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Are EMRs Getting Worse Or Doctors Getting Smarter?

Posted on August 20, 2015 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 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 know it sounds crazy — it’s hard to imagine doctors being more annoyed with EMRs than they already are — but according to one study that’s just what’s happening.

A newly-published study by the American Medical Association and the American College of Physicians’ AmericanEHR division suggests that doctors like the current crop of EMRs less than ever.

About half of study respondents said that their EMR was having a negative impact on costs, efficiency or productivity, the groups reported. Only 22% said they were satisfied with their EMR, and a scant 12% said they were “very satisfied.”

Doctors’ happiness with their EMRs has dropped substantially since five years ago, when 39% reported being satisfied and 22% said they were very satisfied, according to a prior study by AmericanEHR.  In other words, nearly 4 out of 10 doctors surveyed seem to have been content with what they had. But conditions have clearly changed.

The reasons for this are unlikely to be the result of mere peevishness. After all, with EMRs being a reality of doing business today, it seems unlikely that physicians would simply revert into sulking. Actually, my own unofficial survey — of several docs I’ve actually seen as a patient — suggests that most have gone through their stages of grief and decided that EMRs aren’t unholy. (My PCP said it best: “You get used to them, then they’re not so bad.”)

Instead, I’d argue, something good is actually happening, though it may not look that way on the surface. Having adapted to the need to use EMRs, physicians are engaging with them deeply, and beginning to expect more from them than a kludgy interface slapped on a slow database can provide.

Some are actually proposing that EMRs go beyond traditional medical record paradigm, something I see as an exciting development. For example, Dr. Arlen Meyers, CEO of the Society of Physician Entrepreneurs, argues that it’s time to “unbundle and re-engineer the care processes model” by introducing new templates into EMRs. In fact, he’s a fan of rethinking the hallowed SOAP (symptoms, objective findings, assessment and plan) approach to patient notes:

Given how things are changing, it might be time to give the pink slip to SOAP. The main problems are that 1) the model does not prioritize information by levels of urgency, 2) it does not provide decision support when it comes to how one disease affects the other or how one medicine affects another, and 3) it does not add efficiencies to taking care of increasingly complex patients.

And Meyers is not the only one. In fact, a recent paper published in JAMA Internal Medicine suggests that a new format flipping the elements of the SOAP note and reordering them as APSO (assessment, plan, subjective, objective) works well in the EMR age.

According to a 2010 study detailed in the paper, APSO notes were fairly successful at the University of Colorado ambulatory clinics. The study, which looked at APSO use in 13 clinics, found that 73% of participants were “satisfied” or “very satisfied” with the new format, and 75% “preferred” or “strongly preferred” reading APSO notes.

I’m betting that physicians will only be satisfied with EMRs again when EMRs are reshaped to embrace new ways of working. Since new workflow demands are generated by using EMRs, in turn, this cycle may never end. But that’s a good thing. If physicians are engaged enough with their EMRs to propose new ways of working, it will benefit everyone.

Some Warnings for Physician’s Wanting to Be Entrepreneurs

Posted on March 26, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last year I got to know a bit about an organization called the Society of Physician Entrepreneurs. It’s a fascinating organization that works to help physicians with their entrepreneurial dreams come true. I love the concept because so many doctors have ideas that can benefit healthcare, but commercializing an idea is always a challenge.

Arlen Meyers, MD, and Co-founder, President and CEO of the society has a great blog post up called “Don’t Throw Away Your White Coat.” In the post he gives a list of 10 reasons why doctors might want to think twice about leaving medicine for their entrepreneurial dream:

1. Most doctors don’t have an entrepreneurial mindset.

2. Doctors are trained to be risk averse.

3. Doctors are more interested in being problem solvers than problem seekers.

4. Doctors tend to be multidimensional, unwilling to expand their networks beyond an inner circle.

5. The culture of academic medicine, where almost all doctors are trained, tends to be anti-entrepreneurial and sees “money as dirty”

6. The ethics of medicine frequently are at odds with the perceived ethics of business.

7. While things are changing, most doctors are independently minded and not team players.

8. Some are “know it alls” who are not receptive to new ideas

9. Doctors spend a lot of time, money and effort becoming doctors. The opportunity costs or leaving clinical medicine to pursue an entrepreneurial venture is high.

10. The cost to society of losing a clinician at a time when there is a predicted doctors shortage is high.

I really appreciate this kind of frank talk about physician entrepreneurs. I’ve seen both sides of the equation and so I know that many doctors shouldn’t be entrepreneurs. I’ve also seen some doctors who probably should have been entrepreneurs and not doctors. In fact, I’m glad they became doctors because then they’re better able to be healthcare entrepreneurs. However, we shouldn’t be shy in talking about the challenge that many doctors have in crossing the chasm to entrepreneurship. Just like we shouldn’t be shy in talking about a tech person trying to learn healthcare.

Thanks Dr. Meyers for expanding the discussion. What do you think of his list? Have you seen examples of these? Can you leverage some of these challenges into strengths for your healthcare company?