EHRs = Opine “YES” or “NO”

Posted on October 11, 2018 by Dr. David Edward Marcinko MBA MEd CMP™

EHRs = Opine “YES” or “NO”

A Binary Verbal Opinion Poll

OR

What grade would you give the state of EHR in 2018 on a national basis with physicians and hospitals, and are there aspects that have fallen well short of your past expectations of where we would be today?”

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TELL US WHAT YOU THINK?

Filed under: Information Technology, Pruitt's Platform, Voting Polls | Tagged: |

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7 Responses

  1. darrelldk2, on October 12, 2018 at 1:06 AM said:

    On EHRs

    “The ECRI Institute today released its list of top healthcare technology hazards for 2018, outlining major areas of concern for hospital administrators in the coming year. Many items involve patient infection from unclean equipment, but digital threats staked their place as equal or even greater dangers to patient safety.”

    http://www.hcanews.com/news/cybersecurity-threats-digital-failures-top-hospital-hazards-list

    “Cybersecurity Threats, Digital Failures Top Hospital Hazards List”
    By Ryan Black for Healthcare Analytics News
    November 6, 2017

    Darrell K. Pruitt DDS

    Like

  2. Peter R. Kongstevdt MD, on October 26, 2018 at 8:47 PM said:

    EHRs

    The only applicable grade is “incomplete.” That’s what happens when you combine self-study, costly professional consulting firms tutors, few deadlines, no significant penalties for failure to meet course requirements, and a very high tuition cost.

    Peter R. Kongstevdt MD
    via Ann Miller RN MHA

    Liked by 1 person

  3. David Fairchild MD MPH, on October 26, 2018 at 8:52 PM said:

    On EHRs

    I don’t know any physician who is “happy” with their EMR. As a practicing primary care physician in a large faculty practice group, and as a healthcare consultant who interacts with healthcare providers across the country, I talk with clinicians every day. Overall grade for EHRs: B-

    By now nearly 96% of all non-federal acute care hospitals, and 99% of all hospitals over 300 beds, have installed some brand of HHS Certified health IT system with clinical notes. The challenge now is how to clear up the issue of interoperability among IT systems so that data sharing can provide a complete picture of a patient’s health status, and more fully open the door to innovation.

    While progress is being made, the impediments to achieving interoperability are significant. There are multiple EHR vendors in the inpatient and outpatient market, and implementing, running, maintaining and modifying these different platforms is complex and costly. A recent HIMSS Analytics survey indicates that the average health system is running some 18 distinct electronic health record platforms across their inpatient and outpatient practice sites. A number of these are specialty EHRs in areas such as oncology or behavioral health that won’t be easily displaced by core vendors, which may explain why only a small percentage of hospitals have been able consolidate their EHR platforms down to a few vendors.

    In short, if doctors are to “live” in their EHR, they need all relevant patient data to reside there as well. Providers don’t have time to go searching multiple locations for patient data.

    While interoperability remains challenging, EHRs are meeting expectations in a number of ways:

    First and foremost, EMRs provide easy access to the multi-disciplinary team of specialists and their clinical notes related to the referrals I make as a PCP. EHR technology also provides me with information in retrievable formats not available in paper records, and improves chronic disease management, prevention, and screening which is essential for value-based payment. Further, EHRs provide clinicians remote access to patient charts, lab results, and point of care data that enable us to manage patients better when we are out of the office.

    Secondly, EHRs help empower patients. Our patients appreciate having the ability to check lab results, make appointments on line, and to e-mail their provider directly about questions which used to go unasked or unanswered. This is a benefit that doesn’t get talked about enough. Most patients believe that their clinical information is perfectly safe, and they like the way the EHR lets them collaborate in their treatment planning. That said, the capabilities of most EHR portals are a long way away from providing the “frictionless” interface that we have all come to expect from our phone apps.

    Despite these positive benefits, there are other problematic issues:

    First among these is the unintended consequences created by the EHRs insatiable demand for data entry. My colleagues have complained that the need for documentation can take the focus away from having a personal relationship with their patients. Professional satisfaction for physicians is driven by their ability to deliver high quality care in an efficient manner. Dissatisfaction is driven by factors that impede this ability such as excessive regulatory, clerical, and administrative burdens coupled with inefficient practice environments.

    Needed next: data entry/collection mechanisms other than direct provider entry into the EMR, (for example, scribe entered or uploaded patient entered data)

    The implementation of EHRs has been the major driver of change in physician practice patterns in the past 20 years. Despite the quality of care advantages, an unintended consequences of EHR expansion has been some loss of physician practice satisfaction. Some physicians groups report their physicians spend a one-to-one ratio documenting care in their EHR as they do providing face-to-face care. Clearly this is not the best use of our most expensive resource.

    Overall, EHRs have enabled us to increase the quality of care that clinicians provide. However, this quality enhancement has been powered by requiring physicians and other providers to do a great deal of data entry. I believe that much of physician burnout can be traced back to the additional burden EMRs have placed on the backs of providers.

    A B- grade shows promise, but with a definite “needs improvement”.

    David Fairchild MD, MPH
    via Ann Miller RN MHA

    Like

  4. William J. DeMarco, on October 28, 2018 at 12:32 PM said:

    Electronic Medical Records

    Physicians report issues with EHR such as time lost, lack of interoperability and misunderstanding as to the value of this data in improving their practice.

    While the EHR industry has been able to give us granular level reporting and identify patterns of care that we have not had before, the physicians we work with still complain about the complexity and time lost on income from patient visits because of EMR mistakes and or time consuming data entry that they would like to delegate. While they see value in having data points and benchmarks as well as reminders to meet checklist obligations they really do not use data the way the vendors intended, so there is a large GAP between use and understanding.

    The other side of this is the proliferation of EMRs by specialty and location. Some states have dominant EMRs while other health systems report 45 EMRs being used to gather information for their clinically integrated network (CIN) or ACO. This presents the problem of interoperability between systems, and gaps between practices in trying to establish benchmarks and guidelines.

    Add to this the many EMRs who integrate patient appointments and billing and what was supposed to be a tool becomes a burden to many physicians until they realize the value of this data for their own purposes. Reviewing summary data can help improve their practice work flow as well as help them look at pricing and intensity of service which can help to actually see how their payer mix and patient age and gender has changed their practice over time.

    While there are probably no single solutions to any of these issues in the near future, there are industry and government resources being researched to make interoperability improvements. Many physicians see the negative side of the business because it is very different than what they did in the past, however new physicians coming out of school are seeing the structure and organization of the EMR to be an advantage in starting their practices. So while EMRs are here to stay, we see the next generation of EMRs to perhaps be a bit more user friendly and perhaps will be seen more as a business improvement tool versus just a compliance and reporting obligation.

    William J. DeMarco

    Like

  5. darrelldk2, on October 29, 2018 at 1:35 AM said:

    Transparency and EHRs

    I would like to know if anyone has any reason to believe electronic health records will ever be any more secure than they are today?

    D. Kellus Pruitt DDS

    Like

  6. D. Kellus Pruitt DDS, on October 29, 2018 at 6:16 PM said:

    Dear Dr. John O’Keefe, Director, Knowledge Networks, Canadian Dental Association

    In response to your recent Linkedin invitation to dentists to share any “clinical or non-clinical question,dilemma or area of confusion” that Oasis Discussions might be able to clear up, my questions are straight forward: Are electronic dental records cheaper and more secure than paper records?

    Home

    (I have emailed my response to your invitation to the address provided as well as posted it following your Linkedin post. I am also sharing this with friends).

    Thanks for your help, Dr. O’Keefe. Dentists deserve transparency from vendors. Hope to hear from you soon.

    D. Kellus Pruitt DDS

    Like

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