Monday, July 25, 2016

Clicking Your Way to Burnout

The Mayo Clinic published the article Electronic medical practice environment can lead to physician burnout that “shows the use of electronic health records and computerized physician order entry leads to lower physician satisfaction and higher rates of professional burnout.”
It states that the negative effects of decreased efficiency, massive clerical burden, and provider burnout counterbalance the positive potential for quality medical care using an Electronic Health Record. These negative forces seem obvious to any practicing provider but are generally lost on administrators, insurance companies, vendors, and governmental agencies.
Logical reasoning would indicate, however, that when providers, including nurses, are “happy,” productivity, motivation, and commitment are increased, leading to higher quality and greater safety in health care.

The authors conclude that:  "Burnout has been shown to erode quality of care, increase risk of medical errors, and lead physicians to reduce clinical work hours, suggesting that the net effect of these electronic tools on quality of care for the U.S. health care system is less clear."

What is the solution? Some have been mentioned multiple times in previous blogs. But here is a list of EHR functionalities that have great potential to impact quality of care:

1.    User-friendly, site specific, specialty specific documentation

2.    Easy navigation with intuitive, user-friendly interfaces 99.9% consistent every day, every site.

3.    Changes, should be made gradually, to avoid having to relearn the program every outing

4.    Uniform CPOE (computerized physician order entry) that is the same in every system

5.    Institution of a national database to encourage real-time interoperability

6.    Voice activated technology built-in

7.    Bringing back the “Ward Clerk” – that is, let the doc do doctoring, the nurse nursing.

8.    Decreasing the work burden-eliminate unnecessary machine time, as well as homework

9.    “Alert” controls.  Too many alerts are ineffective, become “white-noise.”

10.  Ability to see what other people are documenting without making lots of clicks

11.   Every click should be counted to help design a better interface, with minimized clicks.

12.  Keep clinical interaction IT separate from bookkeeping and billing IT.

13.  Artificial intelligence that provides an “instant second opinion”

Hopefully, the future will brighter. Bean-counters should remember that clicks have financial and psychological costs. And the wrong click could cost thousands of beans.

Monday, July 18, 2016

More Lawsuits More Often

The article EHR safety goes to court discusses a hospital system suing an EHR provider over lack of support due to several safety issues. The issue is complicated by the fact that one provider was purchased by another and then the hospital contracted with a third party. Both claim breech of contract and the hospital system states that patients were harmed.
How were they harmed? There were errors in tracking of patient locations, discharge medications, and there was a general inability to properly use the Computerized Order Entry system (CPOE).  These suits demonstrate that factors such as lack of usability, poor interfaces, poor training, and poor support, inevitably lead to errors. Compound that with the prevalent practice of having non-clinical, non-computer savvy, individuals input sensitive and tricky clinical data, and there is an ever-present recipe for disaster. Why can’t clinicians be counted on to input the data themselves?  Because clinicians really don’t have the time or capacity to deal with poorly designed systems that do not function smoothly and intuitively; caring for patients, rather than nursing IT systems, is their main priority.

The article states: For years, many patient safety advocates have warned that EHR systems carry numerous potential risks due to their poor design and the ease with which data entry errors can lead to medical mistakes. “ The reality is that highly pressured providers have to make multiple clicks, leading to an exponential rise is the potential for error. Rarely are real-time checks and balances built in, so that a person in-putting data has little, if any, verification, that “STAT ORDERS,” for example, were received and/or acted upon.
Anyone who has attended a risk management or critical incident committee meeting in the E HR era is well aware of the many system based medical errors that arise because of the functionality or lack of functionality of the programs and people interacting with them.  Humans !

System-Based Medical Errors” inevitably lead to litigation that pits provider, hospital, and vendor against one another in a complex legal battle. In general, of course, there is no easy resolution as each side can easily point to the weakness of the other parties.

Moreover, lawyers, doctors, and healthcare systems can count on the fact that there will be competing vendors waiting in the wings with baited breath to take over any system wherein complaints are rising.  In this case Epic took over a Cerner client; but in others Cerner has taken over an Epic client.  This juggling occurs across the board. It is almost (but not quite) as bad a politics.  There are promises, promises.  Oh! The promises.  Most often disregarded (or masked) is the fact that experience shows the same complaints regarding the old system will appear in the newly installed system in short order. The political metaphor aside, it is not unlike the story of Sisyphus; the Greek Titan who rolled a huge stone up the mountain, only to find that the stone rolls back down the mountain; Sisyphus again rolls the stone up the mountain; then down it comes; and so on, and so on, and so on. Indeed this circular manner of problem followed by so-called-solution, followed by reemergence of the problem, and again and again is sadly the way of healthcare IT in 2016.  Sad, for sure.

Bottom line is that with the recent publicity that the third leading cause of death is medical error (a claim that most well-respected authorities feel is without solid basis) there will be evermore scrutiny of the different parties involved. The solutions (user-friendly programs, easy interfaces, easy navigation, national based CPOE and interoperability designed databases, etc.) have been elucidated in previous blogs.