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!

When Scribes Don’t Pay Off

Posted on June 30, 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.

Since scribes first hit the scene, there’s been a lot of debate about the benefits of having them in place, as well as what duties they should handle.

Critics have suggested that using scribes only sidesteps the need to look at larger industry issues. On the other hand, some physicians have found scribe support to be a big relief. Many have reported that scribes have reduced their paperwork and reestablished their face-to-face connection with patients.

Those happy doctors include Peter Leavitt, primary care physician with Bend, OR-based St. Charles Family Care. Dr. Leavitt told a local newspaper that using the scribe cut the two hours per day he spent entering notes into the EMR by 40 percent.

But Leavitt won’t have scribes available much longer. St. Charles Health System, the PCP practice’s parent organization, has decided to drop scribe support for primary care offices on July 1st. The health system said that the $480,000 it invested in scribes didn’t produce enough benefits to justify the expense.

Starting in spring of last year, St. Charles has gradually brought a total of 20 scribes on board.  In an effort to test out their impact, the system brought scribes to only four of the clinics.

St. Charles hoped that rollout within the primary care practices would boost physician morale, increase patient throughput and give doctors time to improve their chart notes and documentation. As it turned out, however, adding the scribes didn’t accomplish what execs had hoped.

Yes, the roughly 20 doctors who used scribes seem to be happier once they came on board. But the scribe experiment seemed to fail by other measures. The clinicians were only able to see one-half patient more per day, which didn’t meet execs’ expectations. What’s more, documentation didn’t improve, in part because scribes can’t perform key functions like ordering tests, Leavitt suggested.

What’s more, the health system ran into some unexpected obstacles. In particular, some patients refused to let scribes stay in the exam room, and others would only share private information with the doctor once the scribe left the room.

It’s impossible to say whether the results seen by St. Charles would be duplicated elsewhere. After all, there are a ton of potential confounding factors which could have influenced the results of this trial, including the nature and level of training the scribes had received and the extent to which the clinics‘ existing processes could support workflow improvement.

Though we’ll never know for sure, it could be that if the scribes had a better education or the workflow around documentation was improved, St. Charles would have gotten better results. And it could be that the EMR is so hard to use that even scribe use couldn’t put a dent in the problem.

Regardless, we don’t need to know much to conclude that the health system may have significantly undervalued the benefits of physician satisfaction. I don’t know what dollar value execs assigned to the happiness of doctors, but even a raw number based on physician recruitment costs and the time needed to train them on your EMR would might capture such benefits.

Meanwhile, I’d argue that the metrics St. Charles used to measure scribe value – patient throughput and improved documentation — may or may not be the best way to approach the problem. I’d love to see a similar pilot rolled out which measures success strictly by patient and doctor satisfaction levels.  After all, you can’t lose by making physicians and patients happy.

Physician Burnout

Posted on July 26, 2016 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.

At the HIMSS Annual conference, I talked with Vishal Gandhi, CEO of ClinicSpectrum, about a popular topic at the conference and well beyond: Physician Burnout. You can watch the full video interview I did with Vishal below:

Physician Burnout is such an important topic and I love that Vishal commented that physician satisfaction (the remedy to burnout) is good patient care and an appropriate reward. As it is today, the trend is to ask doctors to compromise good patient care and we’re paying them less in the process. Is there any wonder why physician burnout is so rampant?

Vishal also commented that healthcare technology is used more for documentation than patient care. He argued that the tech piece has focused far too much on documentation as opposed to focusing on the patient. I’d argue that if we focused the tech on the patient, doctors would appreciate technology much more and would be less burnt out.

Finally, I’m always interested to hear what non-EHR technologies Vishal and ClinicSpectrum have launched to make a practice more efficient and profitable. He outlines a bunch of them in the video above. Take a listen and see if some of them can make your life easier and your practice more profitable. It’s time we start considering technology outside the EHR that can make a practice better.

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.

Social Media and Doctor Satisfaction

Posted on June 14, 2011 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.

I found this recent post by Howard J. Luks, MD very intellectually stimulating. It’s a great read. Particularly if you’re a doctor or someone who tries to understand some of the various physician perspectives.

Here’s one section that sounded all too familiar to me:

Discussions about physician dissatisfaction occur at every water cooler, in every operating room lounge, and that every dinner many of us attend. But I often wonder if any of my colleagues are actively pursuing workflow changes, office efficiencies, or changes to their daily habits which may improve their level of job satisfaction. Interestingly, when I pose that question to my colleagues… the answer always seems to focus on finding another job… hmmm.

I can’t tell you how many doctors I’ve had come up to me with some hair brained website/internet idea and they want to build it. The story is so often the same. They make good money as a doctor, but they have to do it forever to make that money. They see the internet as this font of wealth. I try to let them down easy when I describe what it really takes to do what they’ve described. Ok, maybe I’m not that gentle in my description. I don’t want to crush dreams, but I do want them to understand what it really takes to do what they want to do. I digress…

Here’s another powerful part of Dr. Luk’s post:

Last week in my office, I received 5 emails germane to this topic. Three simply mentioned how satisfied they were with their encounter in the office in terms of the time they were given, the time I took to listen to their complaints, and the time I took to explain the natural history of their disease. Two of the e-mails came from long-term patients who are many years out from surgery — yet ventured onto my website and decided that they would touch base.

That simply makes my day.
From a work perspective, there’s no greater level of satisfaction that I could ask for.

The whole post is great since he covers the challenges of medicine as well and has a great golf analogy about how the perfect shot makes up for all the bad shots kind of like the grateful patient makes up for the bad ones.

Of course, all this discussion of patient and doctor satisfaction makes me wonder what role things like social media, PHR and patient portals can play in a doctor’s satisfaction. Many doctors fear the idea of being connected to their patients in some sort of social media. I’m not saying there aren’t reasonable precautions that need to be taken in our litigious society. However, I wonder if many doctors are missing out on some of the satisfaction they could get by using social media.

I have first hand knowledge of the job satisfaction you get when someone sends you a kind email in response to your blog post, tweet, or other communication. I know I can recount many such experiences because they were so satisfying that I’ll never forget them. I’m sure many doctors are missing out on similar experiences, because their afraid to open a channel up for that communication.