By Shane Peng, MD, chief clinical services and innovations Officer, IKS Health.
Shane Peng, MD
“Not enough time with my provider” or “my doctor isn’t listening to me” are among the top five complaints of today’s patients—and those frustrations haven’t changed much over time. Providers feel these pressures more than ever as they are pushed to provide quality care and patient engagement for less cost, while adding to their clinical documentation requirements with less time to do it.
These and other demands have driven providers to find more streamlined, digital solutions to help them save time, while government regulations (MIPS) and health plan providers have made mandates further increasing clinical documentation and reporting requirements.
These factors have led to the challenges of the last decade as stakeholders attempt to find ways to ease charting and administrative tasks during the patient appointment and unlock physician time. The federal government and commercial payers even offered mandates to encourage providers to onboard new technology aimed at optimizing performance.
Unfortunately, these technologies have not had the effect everyone had hoped for, and in fact, have sometimes amplified physician burdens rather than reducing them. Charting in an EHR can sometimes be time-consuming, difficult, and distracting, particularly when tackled during the constraints of the visit. This has led to physician frustration and stress, and worse, errors, as time pressures mount and they are asked to speed documentation while maintaining accuracy and making the appointment more patient-centered.
To lessen the strain, many providers opt to complete documentation after the appointment, often after normal business hours. However, this can quickly burnout physicians as they work a full day seeing patients and then spend their free time finishing up charts. Most physicians report an additional two hours of documentation time per work day. This can unfortunately also lead to more mistakes because the physician is documenting based on the memory of the encounter, which is inherently flawed in terms of accuracy and comprehensiveness.
It’s clear: “The way we’ve always done it” isn’t working
Although organizations appreciate the need to free physician time and smooth the documentation process, they frequently struggle to determine the best ways to realize change. It can be tempting to fall back on traditional methods like ramping up provider training or tweaking the EHR adding customized templates to hopefully streamline workflow.
However, organizations are beginning to see that these conventional tactics aren’t overly effective, and they need to approach the problem from a different angle. Entities must find means to remove the burden from physicians while still ensuring precise and thorough documentation that supports better patient care, stronger quality reporting and tighter reimbursement.
Guest post by Matthew Douglass, co-founder, SVP Customer Experience, Practice Fusion
Matthew Douglass
In part 1 of this series, we reviewed the history of digital health tools and discussed why they are not yet fully satisfying the needs of many physicians.
If you think of the U.S. healthcare system as a vast nationwide transportation network, current electronic health record (EHR) functionality is the basic highway infrastructure. The American Recovery and Reinvestment Act of 2009 provided the incentives for those highways to be built and put in place the structure for ONC-certified EHRs to define the rules of the road via regulatory standards. The roads are now mostly in place: certified EHRs all offer roughly the same base functionality for use by physicians, store clinical information in standardized ways, and have the capabilities to securely communicate with each other.
Sixty-seven percent of medical practices in the U.S. are now using EHRs to run all or part of their daily operations. Patients’ vital signs are stored as discrete values for each visit. Encrypted messages between physicians and their staff are transmitted reliably. Chart notes are being digitally documented and can be shared confidentially with patients. Physicians that have chosen cloud-based EHRs can securely prescribe and refill medications from the convenience of their mobile phones.
Despite having this digital highway system in place, we haven’t yet reached a destination where use of EHRs achieves better patient outcomes or improved clinical experiences. Physicians want more from digital tools than simply receiving, storing, and displaying data values about each patient visit. Rather than devoting too much of their already limited time to data entry and retrieval, physicians want to provide the best patient care possible, and they expect technology to help them achieve this goal.
There is such a thing as too much data, which physicians are reminded of each time they open a digital chart. Clinicians very often are left swimming in more data than they can adequately process, which can erode the crucial patient-provider human relationship.
To address data overload and dehumanization challenges, software partners must go back to the drawing board and visualize dramatic innovations that can be built on top of the nationwide EHR foundation. Significant cognitive overhead is required to distill hundreds of disparate pieces of clinical data into a salient picture of an individual’s overall health. The vast amount of data now available in a patient’s chart is quite often far more than any medical professional, no matter how clinically experienced, can consistently and reliably assimilate.
Physicians and their staff need intuitive technology to be their always-available, intelligent assistant, from start to finish during a patient’s visit.
When a patient’s record is displayed on the computer screen, physicians shouldn’t have to dig for relevant information about that visit. Instead, the EHR should be able to display the pertinent clinical data and health insights for the physician to review and assess a patient’s health condition more quickly and effectively. For example, lab values and vital signs relevant to that patient’s chief complaint are likely already stored as discrete values in the patient’s chart. An EHR that learns along with the physician’s workflow preferences should display only the most relevant data through easily digestible visualizations.
