Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Say It One More Time: EHRs Are Hard To Use

Posted on September 19, 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.

I don’t know about you, but I was totes surprised to hear about another study pointing out that doctors have good reasons to hate their EHR. OK, not really surprised – just a bit sadder on their account – but I admit I’m awed that any single software system can be (often deservedly) hated this much and in this many ways.

This time around, the parties calling out EHR flaws were the American Medical Association and the University of Wisconsin, which just published a paper in the Annals of Family Medicine looking at how primary care physicians use their EHR.

To conduct their study, researchers focused on how 142 family physicians in southeastern Wisconsin used their Epic system. The team dug into Epic event logging records covering a three-year period, sorting out whether the activities in question involved direct patient care or administrative functions.

When they analyzed the data, the researchers found that clinicians spent 5.9 hours of an 11.4-hour workday interacting with the EHR. Clerical and administrative tasks such as documentation, order entry, billing and coding and system security accounted about 44% of EHR time and inbox management roughly another 24% percent.

As the U of W article authors see it, this analysis can help practices make better use of clinicians’ time. “EHR event logs can identify areas of EHR-related work that could be delegated,” they conclude, “thus reducing workload, improving professional satisfaction, and decreasing burnout.”

The AMA, for its part, was not as detached. In a related press release, the trade group argued that the long hours clinicians spend interacting with EHRs are due to poor system design. Honestly, I think it’s a bit of a stretch to connect the study results directly to this conclusion, but of course, the group isn’t wrong about the low levels of usability most EHRs foist on doctors.

To address EHR design flaws, the AMA says, there are eight priorities vendors should consider, including that the systems should:

  • Enhance physicians’ ability to provide high-quality care
  • Support team-based care
  • Promote care coordination
  • Offer modular, configurable products
  • Reduce cognitive workload
  • Promote data liquidity
  • Facilitate digital and mobile patient engagement
  • Integrate user input into EHR product design and post-implementation feedback

I’m not sure all of these points are as helpful as they could be. For example, there are approximately a zillion ways in which an EHR could enhance the ability to provide high-quality care, so without details, it’s a bit of a wash. I’d say the same thing about the digital/mobile patient engagement goal.

On the other hand, I like the idea of reducing cognitive workload (which, in cognitive psychology, refers to the total amount of mental effort being used in working memory). There’s certainly evidence, both within and outside medicine, which underscores the problems that can occur if professionals have too much to process. I’m confident vendors can afford design experts who can address this issue directly.

Ultimately, though, it’s not important that the AMA churns out a perfect list of usability testing criteria. In fact, they shouldn’t have to be telling vendors what they need at this point. It’s a shame EHR vendors still haven’t gotten the usability job done.

A Tool For Evaluating E-Health Applications

Posted on April 11, 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.

In recent years, developers have released a staggering number of mobile health applications, with nearly 150,000 available as of 2015. And the demand for such apps is rising, with the mHealth services market projected to reach $26 billion globally this year, according to analyst firm Research 2 Guidance.

Unfortunately, given the sheer volume of apps available, it’s tricky to separate the good from the bad. We haven’t even agreed on common standards by which to evaluate such apps, and neither regulatory agencies nor professional associations have taken a firm position on the subject.

For example, while we have seen groups like the American Medical Association endorse the use of mobile health applications, their acceptance came with several caveats. While the organization conceded that such apps might be OK, it noted that such approval applies only if the industry develops an evidence base demonstrating that the apps are accurate, effective, safe and secure. And other than broad practice guidelines, the trade group didn’t get into the details of how its members could evaluate app quality.

However, at least one researcher has made an attempt at developing standards which identify the best e-Health software apps and computer programs. Assistant professor Amit Baumel, PhD, of the Feinstein Institute for Medical Research, has recently led a team that created a tool to evaluate the quality and therapeutic potential of such applications.

To do his research, a write-up of which was published in the Journal of Medical Internet Research, Baumel developed an app-rating tool named Enlight. Rather than using automated analytics, Enlight was designed as a manual scale to be filled out by trained raters.

To create the foundation for Enlight, researchers reviewed existing literature to decide which criteria were relevant to determine app quality. The team identified a total of 476 criteria from 99 sources to build the tool. Later, the researchers tested Enlight on 42 mobile apps and 42 web-based programs targeting modifiable behaviors related to medical illness or mental health.

Once tested, researchers rolled out the tool. Enlight asked participants to score 11 different aspects of app quality, including usability, visual design, therapeutic persuasiveness and privacy. When they evaluated the responses, they found that Enlighten raters reached substantially similar results when rating a given app. They also found that all of the eHealth apps rated “fair” or above received the same range of scores for user engagement and content – which suggests that consumer app users have more consistent expectations than we might have expected.

That being said, Baumel’s team noted that even if raters like the content and found the design to be engaging, that didn’t necessarily mean that the app would change people’s behaviors. The researchers concluded that patients need not only a persuasive app design, but also qualities that support a therapeutic alliance.

In the future, the research team plans to research which aspects of app quality do a better job at predicting user behaviors. They’re also testing the feasibility of rolling out an Enlight-based recommendation system for clinicians and end users. If they do succeed, they’ll be addressing a real need. We can’t continue to integrate patient-generated app data until we can sort great apps from useless, inaccurate products.

AMA Approves List Of Best Principles For Mobile Health App Design

Posted on November 29, 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.

The American Medical Association has effectively thrown her weight behind the use of mobile health applications, at least if those apps meet the criteria members agreed on at a recent AMA meeting. That being said, the group also argues that the industry needs to expand the evidence base demonstrating that apps are accurate, effective, safe and secure. The principles, which were approved at its recent Interim Meeting, are intended to guide coverage and payment policies supporting the use of mHealth apps.

The AMA attendees agreed on the following principles, which are intended to guide the use of not only mobile health apps but also associated devices, trackers and sensors by patients, physicians and others. They require that mobile apps and devices meet the following somewhat predictable criteria:

  • Supporting the establishment or continuation of a valid patient-physician relationship
  • Having a clinical evidence base to support their use in order to ensure mHealth apps safety and effectiveness
  • Following evidence-based practice guidelines, to the degree they are available, to ensure patient safety, quality of care and positive health outcomes
  • Supporting data portability and interoperability in order to promote care coordination through medical home and accountable care models
  • Abiding by state licensure laws and state medical practice laws and requirements in the state in which the patient receives services facilitated by the app
  • Requiring that physicians and other health practitioners delivering services through the app be licensed in the state where the patient receives services, or will be providing these services is otherwise authorized by that state’s medical board
  • Ensuring that the delivery of any service via the app is consistent with the state scope of practice laws

In addition to laying out these principles, the AMA also looked at legal issues physicians might face in using mHealth apps. And that’s where things got interesting.

For one thing, the AMA argues that it’s at least partially on a physician’s head to school patients on how secure and private a given app may be (or fail to be). That implies that your average physician will probably have to become more aware of how well a range of apps handle such issues, something I doubt most have studied to date.

The AMA also charges physicians to become aware of whether mHealth apps and associated devices, trackers and sensors are abiding by all applicable privacy and security laws. In fact, according to the new policy, doctors are supposed to consult with an attorney if they don’t know whether mobile health apps meet federal or state privacy and security laws. That warning, while doubtless prudent, must not be helping members sleep at night.

Finally, the AMA notes that there are still questions remaining as to what risks physicians face who use, recommend or prescribe mobile apps. I have little doubt that they are right about this.

Just think of the malpractice lawsuit possibilities. Is the doctor liable because they relied on inaccurate app results collected by the patient? If the app they recommended presented inaccurate results? How about if the app was created by the practice or health system for which they work? What about if the physician relied on inaccurate data generated by a sensor or wearable — is a physician liable or the device manufacturer? If I can come up with these questions, you know a plaintiff’s attorney can do a lot better.

AMA Touts Physician Interest In Digital Health Tools

Posted on October 13, 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 few months ago, the group’s annual meeting, American Medical Association head Dr. James Madara ignited a firestorm of controversy when he suggested that many direct to consumer digital health products, apps and even EMRs were “the digital snake oil of the early 21st century.” Madara, who as far as I can tell never backed down completely from that statement, certainly raised a few hackles with his pronouncement.

Now, the AMA has come out with the results of physician survey whose results suggest that community doctors may be more excited about digital health’s potential than the AMA leader. The survey found that physicians are optimistic about digital health, though some issues must be addressed before they will be ready to adopt such technologies.

The study, which was backed by the AMA and conducted by research firm Kantar TNS, surveyed 1,300 physicians between July 7 and 18. Its content addressed a wide range of digital health technologies, including mobile apps, remote monitoring, wearables, mobile health and telemedicine.

Key findings of the study include the following:

  • While physicians across all age groups, practice settings and tenures were optimistic about the potential for digital health, their level of enthusiasm was greater than their current adoption rates.
  • The majority of physicians surveyed (85% of respondents) believe that digital health solutions can have a positive impact on patient care.
  • Physicians reported that they were optimistic a digital health can reduce burnout, while improving practice efficiency, patient safety and diagnostic capabilities.
  • Physicians said liability coverage, data privacy and integration of digital health tools with EMR workflows were critical to digital health adoption, as well as the availability of easy-to-use technologies which are proven to be effective and reimbursement for time spent conducting virtual visits.

All told, physicians seem willing to use digital health tools if they fit into their clinical practice. And now, it seems that the AMA wants to get out ahead of this wave, as long as the tools meet their demands. “The AMA is dedicated to shaping a future when digital health tools are evidence based, validated, interoperable, and actionable,” said AMA Immediate Past President Steven J. Stack, M.D

By the way, though it hasn’t publicized them highly, the AMA noted that it has already dipped its oar into several digital health-related ventures:

  • It serves as founding partner to Health2047, a San Francisco-based health care innovation company that combines strategy, design and venture disciplines.
  • It’s involved in a partnership with Chicago-based incubator MATTER, to allow entrepreneurs and physicians to collaborate on the development of new technologies, services and products in a simulated health care environment.
  • It’s collaborating with IDEA Labs, a student-run biotechnology incubator, that helps to support the next generation of young entrepreneurs to tackle unmet needs in healthcare delivery and clinical medicine.
  • It’s playing an advisory role to the SMART project, whose key mission is the development of a flexible information infrastructure that allows for free, open development of plug-and-play apps to increase interoperability among health care technologies, including EHRs, in a more cost-effective way.
  • It’s involved in a partnership with Omada Health and Intermountain Healthcare that has introduced evidence-based, technology-enabled care models addressing prediabetes.

Personally, I have little doubt that this survey is a direct response to the “snake oil” speech. But regardless of why the AMA is seeking a rapproachment with digital health players, it’s a good thing. I’m just happy to see the venerable physicians’ group come down on the side of progress.

 

AMA Introduces MACRA Tools – MACRA Monday

Posted on October 10, 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

The American Medical Association has released a package of online tools designed to help physicians cope with major changes to Medicare rolling out next year under MACRA. While it’s likely that practices will still have plenty of challenges to address on their own, these tools seem like they may offer a leg up on the subject, particularly for smaller practices with less resources to throw at MACRA issues.

One of the tools being introduced is the AMA Payment Model Evaluator (Sadly an account is required, but there’s an option to create a new account), designed to help doctors determine how their practices will be impacted by MACRA. The Evaluator, which was developed in partnership with physicians and AMA partners, asks physicians and medical practice administrators to fill out an online questionnaire on their practice. The Evaluator then offers an assessment of their specific situation, along with educational material and other resources. This includes recommendations on which MACRA payment model is best for them, which can help your practice know the best direction for your specific needs.

The AMA has also added new MACRA-specific tools to its AMA Steps Forward collection of practice improvement strategies. The STEPS modules help physicians determine how to report on quality metrics central to MACRA as well as the Physician Quality Reporting System. The STEPS modules each focus on a specific issue and offer solutions, steps for implementation, case studies, CME opportunities and downloadable additional tools.

In addition, the physician group has launched a podcast series, Inside Medicare’s New Payment System, featuring acting CMS administrator Andy Slavitt, AMA staff experts and other healthcare leaders. The series, which will include five episodes, should help get physicians up to speed on MACRA-related changes. I for one am eager to hear what Slavitt has to say about MACRA, as he is about the best source on the subject you could have.

At first glance, it doesn’t seem that the AMA plans to spend a lot of time on the Advancing Care Information subset of MIPS, better known as the replacement for the Meaningful Use program. I guess that’s not a huge surprise, given that physicians are still grappling with broad implications of MACRA which go well beyond HIT issues. However, given how important Meaningful Use has been to physicians over the past few years, one might expect it to get a little bit of special attention. Maybe they’re waiting for the MACRA final rule to come out.

With CMS casting a wider net and looking for more from medical practices than just adequate levels of EMR adoption, the AMA is probably following CMS’ path in talking about more than just the meaningful use (Advancing Care Information) portion of MACRA.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Doctors: EMRs Can Be Quality Obstacles

Posted on October 15, 2013 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.

Many doctors believe that today’s EMRs are difficult to use and stand in the way of quality care at times, according to a new RAND Corporation research report covered by Healthcare IT News.

The RAND report comes from a project, sponsored by the American Medical Association, which was designed to identify what influences doctors’ professional satisfaction.

To research the report, RAND surveyed 30 physician practices in six states–Colorado, Massachusetts, North Carolina, Texas Washington and Wisconsin. RAND researchers also visited each of the practices on site, conducting in-depth interviews with 220 doctors, medical administrators and allied health professionals to see what drives doctors’ satisfaction with their work lives.

One key finding of the report was that being able to provide high-quality care is a primary factor in job satisfaction for physicians — and that anything which hinders them from doing so is a source of stress. And one critical factor that doctors feel impedes their ability to deliver good care is the requirement to use EMRs, Healthcare IT News notes.

Doctors who responded to the survey told RAND that current EMR technology gets in the way of face-to-face discussions with patients, demands that physicians spend too much time on clerical work and lowers the accuracy of medical records by encouraging the use of template-generated notes, according to Healthcare IT News.

What’s more, doctors told RAND that they’re unhappy that EMRs have been more costly than expected, and that the lack of interoperability between various EMRs has been a major frustration, as  it keeps them from easily sending patient data where it’s needed and when it’s needed.

Medical practices are trying to reduce doctor frustration by hiring staffers to perform many tasks involved in maintaining electronic records. And practices are attempting to improve physician satisfaction in other ways, such as giving them more independence in structuring clinical activities and allowing more control over the pace and content of the care they provide.

Still, it’s telling that as many as one-fifth of practices might switch EMRs, searching for an system that solves problems rather than creating new ones.  Whatever practices are doing to help physicians achieve satisfaction with their current EMR, it doesn’t seem to be working very well.

EMRs and the Paperless Medical Office

Posted on October 31, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

From the American Medical Association comes a recent story on EMRs and the paperless medical office. I think it touches quite effectively on the issue facing medical offices today – transitioning new patients to the new EMR has proved a lot easier than turning older paper records electronic. In one of my earlier posts, I’d written about this topic. This article provides some clever strategies in identifying which paper records to convert earlier than others.

Among the points discussed:
EMR use does not equal paperless: And yet, these two ideas somehow seem conflated in people’s minds. A doctor I spoke to recently said he had assumed that the EMR vendor would convert older paper records to electronic as part of the EMR purchase package. Well, the vendor might – for a fee. Electronic conversion ranges from simple paper scans to character/word recognition. For truly rich use of your data, say for report generation purposes, you’ll want something that populates a database. In fact, “data transfer probably is going to be a significant line item in the EMR budget.”

Not all data is equal: Having an EMR doesn’t mean that every little scrap of paper from the patient’s records needs to go into it. Doctors can make the call on the kind of data that they find most useful. It would however need some amount of planning and insight, not to mention time, to make this happen. What’s important depends on specialty as well.

Not all patients are equal: If a small proportion of patients you see tend to be the ones that come for repeat consults, it might make more sense to get the entirety of their paper records into the EMR.

Don’t make a beeline for the shredder immediately: Really, this should be self-intuitive. Unless you’re sure that every important piece of information you need has been transferred to the EMR, and the EMR data matches what’s on paper, don’t shred the patient’s records.

The only real quibble I have with the article was where it mentions that one company found that “having the doctors enter the data ensured the integrity of the information and helped them learn the new system.” Seriously? Have your $200+ per hour physician enter older records into an EMR, when you can get a temp or third-party vendor to do it for a fraction of the cost?

The statistics at the end of the article are quite interesting. The first statistic is especially encouraging.

A survey of 200 health IT professionals found that hospitals are taking varied approaches to digitizing their records. (Respondents could give more than one answer.)
49% have scanned what they need and stayed within their budget.
23% are within budget but still have a backlog of records to scan.
54% are scanning records onsite.
29% are using a centralized scanning location.
72% are relying on full-time employees to scan.
9% are using third parties.
6% are using part-time staff.
44% are not explicitly measuring the effectiveness or productivity of their scanning process.
58% plan to shred paper records once scanning is complete.
38% plan to store paper files in onsite records rooms or offsite storage facilities.

Source: Survey by information management company Iron Mountain, July