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Is Physician Interaction Bad Regardless of EHR?

Posted on September 14, 2012 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 think that EMR and HIPAA has some of the best readers out there. They aren’t afraid to say what’s on their mind and share views even if they’re counter to the predominant thinking. Plus, they aren’t just doing it to be contrary. In fact, I’d suggest in most cases they do so because they sincerely and deeply care about the state of healthcare. They want to improve healthcare and the lives of patients.

One such response came from G. Foster on a post titled 6 Rules for Ethical Data Handling in a Health Organization. For those who missed the comment, here it is:

In my work, I coach Physicians to achieve Meaningful Use of their Certified EHR technology. In my personal life my interaction with Physicians is as a patient. In my work, when Physicians complain that the “new” EMR technology comes between them and their patients, as expressed in the article “A Child’s View of EMR” I bite my tongue. That’s because, I have yet to experience a relationship in which a Physician engages me in my own care.

I’m releasing my tongue from the grip of my teeth. I do not believe that the medical record (paper-based or electronic) disrupts the relationship between Physician and Patient. It is the Physician’s social skills (i.e. bedside manner) and attitude toward patients in general and patients from subgroups specifically that disrupts those relationships. While I try to keep an open mind, I have observed that Physicians present bias against patients by certain conditions, gender and race within minutes of the patient’s first visit.

When patients describe their complaints, Physicians cut off their comments mid-discussion. While there may be some eye-contact between patients and Physicians using paper-base medical records, Physicians don’t listen to their patients. Instead, Physicians believe they know what’s going on just by looking at a patient. To a point that may be true, but Physicians rarely acknowledge the non-medical judgments they make, which often become the basis of a patient’s paper-based medical record. For example, an overweight or obese patient merely needs to eat less and exercise more, there is no reason to consider the endocrine system… even if the patient clearly describes (or tried to describe) symptoms of Cushing’s syndrome, hypothyroidism or PCOS. A female patient is a hypochondriac, even if she describes (or tried to) a family history of cancer, heart disease or diabetes, which test would show she has inherited. African-American patients aren’t in pain; they are drug seekers, despite having undiagnosed fibromyalgia, lupus or ankylosing spondylitis.

My first adult-care Physician infamously cut me off to state “you are too young to be having all these aches and pains.” He ordered no tests or referred me to any specialist. One year later, dramatic weight gain was among three new symptoms. Again, the doctor was not concerned and told me these new symptoms were unrelated and a part of a cycle that was totally up to me to continue or resolve. I always wondered if that Physician took me seriously and engaged me in my own care, rather than dismissing my complaints or blaming me for my poor health; could I have prevented an array of new symptoms, resolved the core condition afflicting me and lived a higher quality of life these past 25 years?

I believe that paper-based medical records, NOT EMRs, are the dream of lawyers. Let’s consider my first adult-care Physician, again. If my condition, untreated, was fatal and I died, my surviving family would have wondered, why I didn’t know about my condition and followed the lifesaving treatment plan. They would have gotten a lawyer, who in turn would have gotten a court order for my entire medical record, from all Physicians whose care I sought. And what would have been noted in the paper-based medical record? Would those paper-based medical records serve well as evidence for a wrongful death lawsuit?

When I speak with Physicians who claim that EMRs stand between them and their patients, I tell them my story and ask them to examine their attitudes about patients and they may be unconsciously expressing them during office visits. Perhaps they didn’t perceive paper-based medical records as standing in the way, because the medically relevant notes were few and far between requiring less attention. If Physicians have always engaged patients in their care, even when using paper-based medical records, they will continue to engage patients in their care when using EMRs.

Now that the CMS is pushing Physicians to use EMRs in a “Meaningful” way, I suggest developing EMR workflows that 1) support patient engagement. It’s the patient’s medical record, so why turn your back on the patient when updating their progress note on paper or electronically? Laptops and tablets make it easier to maintain face-to-face contact with a patient while having the electronic progress note readily available to you both. 2) Meet CMS Meaningful Use. The CMS Meaningful Use rules were established so that the focus is NOT on the technology. If your focus is on the Technology, then have a candid conversation with your vendor about developing the EMR so that you can maintain your patient-centered approach to care. Additionally, until Physicians have had a chance to fully consider the most Meaningful Use of Certified EHR Technology for them and their patients, the CMS criteria serve as a good (not perfect) blueprint. Which brings me to 3) drive EMR use that is Meaningful to you and your unique patients, going beyond the stereotypes of conditions, gender and race.

This was my initial response to G Foster:

Thanks for sharing your views. Quite interesting to consider the question of whether physicians are really engaged in care (EMR or not). That’s a hard question to answered and likely is all over the board depending on the doctor.

Although, I think we have to be careful in a number of ways. For example, if we assume physicians haven’t been as engaged as they should be, that doesn’t mean that EHR can’t still make it worse (or better depending on your view).

The biggest challenge I see is that the reimbursement model incentivizes many of these behaviors. That’s tough challenge to solve.

These are some deep and complicated issues that we’re talking about here. One thing I know that won’t resolve them is to act like they’re not a problem. The reality is that for many doctors, this isn’t a problem (EMR or not). However, many of the issues regarding physician interaction with patients are there regardless of EHR. Does EHR make them worse?

I think technology is a great magnifier. This applies to both good and bad. So, I expect in many cases EHR does make the patient interaction worse. Although, in other cases I think EHR takes the physician patient interaction to a whole new level of collaboration and patient care.

App Developers Urged to Consider Older Generations

Posted on I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Earlier today, I was involved in a discussion about technology, and how “older generations” have a harder time understanding, or even wanting to be involved, in the latest innovations. As I listened to others talk about this topic, I couldn’t help but think about how often I see articles in the health care IT world concerning this very idea. Older doctors are hesitant to embrace EMRs. Smart phone apps can be confusing for someone who grew up with a phone that you had to spin the dial to call anyone (and, well, they can be confusing for me too!). We came to the conclusion that most of us just don’t like change, and someday, when we’re being told we need to “get with the times,” we’ll be longing for the early days of smart phones and technology.

Anyways, after this discussion, I was reading the latest articles over at Fierce Mobile Health Care, and came across one that seemed pertinent to the topic. Apparently, quite a few of the diabetes apps have posed some problems for older users. The article cites a study that was done that analyzed three different diabetes tracking apps that had a 4 star rating or above. The researchers discovered that “for people with declines in cognition, vision, and motor skills, they can be difficult to use — which might lead to a stop in their use entirely.”

Because of this study, the researchers, North Carolina State University’s Laura Whitlock and Anne McLaughlin, are hoping to convince app designers to consider the needs of older users when developing apps. They found that many of the problems in the three apps analyzed were easily fixed, but if they weren’t fixed, many older users would have a hard time using them.

There has been a lot of success with diabetes tracking and adherence apps, especially with people ages 13 to 19. However, because diabetes is a disease that many older people have, it would be nice if these apps could be made more accessible to them. They need to be simple. The text needs to be bigger, and the colors must be easy to read. It may not seem like a big deal to a teenager, or young adults, but for someone who hasn’t been raised with this kind of technology — it makes a big difference.

I do hope that app developers will take the needs of this “older generation” in mind as they create apps. Maybe two different versions could be made — a more “advanced” version, and a simple one. I believe that many people could benefit from health apps, and they should be easily usable by everyone. Obviously, some apps can be designed towards people who are more tech savvy. But for apps that deal with diseases that may affect a large demographic of people, some of the suggestions made in this article should be taken into consideration.