...which is strongly suggestive, that the VA's problem with Cerner implementation? It's coming a lot more from the VA, than…
Plenty of HIMSS exhibitors are talking about ways they can support clinicians including through virtual scribes and artificial intelligence. Burnout remains a hot topic, with Medscape ranking the most burned-out specialties. Based on comments from my physician friends, they’re in agreement that burnout is everywhere, with 100% of them using the word “exhausted” at least three times in casual conversation. Medscape surveyed physicians from June to September 2021, so these are pre-Omicron numbers. Top causes of burnout included too many bureaucratic tasks, lack of respect, long work hours, lack of autonomy, insufficient pay, EHRs, and government regulations. Topping the list:
- Emergency medicine (no surprise due to COVID).
- Critical care (also no surprise due to COVID).
- Infectious disease tied with family medicine.
Beleaguered medical practices have been in the news over the last two years, but there is some encouraging news of a potential rebound. Kaufman Hall’s latest Physician Flash Report shows higher patient volumes helping drive revenue growth in 2021. Physician work relative value units (wRVUs) grew more than 20% per full-time equivalent physician compared to the last quarter of 2020. Primary care practices in particular showed a 13% increase. These increases are partly attributed to patients presenting for care after deferring it during 2020 and early 2021. Unfortunately, expenses also grew, with the metric of total direct expense per physician rising 16% versus 2020 numbers. Word on the street is that physician groups are still cutting salaries and asking physicians to do more because of ongoing staffing shortages. I don’t see these factors positively impacting burnout rates anytime soon.
News of the weird: If you’re a physician, this headline is definitely going to catch your eye – “Healthy Man Dies After Mistakenly Drinking Equivalent of 100s of Coffees.” The patient in question had a misadventure using caffeine powder in his pre-workout drink, resulting in caffeine toxicity. He suffered cardiac arrest and was taken to a hospital, where he ultimately died. A coroner’s report listed his caffeine level at four times that which is considered deadly.
I’ve received several recruiting emails over the last couple of weeks for “a leading Government Systems Integrator” who is in need of multiple clinical informaticists. The opportunities are for a full year with up to 50% travel “depending on the phase of the implementation.” The job involves “performing assessments and evaluation of workflows and content to support the deployment of EHR systems, facilitate process change and provide change management consulting as well as working with hospitals and/or ambulatory and clinical business units to support deployments. Cerner experience is required, so I’ll give you fewer than two guesses at who is now trying to hire the informaticists to address issues that could have been avoided had they employed the right resources in the first place.
A United States Government Accountability Office report to Congress last month found that the Department of Veterans Affairs didn’t adequately ensure the quality of migrated data as it populated the new Cerner system. Clinicians reported challenges in accessing the migrated information as well as concerns with its accuracy. The GAO watchdog noted that “the challenges occurred, in part, because the department did not establish performance measures and goals for migrated data quality.” As a result, the system being deployed “does not meet clinicians’ needs and poses risks to the continuity of patient care.” There were also apparently concerns with ensuring that clinicians knew what data was migrated and how to find it as well as not having appropriate security rights to see critical patient care data, such as immunizations.
Other concerns included data duplications, errors, and inclusion of a greater amount of data than clinicians actually needed. The bulkiness of the transferred data made it harder for clinicians to find what they were looking for. I’ve worked on more EHR data migrations in my career than I care to remember, and making sure the data is not only accurate but winds up in a place where clinicians can actually use it is critical. The GAO’s findings also illustrate the importance of training to ensure end users can hit the ground running. Role-based training would have been particularly helpful here, as would ensuring adequately trained and staffed super users to support clinicians who may not have fully absorbed all the material during training.
The GAO recommended that the VA adopt performance measures and goals so that data quality meets clinician needs in future deployments. It also suggested that the VA “use a register to improve the identification and engagement of all relevant EHR modernization stakeholders to address their reporting needs.” As a consultant, ensuring stakeholder alignment is critical to the success of any project. I still see way too many projects that don’t adequately balance technology, operations, clinical, and other needs while trying to solve complex problems. I thought a project of this magnitude and visibility might have done better, but it just goes to show that the more things evolve, the more they stay the same.
In travel news, Cleveland Clinic is examining an opportunity to open a patient lounge at Cleveland Hopkins International Airport. The facility would allow construction of a nearly 400-square-foot space to replace seating and Rock and Roll Hall of Fame murals. Staff would help coordinate travel to the hospital and provide support for families and caregivers. Approximately 3,000 patients seek care by flying to Cleveland each year from across the US and from more than 180 countries. The Mayo Clinic has its own welcome center at Rochester International Airport, so hopefully Cleveland Clinic will be able to keep up with the destination healthcare Joneses.
I’m finalizing my HIMSS travel plans and also my evening social plans. Invitations are still a little slow, but that’s to be expected given the concerns about the decline of in-person attendance. Orlando can be a tricky destination for party planning since many of the desirable venues are away from the convention center and hotel areas. At HIMSS19, there was one night when cell service issues created rideshare outages, which was extremely frustrating. Traffic is always horrible, and to be honest, the convenience and location of multiple event venues is one of the reasons I actually like Las Vegas as a HIMSS location (as long as it’s not in August).
What’s your favorite HIMSS venue? Leave a comment or email me.
Email Dr. Jayne.