HIStalk Advisory Panel: IT Issues Physicians are Worried or Angry About

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What are the biggest IT-related issues your doctors are worried or angry about?

The lack of basic IT support at the hospital level, the doctors complaining all the time about not having anybody on staff to help them when the system goes down, them needing to send an email to the "headquarters" and virtually having to wait for days when they may need to put an order right then and there in ICU. Our hospital IT department is almost nonexistent and consists of a clinical analyst and few hardware guys and it is basically rudimentary. As one doctor put it, "We need speed, speed, speed!”

The increased documentation requirements of ICD-10. The increased direct interaction with the EMR for MU. The changes in their workflow necessitated by our EMR implementation.

The biggest issues are around being forced to use the systems. There is nothing wrong with any of the electronic systems that we use. Our employed physicians aren’t unhappy as they understand the trade-off for their paycheck. The pushback is with the independent physicians.

Biggest IT issue for doctors is lowered productivity. Since this is the new reality, most are resigned to it. At least for those who can successfully mentally separate IT from ICD-10, Meaningful Use, hospital and insurer intrusions into their practices, and Peyton Manning’s deer in the headlight performance.

The two most common conversations I have with physicians are problems with their access to the hospital systems and concern about their EMR and whether or not it will interface with the hospital HIE or CIN (clinically integrated network). Access and usability issues are a huge headache for physicians in my current health system (and previous). It has to be reliable and fast. We can’t seem to get either right consistently. For the physician that drops in to round on patients, we have very little time with them. Depending on the call schedule of the practice, we may see them once a month or less often. An expired password can require a call to the Help Desk because they haven’t logged in during the time allowed to change the password. The physician planned to spend 30 minutes in the hospital seeing patients and instead they spent 30 minutes trying to resolve their access issue followed by another 30 minutes to see patients and now they are late for the office appointments. The other common access complaint I get is the fact that we require two-factor authentication and do not have true single sign-on. I have had two calls just this week from practices that are ready to sign a contract and they want to know if the software will be able to connect to our CIN. I usually have to call the vendor as I have never heard of many of the small ones.

Too many clicks. Citrix. Texting PHI. Cost of IT.

It seems as though it’s increasingly difficult to sort out direct IT issues from indirect ones. For example, many problems that are worrying or angering doctors are blamed on IT but really result from regulatory agencies and others who are using the advent of electronic records to impose an increasing number of inane demands on clinicians for data entry and documentation. Examples include Meaningful Use, ICD-10, and requirements of CMS and the Joint Commission, for those of us who work in hospitals. Billing related documentation is another big source of consternation. In the pre-EMR era, it was clear that no one could humanly keep all of the E&M coding requirements straight. Now with the ability to have EMR templates and the increased emphasis on "optimizing clinician productivity", we are encouraged to code what we’re actually doing rather than chronically under-documenting and under-coding. Meaningful Use and billing compliance also erect roadblocks for using other professionals to help optimize workflow. Many elements could realistically be obtained or entered by someone else (e.g., NP, PA, med student) but the attending has to do the documentation anyway rather than just confirm the information. In many EMR systems, this is less flexible and more time consuming than it was on paper, so the EMR is blamed. As physicians are staying later and later to finish their notes or signing them from home after dinner, the EMR is blamed. But it is the perfect storm of bureaucratic requirements that’s really at fault and ICD-10 hasn’t even hit yet!

We are doing an EMR conversion this year, so that is their main worry. They don’t know enough about ICD-10 to be worried or angry about it yet … but the more we learn, the more we realize how asinine it is for primary care!

Too many clicks. Workflow processes that put the physician’s work at risk: residents and mid-level providers who start a note which the attending physician later amends and extends (this much OK and was consensus workflow). Document is then altered by resident or mid-level provider subsequent to the attending’s note. “Locking” or “finalizing” note not available because of vendor’s implementation requires these functions apply generally and that breaks other workflows.

Cumbersome medication reconciliation process. Workflows in ED and Surgery slow them down. These areas need optimization.

The biggest thing I hear about is usability issues. Providers worries and anger won’t get any better until that is resolved.

We are going Live with CPOM later this year and the majority of physicians that have approached me are worried, angry, or upset about the impact to the workflows they use every day. It has been a real eye-opener for some as they are brought to the table and see what the nurses and unit secretaries do with the paper-based orders they write. We also have a fair number of docs that can’t wait to do CPOM and are excited to be able to do this electronically from their home and office. They see it as a big quality of life win by not having to drive into the hospital and a big patient safety win by having all the relevant information in front of them when ordering medications, not to mention eliminating undecipherable handwriting . Not surprising is the latter group tend to be younger and more comfortable with technology than some of their counterparts.

EHRs from different sites still can’t talk to each other without effort from the clinician changing screens. Frustrated and also workarounds continue to be major things so as to get to the necessary data with the patient sitting in front of them.

Change management — MU2, ICD-10, and lower reimbursement with higher administrative overhead. None of our providers believe that there will be any demonstrable improvements in patient care as a result of ICD-10, and with the continued increase in non-patient care "bookkeeping," they’re questioning the value of remaining in this industry.

Bad, buggy software that is difficult to use, not accurate or timely, and not improving over time.

The rate of changes and workflows with EHR related to MU.