I had an old physician colleague whose favorite hobby was bitching about EHRs, and one day told a story about…
Morning Headlines 11/5/18
Allscripts Healthcare Solutions (MDRX) Q3 2018 Results – Earnings Call Transcript
Allscripts executives comment on the potential sale of Netsmart and its plan to increase margins for the former McKesson EIS business, but fail to directly answer a question about plans of its biggest client Northwell Health and make no mention of its Avenel EHR that was announced at HIMSS18.
OpenText to Acquire Liaison Technologies, Inc.
Information management technology vendor OpenText will acquire competitor Liaison Technologies for $310 million in cash.
Like clockwork: How daylight saving time stumps hospital record keeping
Users describe how they work around Epic’s inability to handle documentation entries between 1:00 a.m. and 2:00 a.m. when clocks are moved back at the end of daylight saving time.
Why Doctors Hate Their Computers
Atul Gawande, writing about his experience with Epic’s go-live at Partners HealthCare, says EHRs were supposed to increase the mastery of doctors over work, but have actually increased work’s mastery over doctors. He quotes an Epic executive’s description of “the Revenge of the Ancillaries,” where the go-live allowed non-doctors to influence their workflow in unproductive ways. He also notes that EHRs have made the problem list nearly worthless and that Epic’s In Basket is “clogged to the point of dysfunction.” He also quotes Partners Chief Client Officer Gregg Meyer, who reminds that Epic is for the patients, not the doctors, and is at least mildly enthusiastic about using scribes.
Regarding the reported archaic workarounds for daylight savings time. What is truly archaic is that we are still changing our clocks twice a year! I don’t see an easy way to alleviate this problem in the EHR when accurate, timed entries are critical to patient care and also required.
Atul’s concerns about the problem list are entirely the fault of using an insurance system that demands specific diagnosis codes before they will pay for procedures. Maybe, if we didn’t have a ridiculous payment system, we wouldn’t have ridiculous software designed to feed a ridiculous payment system. Just a thought.
That USA Today article is nonsense. Most of it is untrue anyway. They are singling out Epic for something that other EMRs don’t do any better. And comparing the complex and critical data that goes into Epic to Apple and Google settings? Written by someone who thinks all software is the same.
Agreed with CaveNerd that the real problem is that DST is still a thing in the year 2018. But let’s all focus on how Epic doesn’t magically solve all of healthcare’s problems instead.
Its true, all of these new requirements for doctors for document their office notes is in large part for billing, but it also reduces cost for the healthcare organization too. At its face that sounds bad, but if costs for an organization goes up, its not the doctor’s or administrations salary that goes down, its the patients cost that goes up. The story about the neurosurgeon “hacking” the system, and all I see is the patient cost going up. Another interface, another set of man power to implement and support, and another set man power to follow up with the doctors on missing information due to interface or documentation issues.
While I sympathize with long work hour issues and a steep learning curve when it comes to doctors using EHRs. I can’t help but think about how different hospital organizations that I’ve installed at where for a long time the support staff spend hours dealing with whatever the doctor decided to scribble that day on the chart. All those extra hours spent chasing after information at the end of the day is passed down to the patients. Same deal with hiring scribes, whether they are minimum wage medical students or taking advantage or doctors from poorer countries. Does no one see the issue with having a orthopedic surgeon work as a dictation scribe where the productivity is 30 min visit = 1 hour scribing? Does India have too many doctors and not enough jobs for doctors?
I think lot of providers still have the paternalistic view that they know best because they are the smartest and the wisest at all times, and everything in healthcare should be catered to them. That has always resulted in bad outcomes for the patient in the past, and that sort of attitude needs to be checked.
Re: Atul Gawande’s article.
I’ve been in the business a long time. Even big software systems, bureaucratic and resistant to change, are vulnerable to pressure from unsatisfied users. These are human created problems and humans can create the solutions. That’s where the system came from after all.
Software either adapts and satisfies, or it dies.
Having said that, I can also attest that “dilution” effect on systems is real. A really terrific small system can easily become a “meh” larger system, which can become a truly hated enterprise system. Chefs will recognize this as the “too many cooks in the kitchen” syndrome.