currently a 35.2% overall burnout rate among U.S. physicians.

According to research cited by the AAFP, there’s still no definitive data on what causes physician burnout, but notes that common drivers of family physician burnout include paperwork, feeling undervalued, frustration referral networks, difficult patients, medicolegal issues, and challenges in finding work-life balance.

While I don’t want to minimize the impact that a badly-designed EMR can have a negative impact on a physician’s practice, or underplay the findings of the Mayo study cited above, I think it’s worth noting that the group doesn’t cite EMRs as a specific cause of burnout.

Clearly, physicians don’t like using EMRs for administrative work — and it even appears that they would rather use paper to handle such chores. However, let’s not kid ourselves into thinking that doctors loved documenting on paper either. Complaints about not wanting to finish their charts were common in the paper world too.

And the truth is, as EMRs have gradually shifted from being vehicles to support billing to richer clinical documentation and support tools, it may very well have become harder to use them for routine administrative tasks. Vendors probably need to reconsider yet again the balance between clinical and administrative features, and how effective both are.

That being said, I think it’s important not to forget that physicians are facing many, many challenges, most of which began grinding away at their independence and self-respect well before EMRs became an established part of the picture.

Unfortunately, it’s likely that for some physicians, feeling forced to adopt an EMR has proven to be the straw that broke the camel’s back. And they certainly deserve a hearing. But if in the process, we allow ourselves to lose sight of the countless other problems physicians are struggling with, we are doing them a disservice. Addressing physicians’ EMR issues won’t fix everything that’s broken here.

Quality Metrics Have A Negative Impact on the Quality of Care

Posted on October 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A few months ago I asked the question about whether ACOs were more about good accounting than they were improving care. Here’s a summary of the fear:

I think this is a massive challenge with value based reimbursement. We require certain data to “prove” that there’s been a change in how organizations manage patients. However, I can imagine hundreds of scenarios where the organization just spends time managing how they collect the data as opposed to actually changing the way they care for patients in order to improve the data.

I recently came across an article from HealthLeaders Media which says things may be even worse than I described. Not only do quality metrics not improve care, but they may actually have a negative impact on the care provided.

The article cites a survey by the Commonwealth Fund and Kaiser Family Foundation which highlights this result. Here’s an excerpt from the article:

Of the 1600 primary care physicians surveyed, 55% said the growing use of quality metrics to assess provider performance is having a negative impact on the quality of care. Less than a quarter said that quality metrics have a positive impact on healthcare quality.

Fifty-five percent of the nation’s primary care physicians are currently receiving financial incentives based on quality or efficiency measures. Fifty-two percent cited concerns around programs that impose financial penalties for unnecessary hospital readmissions.

Amy Mullins, MD from the American Academy of Family Physicians also has this zinger of a quote, “It often seems [payers] are measuring to measure, not measuring to improve quality.”

This is one of the major challenges associated with trying to legislate or regulate payment based on quality. If you get it right, then the incentives will encourage providers to improve care. If you get it wrong, doctors will jump through the hoops and care will not improve and may even get worse.

I recently wrote that Digital Health is Hard. I think building appropriate quality metrics that actually encourage improved quality care is even harder. Many say that this is the time when we learn from our experiences. I just feel bad for all the guinea pigs who are being tested on without a choice.