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EMR Impact on Patient Care Differs, But Doctors Never Win

Posted on July 14, 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.

Nearly all physicians agree that using EMRs isn’t great for their relationship with patients. But, hospital-based and office-based physicians seem to have different reactions to the problem. (Neither group is happy with their lot, but I’m sure you already guessed that much.)

The study, by researchers at Brown University and Healthcentric Advisors, is based on the open-ended answers provided by 744 doctors to a survey question: “How does using an EHR affect her interaction with patients?” (The question was posed by the Rhode Island Department of Health in 2014.)

In analyzing the responses, researchers found that office-based physicians and hospital-based physicians had different concerns about patients care and EMR use.

Office-based physicians, who typically bring their computer into the exam room, worry that staring at a computer screen will undermine the quality of their visit with the patient. “[It’s] like having someone at the dinner table texting rather than paying attention,” one doctor wrote.

Hospital-based physicians, for their part, usually do their record-keeping on EMRs based outside the exam room.  They said that record-keeping took up too much time, leaving little for direct contact with patients. Said one physician: “I now spend much less time [with] patients because I know I have hours of data entry to complete.”

To maintain their standards of patient care, physicians are doing the data entry at home rather than at work, sometimes many hours at a time. Others are taking CME classes which promise to help them integrate EMR use with patient consults in the least disruptive manner. But nobody had found any good solutions to the patient care conundrum.

Of course, we knew most of this already. This study just offers some added color to a picture we’ve already seen. Both patients and physicians are suffering under current models of EMR use, and there’s little relief on the horizon.

Yes, a few physicians said that EMRs hadn’t impacted their time with patients. This might’ve been encouraging, but this group included one physician who treated newborns and another using a scribe to handle data entry during consults.

And there were a few respondents that cited positive aspects of EMR use in patient care. For example, one hospital-based doctor noted that EMRs offered him an easy way to look at a comprehensive patient history. Some office-based physicians noted that web-based patient portals were improving their patient interactions.

But the striking thing here is that few if any physicians suggested that EMRs offered any ongoing clinical benefits. As researchers have discovered many times over, most doctors saw their EMR use as a work requirement rather than a clinical exercise. This only underscores that as they presently work, EMRs benefit administrators, not care providers.

I wish I was so smart that I’d come up with some sort of solution to this problem. I haven’t. But it doesn’t hurt to harp on the existence of the problem. We should remind ourselves over and over again that it’s time to roll out EMRs that support clinicians.

AAFP EMR Survey Offers Food For Thought

Posted on December 24, 2012 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.

Even the authors admit that the following study has got flaws, given that respondents weren’t randomly selected and some vendors screened out by its design.  Nonetheless, new EMR satisfaction research by the American Academy of Family Practice gives us some interesting stats to consider.

The study, which was published in the November/December issue of its Family Practice Management  journal, draws on 3,088 responses from AAFP members, who responded to a series of questions regarding which EMRs they used and how comfortable they were with those EMRs.  Respondents reported using a total of 160 named EMRs, but the study dropped 129 which were used by 12 or fewer practices in an effort to simplify the results, leaving 31 systems for analysis.

The systems with the strongest satisfaction ratings, ranging from roughly 80 percent too over 50 percent, were Praxis, HealthConnect, MEDENT, Amazing Charts and SOAPware. eMDs,  Practice Fusion, Point and Click EHR, EpicCare Ambulatory and Vista CPRS followed closely, with scores clustered around 50 percent.

Not too surprisingly, EMRs that were ranked easy to use were largely the same ones which got high satisfaction ratings. Topping that list was Point and Click EHR at nearly 80 percent, followed by Amazing Charts, Practice Fusion, Praxis, SOAPware, Aprima, MEDENT,eMDs, HealthConnect, Vista CPRS, with Care360 EHR rounding out the bottom of the top 10 at roughly 47 percent.

The only surprise the authors highlighted came in response to a question asking which EMRs helped doctors see more patients or go home earlier than they could with paper charts. In that case, Praxis stood out, with doctors who agreed hitting about 80 percent. The number who agreed for the next on the list, SOAPware, fell immediately to just over 40 percent, with the other players falling even lower on the scale.

Even with its deliberate statistical laxity — authors described their intent as being more of an “advice from colleagues” format — this certainly offers some stats to chew on. In particular, I’d love to know what Praxis is doing right. After all, when it comes right down to it, productivity is king.

Cognitive Dissonance and EMRs

Posted on July 18, 2012 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 new CDC study has documented what’s pretty much old news to us EMR watchers, that more than half of U.S. doctors have taken their charts digital. The study also concluded that most are pretty happy with their EMR, heaven help us, and that it’s improved patient care.

According to a study by the CDC’s National Center for Health Statistics, 55 percent of U.S. doctors have adopted some type of EMR.  More interestingly, for folks like me at least, 75 percent of those who have have met Meaningful Use Stage 1 criteria, something I might not have predicted if I hadn’t read the study.

This seems a bit strange to me, honestly. I’ve talked to countless doctors about their EMRs, both hospital- and practice-based, and I’ve only met a couple who actually felt satisfied with the system(s) they use. I haven’t met any that felt the systems have improved patient care, though I admit my sample isn’t drawn scientifically. (Vendors, I’m not saying that *nobody’s* happy, just that these numbers sound high, to be clear.)

The best explanation I can come up with for such results, which came from 3,200 doctors completing a mail-in survey, is the impact of cognitive dissonance.  Let me explain.

Doctors are being  pressured with thumb screws to make the switch, and it’s hardly surprising that most have come around.  So they’ve gone ahead and spent what in some cases are huge sums of money to make the leap.

The thing is, when you’re forced to use something every day, you can’t just keep on hating it more and more. Nobody has that much energy.  So over time, you resolve the cognitive dissonance — the battling “EMR painful” and “EMR necessary” thoughts — by learning to love Big Brother EMR, or at least believe that you do.

Then again, though I’d have trouble believing this, maybe there’s hordes of satisfied doctors that never come to the attention of a cynic like me. What do you think?