My readers make some of the best comments. They’re definitely engaged in what’s happening in the EHR world and provide me amazing inspiration for future posts. In this case, John Brewer commented on my post about meaningful use forcing doctors into ACOs. Here’s a portion of his comment:
MU is actually easy…depending on your EHR. Much of MU is dependent on whether you EHR is able to pull the relevant data – Oh sure, you need to change your ways to ensure you get the required “counters”, and THIS is really where many docs get frustrated.
Add to the frustration that it generally takes clicking in 3 to 7 different places within an EHR to get ONE counter, and you can see why the frustration grows.
I really find it interesting that John Brewer says that meaningful use is easy, and then illustrates what makes it not easy. I think the point he’s making is that there’s nothing that’s a real challenge to accomplish in meaningful use. You can do any of the tasks really easily. However, just because something is easy doesn’t mean that it’s not time consuming. Meaningful use really is quite easy, but it can also be a real time suck.
When I think about the meaningful use time suck, I wonder if we’re creating a generation of doctors who hate their EHR because of the meaningful use time suck. I’ve written previously about the EHR physician revolt. If I dig a little deeper into this revolt, I see a revolt against the EHR time suck and not the technology itself.
Doctors don’t want to become data entry clerks. Unfortunately, the meaningful use requirements often have this affect on doctors. I fear that this will create a cohort of doctors who hate their EHR. Most doctors won’t be able to separate the technology from the regulations. For them it will always be the software’s fault.
Are we creating a generation of doctors who hate EHR?
Meaningful use (like managed care utilization review and pre-authorizations) is designed to be just onerous enough that a sizeable number of people decide the prize isn’t worth the price. They just throw up their hands and decide to take a financial hit rather than deal with the endless frustration. And when the financial hit and frustration get bad enough, they retire early, leaving a group of physicians who don’t know any other system.
If the true goal was accountability for the money that was spent, the regulators would have allowed for much more flexible criteria that could be tailored to individual practice types and/or specialties. Does a patient coming for weekly chemotherapy or weekly psychotherapy really need to get a 9+ page printout with every visit when their medications are stable and their diagnosis is unchanged? And do you really need to “reconcile” all of their 14 meds every week rather than simply noting “Pt. reports no med changes since last visit.”? Does a 19 year old being seen in a non-primary care setting really need to have their height/weight plotted on a growth chart? And why can’t the available quality measures be better targeted to different specialties to make it “easy” for all? (And why were quality measures bundled with MU at all?) These are but a few of the examples of workflow changes (and unnecessary hassles) that are solely aimed at checking off meaningful use boxes.
This simply adds to the rushed “patient throughput” emphasis and the checkbox mentality of E&M coding which similarly distract physicians from the important clinical tasks of taking a history (and actually looking at the patient), doing a thoughtful physical and actually thinking about what the diagnosis and treatment plan should be, each of which might help to reduce the high rates of diagnostic error (Singh et al., Types and Origins of Diagnostic Errors in Primary Care Settings, JAMA internal medicine 173(6): 418-425).
Superimpose this on the fact that physicians of all ages have become savvy computer and electronic device users, who are used to high usability products with responsive screens. They are no longer acclimated to waiting many minutes for information to come through a 1200 baud modem, so waiting several minutes for the EMR to boot up or watching an hourglass for 30 seconds during a page refresh between meaningless MU tasks (like my hospital’s EMR from a major commercial vendor) gets pretty intolerable pretty quickly. Especially when it cuts into your pay check, your time with your family or both.
So yes, we’re creating a generation of doctors who would love to use EMRs to facilitate their work and their ability to care for patients, but who just end up hating EMRs despite their pluses (e.g., legibility) because they generally make life (even) more difficult than it needs to be.
Do you know if and systems or software is available viz HL-7. If so, do you need to be amember to use it?
Glen,
Can you be more specific about what you’re asking. Every EHR system uses HL7 to some extent. Although, it’s not really implemented as an open API that you can just access. In most cases the HL7 is applied to a specific interface project.
” I wonder if we’re creating a generation of doctors who hate their EHR because of the meaningful use time suck”.
If Physicians purchase EMRs that are designed to first accommodate their specific forms, templates and workflows, then achieve MU mostly via serendipity, they will have to find something else to hate. I agree, there are a LOT of EMRS available that fit everything described earlier, but NOT ALL EMRS are this poorly designed. BuildYourEMR was designed to capture the relevant data required for MU in the routine physician workflow.
I believe doctors should hate their advisors, and sometimes themselves, for not shopping for an EMR that really lets them practice medicine. Stop hating the EMR and start holding your experts accountable.
Funny, I wrote my recent blog entry that gives my opinion about this same question…”I wonder if we’re creating a generation of doctors who hate their EHR because of the meaningful use time suck”.
Here’s the link to my post. http://noshemr.wordpress.com/2013/07/16/forcing-an-infant-to-walk-on-stilts-a-story-about-meaningful-use/
It’s an important question. I’m afraid of the answer.
I’ve taken the assumption that the answer we don’t like to here is the answer indeed. Although it may be too soon to tell, I know that some of these same doctors (like the one you referenced in your previous post who was creating his own EMR) are the same ones that throughly embrace technology – they are just not happy with what is out there and how MU has perverted the choices and the cost therof of adopting an EHR. Most of my clients who’ve been embracing open source are the ones that are trying to go outside of the system, and possibly outside of the ACO realm so that they can provide more direct patient care. Perhaps there is something to that relationship. Who knows? But there is certainly an interesting divergence between hospital EHR adoption (what it is they’re getting and who’s getting it) versus outpatient EHR adoption as MU drags on.
Bad EMR or lousy implementation = painful MU.
Great EMR & great implementation = easy MU.
90% of meeting MU for my group has been invisible, completed entirely behind the scenes by the EMR with minimal additional thought or effort on the part of the docs. We had to jump through a few hoops (creating a checkout process to ensure clinical summaries were provided, spending 20-30 hours doing the security risk assessment, getting check-in staff to document ethnicity) but nothing I would consider onerous.
Docs who hate their EMR because of MU probably have a lot of other reasons to hate their EMR too. Bad execution of MU probably means there are many, many other redundant tasks and inefficiencies that make their EMR experience suboptimal.
Docs shouldn’t blame MU for their pain. Blame the EMR and/or its implementation and consider jumping ship to a better EMR solution.
You are correct to a certain degree:
If 90% of meeting MU for you has been invisible, then you already have good processes in place, which is great, and your EHR didn’t require an inordinate amount of clicks to generate one “counter”.
Many EHRs implement MU poorly, as it was/is an after thought for most EHRs…since MU wasn’t created before many of the EHRs out there.
BUT, MU isn’t what drives docs to hate their EHRs, the poor execution, poor implementation, poor training, etc are what generally create the hate.