The news on physician burnout lately has been mixed. A 2018 Massachusetts Medical Society/Harvard report received considerable attention – it proclaimed physician burnout has become a crisis, widespread in the medical profession, driven by rapid changes in health care and physicians’ professional environment. Yet last month a study published in Mayo Clinic Proceedings found that physician burnout actually declined more than 10 percentage points from 2014 to 2017, though the rate for doctors was still considerably higher than for U.S. workers at large. And just last week, an American Academy of Family Physicians survey reported that 71 percent of practicing physicians are happy, albeit frustrated by the extent to which administrative and clerical tasks have become part of their daily work.
What to make of all this seemingly contradictory data?
When I began practicing as a hospitalist in the 1990s, the administrative burden on physicians was much less than today, owing in part to the regulations and routine processes of the day and the typical patient caseload. Back then I saw 12 patients per day. With that caseload, you could break even on billing while still having plenty of time to interact with patients and colleagues. While it would not be feasible to return to that volume today, the point is that the hospital afforded a much more professionally rewarding environment. There was time to discuss interesting cases with colleagues. There was time to revisit patients and dig deeper into their records. You had time to sit at a patient’s bedside and hold their hand. The pace today does not afford this opportunity, much to the dissatisfaction of physicians. The resulting isolation from patients and peers is a contributing factor to the burnout seen among physicians.
Then there’s the technology component. EHRs are widely regarded as a significant cause of physician stress and a distraction from patient care. For example, when hospitals installed computerized order entry (CPOE), it eliminated the order clerk and created an additional job for the physician. The evolution of the clinical note is another example of unintended clinical burden, with roots in the evolution of medical practice and the emergence of EHRs.
Take a step back and consider what the original purpose of a physician’s note was: to advance patient care. The note would be updated on a visit-to-visit basis by the same physician or perhaps another physician in the same group covering a weekend. Then shift-based medicine came into play, and the note became a vital mechanism to facilitate care transitions. Then, as malpractice suits became more commonplace, lawyers began requiring physician documentation to support their legal case. From there, we saw the note transform from a clinical and legal document to a billing document and a check for RAC audits.
Given these trends, the pressure on provider organizations (and physicians individually) to document extensively and bill correctly for every service performed has grown over time. Concurrently, the practice of regularly reconciling clinical notes and charges also has grown in importance, both to identify missing charges (for revenue enhancement) and to identify missing notes (for compliance). In order that this process doesn’t become another straw on a physician’s administrative back, many organizations prefer to automate charge-note reconciliation within the revenue cycle management workflow.
For a variety of compelling business reasons, not limited to concerns about physician burnout, healthcare systems must attend to their physician experience with the same level of care and intention as their patient experience. Here are three ways that improving physician experience can help to bolster a hospital’s bottom line:
Advances in technology have fundamentally altered and inarguably improved the way we drive, shop and travel. Just ask anybody who uses Google Maps, Foodler or Uber.
Sadly, however, information technology has failed to deliver so far in the most crucial service of all – healthcare. This is at least partly because electronic health records (EHR) systems grew out of the computer systems that run the hospital’s inner workings — patient scheduling, admission and discharge, staff payroll and accounts receivable. For system designers, physicians’ needs were an afterthought, which is problematic because physicians are, after all, the linchpin of the healthcare delivery system.
To begin pulling healthcare IT out of the past, we must first take a look at how it supports physicians. The short answer today is “not well.” In fact, EHRs are creating as much frustration as benefit. Problems include poor presentation of patient data, fragmented information sources and unwieldy user interfaces that require dozens of mouse clicks or screen taps. It’s no wonder more than half of physicians who responded to a recent survey claimed their EHR system had negative impacts on costs, efficiency and productivity – three things IT should help, not hinder. These issues not only affect physicians’ professional satisfaction, they contribute to the phenomenon of physician burnout, which is a growing concern across healthcare. Studies show some 30 percent of primary-care physicians age 35 to 49 plan to leave medicine, and there’s an expected shortage of 25,000 surgeons by 2025. A Mayo Clinic study released earlier this year directly connected the burnout problem to physicians’ use of EHRs.
Today’s EHRs have done little more than “pave the cow paths.” We’ve gotten rid of paper in the hospital and made processes electronic, which is why EHRs can legitimately claim to have reduced transcription errors. But eliminating paper is just table stakes; the critical next phase is to do for healthcare what Uber has done for transportation: Reinvent the process so it’s optimized for and native to the technology that enables it.
Patients and physicians can and should advocate for such change. Today, patients have access to a vast body of information—the notes a doctor took, quality of care rankings, the level of personalization provided—and it’s only going to increase. As Lygeia Ricciardi, former director of the Office of Consumer eHealth at ONC said, “Getting access to personal health information is the start of engaging patients to be full partners in their care.”
Vice President Joe Biden recently took the stage at Health Datapalooza in Washington, D.C. to discuss where healthcare technology currently stands, and he didn’t hold back. Among other things, he chastised the industry for poor health IT system interoperability and the resulting difficulties it causes providers and patients. “We have to ask ourselves, why are we not progressing more rapidly?” Biden lamented.
Biden’s criticism is only the latest high-profile commentary about the unfulfilled promise of information technology in healthcare. AMA leaders and individual physicians have been grousing about it for years. We’ve seen technology increase efficiency, reduce costs and improve productivity in every other industry – but why not healthcare?
Ironically, seven years after the passage of the HITECH Act of 2009, doctors are less productive than they were before, and IT is the culprit. Rather than enabling a better, more streamlined workflow, IT has become a burden.
The drag that IT is placing on healthcare providers is a principal reason why U.S. Health and Human Services (HHS) Secretary Sylvia Burwell announced with great fanfare at the HIMSS16 conference an “interoperability pledge,” which vendors and providers alike are encouraged to take. Its purpose in part is “to help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community.”
This call resonates because the promise of better healthcare through technology has been broken. Technology has changed the way we communicate, the way we shop, the way we watch TV, the way we drive, and the way we interact with our homes. As an industry, healthcare is lagging way behind. The consequences are drastic. In order for us to deliver the kind of holistic care that will truly improve people’s health, it’s time not only to talk about the potential, but to make it a reality for users and providers across the healthcare continuum.
Here’s the reality: we have today what 10 years ago was called a supercomputer in front of physicians – a device that knows virtually everything about the patient – but it isn’t helping out in ways that we take for granted in our everyday lives when we shop online, use Google Maps or order an Uber.
Guest post by Amy Sullivan, vice president of revenue cycle sales, PatientKeeper.
The multi-year run-up to the ICD-10 cut-over last October had a “Chicken Little” quality to it. There was prolonged hand-wringing and hoopla about the prospect of providers losing revenue and payers not processing and paying claims – the healthcare industry equivalent of “the sky is falling.”
Then CMS helped calm things down by announcing last July (as the AMA reported at the time), “For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.”
Since ICD-10 is all about specificity – the number of diagnosis codes increased approximately four-fold over ICD-9 – this was a big relief to all involved. And, if you believe new research data, the sky indeed has not fallen: Sixty percent of survey respondents “did not see any impact on their monthly revenue following Oct. 1, 2015… Denial rates have remained the same for 45 percent of respondents. An additional 44 percent have seen an increase of less than 10 percent.”
Still one has to wonder what will happen after Oct. 1, 2016, when the current leniency expires and ICD-10 code specificity is required. Will physicians be in a position to enter their charges completely and accurately once “in the general neighborhood” coding no longer suffices?
They will if their organization has invested in technology that adheres to best practices in electronic charge capture system design. The three watch-words are: specialize, simplify and streamline.
A charge capture system is specialized when it exposes only relevant codes to physicians in a particular specialty or department, and when it provides fine-tuned code edits. With different types and processes of workflows (and let’s face it, personal preferences), physicians need an intuitive and personalized application that easily fits into their individual work styles. A tailored user experience allows providers to build and display their patient lists in whatever way is most convenient and meaningful to them – down to lists organized by diagnosis and “favorites.”
Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the third installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.
Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read the first installment in the series, go here: Health IT’s Most Pressing Issues and Health IT’s Most Pressing Issues (Part 2). Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.
The healthcare industry has undoubtedly become a bigger target for security threats and data breaches in recent years and in my opinion that can be attributed in large part to the industry’s movement to virtualization and the cloud. By adopting these agile, effective and cost-effective modern technological trends, it also widens the network’s attack surface area, and in turn, raises the potential risk for security threats.
We actually conducted some research recently that addresses evolving security challenges, including those impacting the healthcare industry, with the introduction of cloud infrastructures. The issue is highlighted by the fact that the growing popularity of cloud adoption has been identified as one of the key reasons IT and security professionals (57 percent) find securing their networks more difficult today than two years ago.
Paul Brient, CEO, PatientKeeper, Inc. No industry on Earth has computerized its operations with a goal to reduce productivity and efficiency. That would be absurd. Yet we see countless articles and complaints by physicians about the fact that computerization of their workflows has made them less productive, less efficient and potentially less effective. An EHR is supposed to “automate and streamline the clinician’s workflow.” But does it really? Unfortunately, no. At least not yet. Impediments to using hospital EHRs demand attention because physicians are by far the most expensive and limited resource in the healthcare system. Hopefully, the next few years will bring about the innovation and new approaches necessary to make EHRs truly work for physicians. Otherwise, the $36 billion and the countless hours hospitals across the country have spent implementing electronic systems will have been squandered.
Email security is one of healthcare’s top IT issues, thanks, in part, to budget constraints. Many healthcare organizations have already allocated the majority of IT dollars to improving systems that manage electronic patient records in order to meet HIPAA compliance. As such, data security may fall to the wayside, leaving sensitive customer information vulnerable to sophisticated cyber-attacks that combine social engineering and spear-phishing to penetrate organizations’ networks and steal critical data. Most of the major data breaches that have occurred over the past year have been initiated by this type of email-based threat. The only defense against this level of attack is a layered approach to security, which has evolved beyond traditional email security solutions that may have been adequate a few years ago, but are no longer a match for highly-targeted spear-phishing attacks.
Dr. Rae Hayward, HCISPP, director of education and training at (ISC)²
Dr. Rae Hayward
According to the 2015 (ISC)² Global Information Security Workforce Study, global healthcare industry professionals identified the following top security threats as the most concerning: malware (77 percent), application vulnerabilities (74 percent), configuration mistakes/oversights (70 percent), mobile devices (69 percent) and faulty network/system configuration (65 percent). Also, customer privacy violations, damage to the organization’s reputation and breach of laws and regulations were ranked equally as top priorities for healthcare IT security professionals.
So what do these professionals believe will help to resolve these issues? Healthcare respondents believe that network monitoring and intelligence (76 percent), along with improved intrusion detection and prevention technologies (73 percent) are security technologies that will provide significant improvements to the security posture of their organizations. Other research shows that having a business continuity management plan involved in remediation efforts will help to reduce the costs associated with a breach. Having a formal incident response plan in place prior to any incident decreases the average cost of the data breach. A strong security posture decreases not only incidents, but also the loss of data when a breach occurs.
Many physicians and revenue cycle professionals at healthcare provider organizations are suffering acute ICD-10sion as the calendar flips relentlessly toward October 1.
For all the complexity associated with ICD-10, there are some relatively simple things healthcare providers can do to prepare the front-end of their revenue cycle for the change-over. By “front-end” we mean physician charge capture, the origin of much of a practice’s revenue. The key to success is to make physician charge capture as tailored, flexible, and straightforward as possible for physicians, billers and coders.
A system is tailored when it exposes only relevant codes to physicians in a particular specialty or department, and when it provides fine-tuned code edits. It is flexible when it lets physicians enter charges on the device of their choice – a computer in the office or at home, a smartphone in the car, a tablet anywhere – and when it gives physicians the ability to use familiar clinical terminology to look up codes. And a charge capture system is straightforward when it is seamlessly integrated into physicians’ workflow via the EHR, and into the finance staff’s workflow via the billing system, necessitating fewer clicks, taps and swipes by all users.
An organization that knows this firsthand is Stony Brook University Physicians on New York’s Long Island. This academic practice affiliated with Stony Brook University School of Medicine has 17 clinical departments through which patient care services are rendered and billed.
For a variety of business reasons, the group’s administrative arm, called the Clinical Practice Management Plan (CPMP), implemented an electronic charge capture solution 10 years ago. A return-on-investment (ROI) study of several departments showed that, over a six month period, charges increased by $2.5 million ($5 million annualized) and claim volume increased by 29 percent. Overall, these departments saw a 50 percent reduction in lag days. One department with particularly dramatic results saw its number of claims increase by nearly 70 percent, while the number of coding issues actually declined by six percent. Clinicians can now quickly and easily record charges for services they deliver – at the point of care, in the office, or anywhere in between.
Along the way, Stony Brook CPMP gained valuable insight into the critical elements that make up a successful charge capture system.
In this series, we are featuring some of the thousands of vendors who will be participating in the HIMSS15 conference and trade show. Through it, we hope to offer readers a closer look at some of the solution providers who will either be in attendance – with a booth showcasing and displaying key products and offerings – or that will have a presence of some kind at the show – key executives in attendance or presenting, for example.
Hopefully this series will give you a bit more useful information about the companies that help make this event, and the industry as a whole, so exciting.
PatientKeeper provides workflow applications for physicians that transform hospital EHRs from what they typically are – a distraction or hindrance topatient care – into what they should be: an intuitive support system for physicians.
PatientKeeper, Inc. is a leading provider of healthcare applications for physicians. PatientKeeper’s highly intuitive software streamlines physician workflow to improve productivity and patient care. PatientKeeper’s CPOE, physician documentation, electronic charge capture and other applications run on desktop and laptop computers and popular handheld devices and tablets. PatientKeeper’s software integrates with many existing healthcare information systems to help provider organizations drive physician adoption of technology, meet Meaningful Use, and transition to ICD-10. More than 60,000 physicians across North America and the UK use PatientKeeper software.
PatientKeeper plays in two different market segments: (1) EHR optimization, and (2) revenue cycle optimization. In the former, we target 100+ bed community hospitals and hospital networks that rely primarily on affiliated physicians (vs. employed physicians) for patient admissions – clinicians whose loyalty (and business) must be “courted” and competed for – and which have not deployed or committed to an Epic EMR system. In the “Revenue Cycle Optimization” side of our business, we target physician practices of 25 doctors or more (but typically larger academic medical groups), and hospitals with a significant corps of employed physicians.
Health IT pain points seem to be lingering long despite the never ending promises and hope eternal new technology innovation seems to offer. Every sector has its prickles, no doubt, and much is left to overcome in healthcare, but given the complexity and the copious amount of change and development here, it’s of little surprise that pain is being felt.
What may be surprising, though, is that like patient engagement, there seems to be a different type of pain, and severity of pain, depending on who you ask.
With that, for greater clarity, I decided to ask some of health IT industry insiders what they’re pain points were and why. Their responses follow:
Dr. Trishan Panch, chief medical officer, Wellframe
One of the biggest pain points for hospitals is that we’ve come across a health system’s inability to scale care management resources. They are effective in improving outcomes when patients are engaged, but because of limitations around existing models (i.e. human interaction via phone or in-person) only a small proportion of the patient population can be engaged. That’s why organizations are turning to technology solutions to scale care management resources to reach more people.
One of the biggest pain points for physicians today is the lack of interconnectivity between different IT systems. Participation in the meaningful use program has helped create some common standards for communication but, for a variety of reasons, these have not yet lead to widespread, effective clinical data sharing. Few physicians can operate in the ecosystem of a single electronic medical record, since they often work in systems that are different, from practice, various hospitals and other places of care.
Interoperability is a pain point in healthcare IT, particularly when it comes to transitions in senior care. Connecting the care delivery ecosystem to provide safer transitions of care is critical to long-term care. While some individuals may require short-term rehabilitative care, others may need home-based care, assisted living or long-term and hospice care. As seniors move through these different stages or between acute care and post-acute care, these transitions pose challenges for healthcare providers. Ideally, all the information that clinicians need to treat the individual will be available when he arrives at his new destination. However, this is not always the case. Healthcare providers, both long-term and acute, must invest in an infrastructure that supports seamless transitions of care; interoperability plays a vital role. Connecting healthcare providers across the care continuum will allow for better health outcomes, help reduce unnecessary hospital re-admissions, as well as keep healthcare costs down.
There are various statistics about the negative impact paperwork has upon providing healthcare. The AHA has estimated it adds at least 30 minutes to every hour of patient care provided. A main pain point continues to be the ability for IT to implement efficient EHR systems. At the core of any EHR system are its image capture capabilities. It must be simple to use throughout the workflow process. This includes image capture, editing, saving and sharing. The capture, or scanning, must be speedy. Editing features must be clear in how to use. This minimizes learning curves at the start. It also optimizes the speed of processing documents during the life of its use. Easy saving to local or network locations should also enable simple and secure sharing too. When one, some or all of these areas stall, it can cripple the realization of benefits from digital document management.