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September 6, 2016 News 12 Comments

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A  tiny AMA-sponsored time and motion study finds that ambulatory practice doctors spend almost twice as much time working on the EHR or performing other desk tasks than seeing patients, with the observed physicians spending only 27 percent of their available time in face-to-face contact with patients.

Physicians spent only around half of their exam room time directly interacting with the patients in front of them, with most of the rest consumed with EHR and desk work. The doctors studied also spent another 1-2 hours past their quitting time doing clerical catch-up.

It’s a very small study, both in numbers as well as the breadth of specialties, practice settings, and geographic areas that were observed. It also contains subjective interpretation of what constitutes non-patient time, in that doctors may be discussing health issues with patients or reviewing information on the screen while using the EHR since those activities are not necessarily mutually exclusive. It also doesn’t address the fact that EHR time may not necessarily be wasted depending on the situation, any more than arguing that radiologists spend too much time looking at PACS images or that anesthesiologists should pay more attention to patients and less to their monitors.

The study also does not compare the time doctors spend using paper charts or the benefits of EHRS while obviously trying to make the AMA’s point that EHRs – and not the healthcare system doctors created in voluntarily accepting checks from insurance companies and the federal government and thus being required to meet their documentation requirements – are responsible for their unhappiness and lack of productivity. I don’t like the tax system, but I don’t blame TurboTax.


An accompanying Annals of Internal Medicine editorial touts the AMA’s STEPS Forward program and concludes, “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the healthcare system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine.”

Reader Comments


From Voice of Reason: “Re: Epic’s succession plan. As a former Epic employee, the whispers I heard during my time there was that Sumit Rana was going to take over as the next CEO once Judy steps down. The recent piece on HIStalk on Epic’s board of directors corroborates this – he and Stirling are the only two members other than Judy/Carl that work at Epic. Ultimately, I think Sumit will get the nod over Stirling since Sumit has much more visibility within the company and he is a developer whereas Stirling is a TS – there’s an unwritten rule that people defer to developers within the company.” Sumit went to work for Epic in 1998 immediately after he graduated from Delhi College of Engineering and has worked his way up to SVP. Note: I don’t usually correct reader comments, but as other readers have noted and his LinkedIn profile clearly states, Stirling Martin’s background is as a developer (going back to June 1997) and he has never been a TS.

From Former Epic: “Re: Epic’s succession plan. Unless things have changed since I worked there (about three years ago), Judy is very tight-lipped about how things will work after she’s gone. She addressed it once to my knowledge, and all she said was ‘There’s a plan in place.’ As far as the qualifications of her children to run the company, Judy herself wasn’t necessarily qualified back in 1979, so I don’t see that stopping them. At this point, I think Carl Dvorak is the real brains of the operation.” The challenge might be that while the second generation of family business owners usually are much more trustworthy than the third generation, there’s still the issue of mixing founder offspring and business, especially when company ownership is turned over to a foundation. On the other hand, Judy has shown remarkable talent and focus in taking Epic where it is today, so I’m sure she is not oblivious to the challenges and will make every effort to mitigate any threat to the company’s current state. A success story to be emulated is S.C. Johnson & Son, the cleaning supply company (also based in Wisconsin) that’s in its fifth generation of family ownership and leadership with 12,000 employees and $7.5 billion in sales.

From Super Bill: “Re: Epic. Suing one of its customers. Perhaps they don’t want anyone to know how Epic forces smaller regional hospitals and independent practices to enter into agreements with larger players to help with interoperability issues. See this filing.” Epic attempts to block University of Iowa Hospitals and Clinics from complying with an open records request from an unidentified individual who seeks information about services provided by KLAS. An Epic employee sent the health system a KLAS report covering EpicConnect and included attachments that Epic doesn’t want released. Epic argues that the attachments are not public record and are proprietary. I can say from first-hand experience that Epic fights tooth and nail any attempt to obtain contract records from tax-supported organizations that are required by law to provide them to anyone who asks, apparently requiring in their sales contract that the health system send such requests to Epic’s team of lawyers that will use every available company resource to keep the information private in the ultimate form of information blocking.

From What Would HIPAA Do?: “Re: security. I work for a vendor and one of our practices is being forced our EHR after joining a local healthcare system. The new vendor gave us access to an SFTP site to transfer the practice’s data. When we logged in, we could see the data from another 4-5 practices sitting there in plain view. We reported this to the vendor and they said they aren’t worried since they only give the log-in to people they know. Should we report this or formalize our complaint to the vendor? Are we overthinking this?” I’ll invite readers to respond. Personally, I would let your customer know and let them decide how to proceed since any complaint directly from you as a competitor would look like sour grapes, not to mention that there’s no upside to your involvement. It’s always touchy to report a potential security issue that (a) does not and could not affect you; (b) is purely theoretical; and (c) risks having the insecure (pun intended) vendor file an FTC or other form of complaint claiming that you illegally accessed the information of their clients, hoping to deflect the potential damage to the messenger as has been done in several recent health IT examples.

From Will Eye Am: “Re: the magazine that always features men on the cover. Why would you question their choice of featured subject if it’s mostly men in CIO roles?” Mostly because the magazine is produced by an India-based company, and in my admittedly limited experience, it’s more culturally acceptable there than here to treat women as less than equals. Perhaps I’m jaded by my first hospital job in a rural, for-profit hospital that was a veritable Statue of Liberty for the unskilled medical huddled masses yearning to bill Medicare, where our multicultural medical staff insisted (and hospital policy mandated) that female nurses hug the hallway walls with eyes reverentially downturned as they passed. Companies can do whatever they want, but as such shouldn’t be insulted if I report the percentage of non-white men on the boards or leadership teams or, in this case, note that the magazine can’t seem to find anyone other than white men for its covers.


None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock


3M acquires Switzerland-based semantic coding vendor Semfinder.


McKesson discloses in an SEC filing that the Department of Justice has requested information about its previously announced divestiture of its IT business to a new entity created in a venture with Change Healthcare. DOJ is reviewing the proposed plan for any antitrust concerns.


In Scotland, Craneware reports an 11 percent increase in first-half revenue to $67 million, with pre-tax profit of $19 million.


CompuGroup Medical acquires Italy-based pharmacy software vendor Vega Informatica e Farmacia S.r.l.


Vanity Fair runs a fascinating summary of the Theranos debacle and CEO Elizabeth Holmes that includes interesting observations:

  • Holmes mimicked Apple to the point of wearing Steve Job-like black turtlenecks, forbidding company teams from communicating with each other about their projects, and emphasizing the company’s “story” instead of its actual technology.
  • The Wall Street Journal reporter who broke the story was surprised that Holmes, who micromanaged every company decision, could not explain how its technology worked.
  • Company insiders urged Holmes to rebut the damaging initial WSJ report by enlisting scientists to endorse the company’s work, but that wasn’t possible because Holmes hadn’t allowed scientists to publish peer-reviewed papers about it.
  • The company’s chief scientist could not make the product work even as Holmes touted it to a widening audience, leading to his 2013 suicide.The company’s response upon being told that he had died was to demand that his widow return the company’s confidential information and later to threaten to sue her for talking to reporters.

The author summarizes the Silicon Valley mentality that created Theranos as:

The venture capitalists (who are mostly white men) don’t really know what they’re doing with any certainty—it’s impossible, after all, to truly predict the next big thing—so they bet a little bit on every company that they can with the hope that one of them hits it big. The entrepreneurs (also mostly white men) often work on a lot of meaningless stuff … [they] generally glorify their efforts by saying that their innovation could change the world, which tends to appease the venture capitalists because they can also pretend they’re not there only to make money. And this also help seduce the tech press (also largely comprised of white men), which is often ready to play a game of access in exchange for a few more page views … In the end, it isn’t in anyone’s interest to call bullshit.



Culbert Healthcare Solutions hires Nancy Gagliano, MD, MBA (CVS Health) as chief medical officer.

Announcements and Implementations


Uniphy Health announces GA of its Sentinel sepsis alerting platform.


MedStar Health (MD) delivers patient education delivered using the technology platform of local startup Mytonomy.

Privacy and Security

In Scotland, an environmental activist sues Donald Trump’s Aberdeen golf course, charging its employees with violating the Data Protection Act by using their phones to film her peeing behind a dune on the course. The course admits that it did not register with the data protection regulator despite running at least nine security cameras that were recording guests who weren’t warned that they were being filmed, but says that’s irrelevant because those weren’t the cameras used to record the alfresco urination.



Microsoft, which decided against offering $8 billion for team communications app Slack, is reportedly working on a similar Skype product called Teams, which will offer chat room-like channels, private direct messaging, and Facebook-like threaded conversations.



Franciscan Alliance will rename the 13 of its 14 hospitals that are named after saints to new names that reflect “Franciscan Health” plus their city name, effective next week.

Business Insider profiles the CIO of drugmaker Merck, who believes that companies must undertake digital transformation or die. The CIO says it’s a change in operation that doesn’t necessarily increase IT spending. Merck gets its CIO involved with technology VCs to get early access to startups, encourages its IT employees to find interesting startups and work with them on technology, and allows its developers to create software and sometimes helps them turn it into a startup.


A study finds that the US has the second-highest maternal mortality ratio among 31 developed countries, with Texas recording alarmingly high numbers of women who die during and after pregnancies mostly due to state government decisions about healthcare funding and access.


ED doctors treating an Arizona man‘s small facial cut are shocked to find that it’s the entry wound for a four-inch piece of a broken chopstick lodged deep in his brain. The man reported that he had grabbed his brother from behind in a Chinese restaurant and his brother stabbed him with the chopstick over his shoulder. He’s OK. Googling  turns up other examples of chopstick-related violence, such as a prisoner who killed himself by stabbing himself with a chopstick and a more recent example in which a man confessed to killing his elderly father during an argument by stabbing him in the throat with the wooden utensil. The National Chopstick Association has not yet invoked the “chopsticks don’t kill people” argument.

Sponsor Updates

  • PatientPay will present at the CED Tech Venture Conference next week in Raleigh, NC.
  • Aprima will exhibit at the Arizona State Physicians Association meeting September 15-17 in Scottsdale.
  • Audacious Inquiry Senior Manager King Yip is named a finalist in ONC’s Blockchain in Healthcare Challenge.
  • Bernoulli Health pledges to share its data as part of the Patient Safety Movement.
  • Besler Consulting releases a new podcast, “Live from HFMA Region 3.”
  • Boston Software Systems releases a new podcast, “Improving Clinical Workflow at Patient Discharge.”
  • CoverMyMeds will exhibit at the American Society for Pain Management Nursing Annual Conference September 7-10 in Louisville, KY.
  • Cumberland Consulting Group will exhibit at the Healthcare Executive Group Annual Forum September 12-14 in New York City.
  • Elsevier Clinical Solutions will exhibit at the Emergency Nursing Association annual conference September 14-17 in Los Angeles.
  • EClinicalWorks will exhibit at International Vision Expo West September 15-17 in Las Vegas.

Blog Posts


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Currently there are "12 comments" on this Article:

  1. Stirling is a hard core University of Wisconsin Computer Science trained developer and responsible for much of Epic’s success in the inpatient realm. He’s not TS (Epic for Technical Support) but is personally involved and engaged in any problem a customer might experience or any opportunity to advance the product.

    He’s also the President of Epic Hosting.

    That said, both he and Sumit are extraordinary development talents. They are individuals that would rival any companies development leaders and you’d be unwise to challenge either of them to a coding challenge.

  2. From Will Eye Am: “Re: the magazine that always features men on the cover. Why would you question their choice of featured subject if it’s mostly men in CIO roles

    Will Eye Am — SERIOUSLY! So, even if it is mostly men in CIO roles (a problem onto itself), it is absurdly ignorant and naïve to ignore their lack of understanding of the industry. So, CIO’s in healthcare are mostly male, yet what is the average sex ratio in any health organization? I bet even you could answer that question…….and the point of the comment was that when they FINALLY featured a female, it was the ONLY time they had another pic on the cover! This publication should publish an apology for the HIPPA cover alone, and really should face the music. Culturally, the observation has merit, and I have been around one too many partners, vendors, etc, who have forced their cultural norms in our industry. I work and live in the US for a reason — maybe they should focus on regions that don’t care about their sexism and stop trying to make money off of a region and a culture who finds it unacceptable!.

    Women make the healthcare industry go-round, and that is just the cold hard fact!

  3. Im sorry I have yet to see the huge number of article stating that all the massive data entry MU PQRS numbers have brought about a digital nirvana of healthcare? Where are all those reduced costs and improved care of ICD-10? Where are all those fancy studies showing after 6 years of MU and PQRS and HITECH and 25 Billion spent on EHRs, shouldn’t we have study after study showing improved safety (yikes no), security (lol breaches anyone?), usability(haha, nope), efficiency (def not) and interop (maybe never). Its time to STOP mandatory Certified EHRs. We need to let innovation back in the game, get these old billing platforms like Epic and Cerner etc out. and get new innovative ideas back in…We need real action, not MACRA which is more of the same, if not worse with Clinical Practice Improvement Nonsense, etc. And trying to attribute resource use to a single MD across the spectrum of a medicare patient’s complex care. We are in an absolute nightmare out here on the front lines. You are losing us faster than ever. Just this week 2 more retired, one at 40 yrs old. Be wary.

  4. @sinsky

    The EHR commands more attention than the patients. In many instances, the poor usablility of the EHR requires more intellectual power than do the patients’ diseases.

    It is as if the EHR represents an emerging disease.

    Your defensiveness, and your criticism of the report is typical for IT experts sans patient care experience.

  5. Of the 27% left to meet with patients, 26% of that was spent asking and re-asking questions which could be answered from the patient’s chart.

  6. Theranos should consider changing their name to


    It is reflecting on the quality of their products and scientific rigor not to mention the impressive leadership style of their CEO. Their motto should be: “If you think experts are expensive, why don’t you try an amateur ?”

  7. If Epic is going to be directed by Judy’s kids, they’re going to need much more acquaintance with the “family business.” There’s no evidence they’ve ever been involved in the operations of the company, and more importantly, while their careers are interesting and important, there’s little to show that they’ve developed a skill set that qualifies them to lead an company that manages millions of Americans medical records. Judy’s children are a veterinarian, a woodworker who seems to have dabbled in coding years ago, and the other one is on the payroll of one of Judy’s non-profits.

  8. RE: doctors created in voluntarily accepting checks from insurance companies and the federal government and thus being required to meet their documentation requirements – are responsible for their unhappiness and lack of productivity

    Right on. Remember…he who pays the piper calls the tune. Seems to me if docs have had it with gvt requirements, don’t accept Medicare/Medicaid patents. As some docs are now doing. And by the way who created the first health insurance company (Blue Shield) in 1939?? The AMA !!!

    As bad as the gvt reporting requirements are for docs…and I agree it’s really bad, it’s really no worse than in the defense industry. Ever see the reams of gobbly-gook reports they have to file??

  9. Thanks to In The Know for defining an Epic “TS”. All I was getting from Google was the decidedly Urban Dictionary version.

  10. Gotta love how Vanity Fair had to clarify that the investors were mostly white men, in an article about a company run by a female.

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Reader Comments

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