Fighting physician burnout - don't blame EHR or healthcare IT

The Healthcare IT News article “Fighting Physician Burnout: How Tech Can Undo the Damage Done by EHRs” is enticing; it promises that healthcare information technology and EHR can solve the burnout problem.

I have a different take on it. The physician burnout problem is not caused by technology per se; it’s about workflow and how technology is used.

As I read the article, standard concerns about healthcare information technology stood out:

  • Software should not go down.
  • Service should not be interrupted.
  • EHR should be integrated with critical systems.
  • Better document management is important.
  • Information should be readily available and easily searchable.
  • Information must be reportable.
  • Communication within the practice is important.

There are many very good systems I’m aware of that do all of the above quite well. Many tech-savvy physicians have been using these systems, and despite all of this, these tech-savvy physicians complain of burnout — they complain of turning into data entry operators!

What is the real issue?

Efficiency must be measured in terms of the big picture rather than as just software and clicks. Physicians are a practice’s most important — and expensive — resource. Their every moment is valuable and must be spent taking care of patients. All other tasks can, and should, be delegated to staff who can utilize healthcare information technology to accomplish everything a physician needs for critical clinical decision-making.

What this means is using technology to have information at the physician’s fingertips and making the information available when and where he or she needs it; however, the physician doesn’t have to be the primary technology user to enter or pull data.

It’s all about the workflow

I’ve helped many physicians jump the hurdle of the EHR technology barrier. It is possible for the provider to deliver good care without becoming a data entry operator, but still take advantage of everything healthcare information technology has to offer. The provider can do all this with minimal keyboard and screen contact.

Workflow example

Provider walks into the exam room. Past notes, triage notes, vitals, results of orders and radiology, are all available and displayed on the computer screen for the provider to review immediately. How that happens varies from practice to practice. The important thing is that the provider doesn’t have to spending time clicking or typing.

Provider spends time talking to the patient. It is important to note that the provider’s only task is to talk to the patient while maintaining eye contact.

As the provider talks to the patient, the nurse or medical assistant interacts with the EHR to enter the discussion’s pertinent details.

Provider has minimal interaction with the computer. Their interaction should be limited to selecting diagnostic and CPT codes and e-prescriptions, if necessary.

Provider goes to his or her office and dictates a personalized narrative into the EHR system. This should not take more than 60 seconds. Often, it takes fewer than 30 seconds.

Provider can quickly view the note and sign it.

Provider moves on to the next patient.

Some of you may argue that the provider cannot afford to have additional staff in the exam room. What I fail to understand is when does it become acceptable to have a provider with a very high hourly rate perform data entry instead of a medical assistant? The above workflow may allow a provider to see one more patient per day, or to go home early, thus achieving a work-life balance.

Efficient medical practices use a combination of great technology and improved workflow. The above scenario allows all the advantages that EHR technology has to offer without converting a provider into a data entry operator.

How much should you pay for EHR?

They range from $0 (Practice Fusion) to $800 per provider per month. Most EHR systems charge a monthly subscription fee these days.

So, how much should you pay?

If you think all EHR systems are the same, buy the cheapest Certified EHR system. Right? 

When you say 'they are all the same', what you really mean is that all certified EHR systems have the same 'features'. i.e., they do charting, they store patient data, labs, ePrescription, ICD-10, CPT and E&M coding, etc.

For Example, both iPhone and Android devices have all the 'features', yet you choose one versus the other. Why?

OK, so they are all NOT the same. 

Second Question: How much can you Afford to pay?

Before we try to answer that, ask your self this.

What would be at stake if this is NOT the right system for your practice, makes everyone non-productive, staff wastes lot of time?

EHR should not be taken likely. The negative impact is very critical. By implication, looking at EHR as a cost and expense is not correct. EHR must be a proper financial and investment decision. You wouldn't hire a nurse that wants the lowest salary would you?

Let's break it down.

  1. All EMR are NOT the same.
  2. Don't go by Price. Don't start a conversation with 'how much'? You are not buying potatoes.
  3. Prepare very hard and meticulously - as if you are starting a business. 

Prepare very hard - as if you are starting a business

This is one element of your practice that, as I mentioned earlier, can have a tremendous impact on our business bottom-line if you choose the wrong system and wrong vendor. Here are some things I recommend you must do before you see any demonstration.

  • Have a written document outlining the complete practice workflow.
  • Have your staff write specific parts of the practice workflow that are inefficient and can be improved.
  • Identify 5 cases that represent 80 - 90% of your patients (unless you're a super-specialist where each patient is truly unique). Use these cases to benchmark systems. Share these cases with the vendor (de-identified) and ask them to walk you through these cases.
  • Ask the vendor to show how they can bring improvement to your practice rather than focusing on particular features. There may be many ways to accomplish the goal.

And finally, determine a budget that you can afford and something that can bring positive 'return-on-investment' (watch the video below)

 

EMR Systems are NOT expensive.

Talk to your Accountant/CPA. Look at your Profit and loss statement and determine the distribution of costs. You may quickly find that you sometimes spend more than the monthly fee of an EMR on things that do not have such an impact on the success (or failure) of your practice.

And finally, don't be afraid of spending slightly more than you can afford to get the maximum value and support from your vendor. It will pay off!

A Pre-Judgement Problem - Why Most Practices select Wrong EMR/EHR

For most companies, businesses, medical practices included, success depends a lot on the team that you have recruited. It goes without saying that picking a winning team is crucial. The problem is we are very bad at it.

SAT is a bad indicator of college performance and even life performance. Yet colleges have to use it anyway. Somehow we keep on pushing our kids along the same path.

Professional sports spend billions of dollars every year to recruit what they think are the best players. Yet scouts continue to pick the wrong players. Having watched Moneyball we know that we tend to ignore useful data and rely too much on our instincts.

Selecting and choosing EMR systems is no different.

When we invite vendors for a demonstration do we even think about what was a criteria for their preselection? We may have gone by recommendation of a third-party or a trusted friend. We allow somebody else to prejudge for us. What we should really be doing, is to understand our internal needs first by talking to the entire team. Focus on prioritizing what is important and what is not.

It takes guts to stop prejudging because it feels like we're giving up control. But, as far as EMR is concerned, we never had control did we?

Inspired by Seth Godin.

 

What is wrong with this Title - "AAFP and HealthFusion Partner to Deliver EHR Benefits..."

When you read this headline, what goes on in your mind? If you are a Family Physician, and member of AAFP, wouldn't you think - 'my academy had whetted, evaluated, or done something where they tested hundreds of EMR out there and picked the best one for me'.

Media twists it even more - read this.

Nothing can be further than truth. 

I am sure AAFP does not have the time do any of that. Also, AAFP in general does not endorse any product. Furthermore, this headline gives the impression that AAFP picked Healthfusion exclusively and recommends it. If I want, I can read even more into it thinking there is perhaps an incentive for being an AAFP member, or that it is being subsidized.

This is misleading Advertising.

AAFP should be more strict about how their partners put out press releases. 

Wrong Reason not to choose Cloud EHR

A Doctor mentioned today he does not want to use cloud EMR. 

Reason? A colleague 'lost data on the cloud'. 

I'm not really sure what that means, but I have a sneaky suspicion that the vendor of that particular cloud EMR system did not provide data when the doctor wanted it, or that the EMR vendor was holding data hostage for a large fee. 

In fact, client/server systems are more prone to losing data in the traditional sense. The solution to that problem of not getting the data from a cloud EMR vendor, is not to use client server systems, but to do a better job of negotiating upfront and incorporating associated data extraction fees into the contract. 

I have seen too many cloud EMR vendors holding doctors data hostage and demanding a large sum of money if the doctor wants to switch their EMR system.

What should you do?

Don't jump from frying pan to fire. If you think cloud systems are a problem with your data, client server systems are even worse - unless you spend a lot of resources managing the infrastructure internally.