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Physician Burnout, a Healthcare Issue Unique to Our Healthcare Providers

Posted on May 25, 2018 I Written By

The following is a guest blog post by Justin Campbell, Vice President, Strategy, at Galen Healthcare Solutions.

I Can’t Get No Satisfaction…but I try, and I try, and I try, and I try – Rolling Stones

Justin CampbellIn a 2018 Medscape survey exploring the professional satisfaction of providers, 42 percent of 15,000 survey respondents reported feeling burnt out with their jobs, up from an overall rate of 40 percent in 2017. In recent years, physician burnout has become a serious industry issue, with national policy discussions ensuing on how to best combat the problem. Researchers have drawn correlations between physician burnout and higher medical error rates, lower overall quality of care, and increased clinical staff turnover. Year after year, the underlying drivers of dissatisfaction have remained consistent: overwhelming charting requirement, long work hours, and cumbersome EHRs.

As health IT leaders, one question we should be asking ourselves is how we can best apply our EHR expertise to help reduce physician burnout. To answer this question, let us look to the doctors we aim to help. When physicians are at the bedside, they analyze a patient’s condition and formulate a care plan accordingly. They look to diagnostic test results, review trended vitals, pain scores, and nursing assessments, and consult with specialists in a massive data gathering exercise all aimed at quantifying the problem and crafting a treatment plan.

Providers are telling us there is a problem, and they are consistently identifying the primary underlying causes. IT department leaders have a direct influence over many of the drivers of physician burnout, so it is time for us to dig into the details, measure the problem, and craft a treatment plan. How do we measure and manage physician burnout?

There’s Gold In Those EHR Audit Logs

The Office of the National Coordinator’s EHR Certification Requirements mandate that all certified EHRs be capable of generating an audit log detailing all user activity, stored in a database alongside user credentials and a date and time stamp. At first glance, these unassuming audit logs appear to provide little actionable insight, but buried in the data there is value. When audit logs are compiled across several months, data analysts will quickly see that they have a rich dataset that can be sliced and diced to expose the EHR navigation and module utilization trends of key physician populations.

Analyzing patterns within EHR audit logs will allow savvy data analysts to determine the average length of time providers spend working in the EHR. This information can be calculated at the individual level or aggregated across all providers.

Source: Galen Healthcare Solutions

Knowing how long providers are spending on administrative tasks in the EHR is valuable information for a number of reasons. First and foremost, this information can be used as a benchmark to measure the impact of future software updates or optimization projects. Any significant changes to provider workflow should be retrospectively reviewed to understand how it impacts the average time providers spend in the EHR. First, do no harm.

Analyzing user activity logs at the individual level also helps identify highly efficient EHR users within each specialty. The EHR workflow patterns of these EHR champions can be modeled. Peers can be educated on how to adjust their own workflows to mirror specialty-specific champions, reducing their own daily EHR burden. These “quick win” workflow adjustments are changes that can be adopted by clinical staff immediately, before extensive EHR optimization efforts are undertaken.

Audit log analysis can also highlight which EHR modules providers spend the most time in. In most cases, updating user preferences and optimizing the information displayed on EHR screens can expedite chart navigation. Simplified documentation templates and macros training can expedite the documentation process. A library of evidence-based order sets and targeted clinical decision support algorithms can minimize time spent entering orders.

Analyzing utilization trends at the EHR module level exposes the workflow tasks that are consuming a disproportionate amount of provider time.

Don’t. Stop. There.

EHR audit log analysis can reveal how much time providers are spending in the EHR, and where specifically they are spending that time. It can identify physician champions, and highlight those that are struggling. Audit log analysis can be used to measure EHR-induced physician burnout and support system-wide optimization efforts aimed at improving satisfaction.

Beyond this, EHRs offer a wealth of additional datasets that can help highlight inefficiencies in clinical workflows. Traditional health IT data analytics typically aims to uncover problems in care quality or revenue cycle management, but analysis focused on EHR workflow improvement is just as noble an effort, and one providers have long been seeking.

Gain perspectives from HDO leaders who have successfully navigated EMR clinical optimization and refine your EMR strategy to transform it from a short-term clinical documentation data repository to a long-term asset by downloading our EMR Optimization Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement & data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and Gold sponsor of Health IT Expo. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on TwitterFacebook and LinkedIn.

 

Designing for the Whole Patient Journey: Lumeon Enters the US Health Provider Market

Posted on April 23, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Lots of companies strive to unshackle health IT’s potential to make the health care industry more engaging, more adaptable, and more efficient. Lumeon intrigues me in this space because they have a holistic approach that seems to be producing good results in the UK and Europe–and recently they have entered the US market.

Superficially, the elements of the Lumeon platform echo advances made by many other health IT applications. Alerts and reminders? Check. Workflow automation? Check. Integration with a variety of EHRs? Of course! But there is something more to Lumeon’s approach to design that makes it a significant player. I had the opportunity to talk to Andrew Wyatt, Chief Operating Officer, to hear what he felt were Lumeon’s unique strengths.

Before discussing the platform itself, we have to understand Lumeon’s devotion to understanding the patient’s end-to-end experience, also sometimes known as the patient journey. Lumeon is not so idealistic as to ask providers to consider a patient’s needs from womb to tomb–although that would certainly help. But they ask such questions as: can the patient physically get to appointments? Can she navigate her apartment building’s stairs and her apartment after discharge from surgery? Can she get her medication?

Lumeon workflow view

*Lumeon workflow view

Such questions are the beginning of good user experience design (UX), and are critical to successful treatment. This is why I covered the HxRefactored conference in Boston in 2016 and 2017. Such questions were central to the conference.

It’s also intriguing that criminal justice reformers focus attention on the whole sequence of punishment and rehabilitation, including reentry into mainstream society.

Thinking about every step of the patient experience, before and after treatments as well as when she enters the office, is called a longitudinal view. Even in countries with national health care systems, less than half the institutions take such a view, and adoption of the view is growing only slowly.

Another trait of longitudinal thinking Wyatt looks for is coordinated care with strong involvement from the family. The main problem he ascribed to current health IT systems is that they serve the clinician. (I think many doctors would dispute this, saying that the systems serve only administrators and payers–not the clinician or the patient.)

Here are a couple success stories from Wyatt. After summarizing them, I’ll look at the platform that made them possible.

Alliance Medical, a major provider of MRI scans and other imaging services, used Lumeon to streamline the entire patient journey, from initial referral to delivery of final image and report. For instance, an online form asks patients during the intake process whether the patient has metal in his body, which would indicate the use of an alternative test instead of an MRI. The next question then becomes what test would meet the current diagnostic needs and be reimbursed by the payer. Lumeon automates these logistical tasks. After the test, automation provided by the Lumeon platform can make sure that a clinician reviews the image within the required time and that the image gets to the people who need it.

Another large provider in ophthalmology looked for a way to improve efficiency and outcomes in the common disease of glaucoma, by putting images of the eye in a cloud and providing a preliminary, automated diagnosis that the doctor would check. None of the cloud and telemedicine solutions covered ophthalmology, so the practice used the Lumeon platform to create one. The design process functioned as a discipline allowing them to put a robust process for processing patients in place, leading to better outcomes. From the patient’s point of view, the change was even more dramatic: they could come in to the office just once instead of four times to get their diagnosis.

An imaging provider found that they wasted 5 to 10 minutes each time they moved a machine between an upper body position and a lower body position. They saved many hours–and therefore millions of dollars–simply by scheduling all the upper body scans for one part of the day and all lower body scans for another. Lumeon made this planning possible.

In most of the US, value-based care is still in its infancy. The longitudinal view is not found widely in health care. But Wyatt says his service can help businesses stuck in the fee-for-service model too. For example, one surgical practice suffered lots of delays and cancellations because the necessary paperwork wasn’t complete the day before surgery. Lumeon helped them build a system that knew what tests were needed before each surgery and that prompted staff to get them done on time. The system required coordination of many physicians and labs.

Another example of a solution that is valuable in fee-for-service contexts is creating a reminder for calling colonoscopy patients when they need to repeat the procedure. Each patient has to be called at a different time interval, which can be years in the future.

Lumeon has been in business 12 years and serves about 60 providers in the UK and Europe, some very large. They provide the service on a SaaS basis, running on a HIPAA-compliant AWS cloud except in the UK, where they run their own data center in order to interact with legacy National Health Service systems.

The company has encountered along the way an enormous range of health care disciplines, with organizations ranging from small to huge in size, and some needing only a simple alerting service while others re-imagined the whole patient journey. Wyatt says that their design process helps the care provider articulate the care pathway they want to support and then automate it. Certainly, a powerful and flexible platform is needed to support so many services. As Wyatt said, “Health care is not linear.” He describes three key parts to the Lumeon system:

  1. Integration engine. This is what allows them to interact with the EHR, as well as with other IT systems such as Salesforce. Often, the unique workflow system developed by Lumeon for the site can pop up inside the EHR interface, which is important because doctors hate to exit a workflow and start up another.

    Any new system they encounter–for instance, some institutions have unique IT systems they created in-house–can be plugged in by developing a driver for it. Wyatt made this seem like a small job, which underscores that a lack of data exchange among hospitals is due to business and organizational factors, not technical EHR problems. Web services and a growing support for FHIR make integration easier

  2. Communications. Like the integration engine, this has a common substrate and a multiplicity of interfaces so doctors, patients, and all those involved in the health care journey can use text, email, web forms, and mobile apps as they choose.

  3. Workflow or content engine. Once they learn the system, clinicians can develop pathways without going back to Lumeon for support. The body scan solution mentioned earlier is an example of a solution designed and implemented entirely by the clinical service on its own.

  4. Transparency is another benefit of a good workflow design. In most environments, staff must remember complex sequences of events that vary from patient to patient (ordering labs, making referrals, etc.). The sequence is usually opaque to the patient herself. A typical Lumeon design will show the milestones in a visual form so everybody knows what steps took place and what remain to be done.

Wyatt describes Lumeon as a big step beyond most current workflow and messaging solutions. It will be interesting to watch the company’s growth, and to see which of its traits are adopted by other health IT firms.

Vocera Aims For More Intelligent Hospital Interventions

Posted on November 14, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Everyday scenes that Vocera Communications would like to eliminate from hospitals:

  • A nurse responds to an urgent change in the patient’s condition. While the nurse is caring for the patient, monitors continue to go off with alerts about the situation, distracting her and increasing the stress for both herself and the patient.

  • A monitor beeps in response to a dangerous change in a patient’s condition. A nurse pages the physician in charge. The physician calls back to the nurse’s station, but the nurse is off on another task. They play telephone tag while patient needs go unmet around the floor.

  • A nurse is engaged in a delicate operation when her mobile device goes off, distracting her at a crucial moment. Neither the patient she is currently working with nor the one whose condition triggered the alert gets the attention he needs.

  • A nurse describes a change in a patient’s condition to a physician, who promises to order a new medication. The nurse then checks the medical record every few minutes in the hope of seeing when the order went through. (This is similar to a common computing problem called “polling”, where a software or hardware component wakes up regularly just to see whether data has come in for it to handle.)

Wasteful, nerve-racking situations such as these have caught the attention of Vocera over the past several years as it has rolled out communications devices and services for hospital staff, and have just been driven forward by its purchase of the software firm Extension Healthcare.

Vocera Communications’ and Extension Healthcare’s solutions blend to take pressures off clinicians in hospitals and improve their responses to patient needs. According to Brent Lang, President and CEO of Vocera Communications, the two companies partnered together on 40 customers before the acquisition. They take data from multiple sources–such as patient monitors and electronic health records–to make intelligent decisions about “when to send alarms, whom to send them to, and what information to include” so the responding nurse or doctor has the information needed to make a quick and effective intervention.

Hospitals are gradually adopting technological solutions that other parts of society got used to long ago. People are gradually moving away from setting their lights and thermostats by hand to Internet-of-Things systems that can adjust the lights and thermostats according to who is in the house. The combination of Vocera and Extension Healthcare should be able to do the same for patient care.

One simple example concerns the first scenario with which I started this article. Vocera can integrate with the hospital’s location monitoring (through devices worn by health personnel) that the system can consult to see whether the nurse is in the same room as the patient for whom the alert is generated. The system can then stop forwarding alarms about that patient to the nurse.

The nurse can also inform the system when she is busy, and alerts from other patients can be sent to a back-up nurse.

Extension Healthcare can deliver messages to a range of devices, but the Vocera badge and smartphone app work particularly well with it because they can deliver contextual information instead of just an alert. Hospitals can define protocols stating that when certain types of devices deliver certain types of alerts, they should be accompanied by particular types of data (such as relevant vital signs). Extension Healthcare can gather and deliver the data, which the Vocera badge or smartphone app can then display.

Lang hopes the integrated systems can help the professionals prioritize their interventions. Nurses are interrupt-driven, and it’s hard for them to keep the most important tasks in mind–a situation that leads to burn-out. The solutions Vocera is putting together may significantly change workflows and improve care.

Improving Clinical Workflow Can Boost Health IT Quality

Posted on August 18, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

At this point, the great majority of providers have made very substantial investments in EMRs and ancillary systems. Now, many are struggling to squeeze the most value out of those investments, and they’re not sure how to attack the problem.

However, according to at least one piece of research, there’s a couple of approaches that are likely to pan out. According to a new survey by the American Society for Quality, most healthcare quality experts believe that improving clinical workflow and supporting patients online can make a big diference.

As ASQ noted, providers are spending massive amounts of case on IT, with the North American healthcare IT market forecast to hit $31.3 by 2017, up from $21.9 billion in 2012. But healthcare organizations are struggling to realize a return on their spending. The study data, however, suggests that providers may be able to make progress by looking at internal issues.

Researchers who conducted the survey, an online poll of about 170 ASQ members, said that 78% of respondents said improving workflow efficiency is the top way for healthcare organizations to improve the quality of their technology implementations. Meanwhile, 71% said that providers can strengthen their health IT use by nurturing strong leaders who champion new HIT initiatives.

Meanwhile, survey participants listed a handful of evolving health IT options which could have the most impact on patient experience and care coordination, including:

  • Incorporation of wearables, remote patient monitoring and caregiver collaboration tools (71%)
  • Leveraging smartphones, tablets and apps (69%)
  • Putting online tools in place that touch every step of patient processes like registration and payment (69%)

Despite their promise, there are a number of hurdles healthcare organizations must get over to implement new processes (such as better workflows) or new technologies. According to ASQ, these include:

  • Physician and staff resistance to change due to concerns about the impact on time and workflow, or unwillingness to learn new skills (70%)
  • High cost of rolling out IT infrastructure and services, and unproven ROI (64%)
  • Concerns that integrating complex new devices could lead to poor interfaces between multiple technologies, or that haphazard rollouts of new devices could cause patient errors (61%)

But if providers can get past these issues, there are several types of health IT that can boost ROI or cut cost, the ASQ respondents said. According to these participants, the following HIT tools can have the biggest impact:

  • Remote patient monitoring can cut down on the need for office visits, while improving patient outcomes (69%)
  • Patient engagement platforms that encourage patients to get more involved in the long-term management of their own health conditions (68%)
  • EMRs/EHRs that eliminate the need to perform some time-consuming tasks (68%)

Perhaps the most interesting part of the survey report outlined specific strategies to strengthen health IT use recommended by respondents, such as:

  • Embedding a quality expert in every department to learn use needs before deciding what IT tools to implement. This gives users a sense of investment in any changes made.
  • Improving available software with easier navigation, better organization of medical record types, more use of FTP servers for convenience, the ability to upload records to requesting facilities and a universal notification system offering updates on medical record status
  • Creating healthcare apps for professional use, such as medication calculators, med reconciliation tools and easy-to-use mobile apps which offer access to clinical pathways

Of course, most readers of this blog already know about these options, and if they’re not currently taking this advice they’re probably thinking about it. Heck, some of this should already be old hat – FTP servers? But it’s still good to be reminded that progress in boosting the value of health IT investments may be with reach. (To get some here-and-now advice on redesigning EMR workflow, check out this excellent piece by Chuck Webster – he gets it!)

Problems EMRs Don’t (Necessarily) Cause

Posted on January 29, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

In publications like this one, we spend a lot of time and energy clubbing EMRs and EMR vendors for the problems they cause.  That’s all well and good, but it’s also worth remembering that some of the big problems surrounding medical operations may not be due to EMR use:

* HIPAA carelessness:  When someone shouts private medical information across a room, or loses a flash drive or tablet with records on it, or leaves patient records in a public place, you’ve probably got a nasty HIPAA violation. But the EMR almost certainly had nothing to do with it.

* Clumsy office workflow:  Sure, introducing an EMR into a clinical setting can screw up existing workflow. But was it working well in the first place?  For those whose business falls apart post-EMR, I’d argue “no.”  Businesses that don’t do well after an install had jury-rigged processes in place already, I’d argue.

* Patient care slowing down:  As with staff workflow, clinical workflow can be discombobulated — badly — by an EMR installation. Learning to fit practice patterns to the system is a big job for most clinicians, and they may slow down significantly for a while. But if the patient care flow stays “broken” it’s likely that there were aspects of the pre-EMR system that didn’t work.

I realize that I might get flamed for saying this, but I’m pretty confident that a goodly number of problems that are laid at the feet of dysfunctional EMRs don’t belong there.  And that’s not a good thing.

After all, there are enough poorly designed, trouble-ridden EMRs out there to keep us busy critiquing them for a century or two.  Why distract ourselves by adding more to the pile when the real issues may be elsewhere?