Major Health Organization Stops Forcing Doctors To Adopt New Technology (internalmedicinenews.com)

nbauman writes: The administrator of the Centers for Medicare & Medicaid Services, told an investors' conference that they will be backing off the unpopular requirement that doctors show "meaningful use" of their new computer systems. Andy Slavitt, acting administrator, admitted that "physician burden and frustration levels are real. Programs that are designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that the people who build these programs just don't get it."

Dr. James L. Madara, CEO of the American Medical Association, agreed that EHRs were having a negative impact on physicians' practices. Many physicians are spending at least two hours each workday using their EHR and may click up to 4,000 times per 8-hour shift, he said. Instead, CMS will reward health care providers for patient outcomes through the merit-based incentive pay systems created by last year's Medicare Access and CHIP Reauthorization Act (MACRA) legislation.CMS is calling on the private sector to create apps and analytic tools that will keep data secure while fostering true and widespread interoperability.

Comments

Doctors: Whiny bitches, all of 'em.

[mythosaz]

I spent about a decade doing high-level end-user compute management for a large healthcare organization.

There are two major forces at play.

Doctors just want fancy equipment so they can keep up status.
Doctors are lazy and entitled, and can't be bothered to do anything beneath them.

I've been on countless projects for SSO or (reduced signon, anyway) and context management. I've had to make sure countless pretty-boy doctors could get the new device that the OTHER hospital gave THEIR doctors. It's **all** about physician satisfaction. It's a seller's market, and if you don't give the doctors every last thing they demand they will go to work at the other hospital down the street. Of course, doctors know EVERYTHING, so there's no negotiating with them at any level. Site managers know they're fucked, and we know site managers are fucked, so we bend over and take it.

The context management systems (that keep patients synchronized across multiple clinical apps -- your EMR, or your radiology app, or your bed placement app, or your 10 other non-integrated apps) all suck and are fantastic boondoggles. SSO works for major systems, but unless you're AMAZING and have every last system in Cerner (or whatever you use), your docs will fuck that up too and blame IT.

Whiny bitches, all of 'em.

Re:Doctors: Whiny bitches, all of 'em.

[Rei]

I've also worked in the industry, and I'm of the opposite view: a lot of interface designers have given doctors crappy interfaces that don't take into account real-world use cases.

My particular field was psychiatry, so a lot of the software was tablet-based and focused on asking subjects questions and recording observations of the subjects. The important thing was to realize that these aren't some sort of web-poll - the real world is complex. Maybe the subject will throw a fit and walk out partway through or refuse to answer questions, or only give answers that don't make sense or aren't clear. Perhaps a question's answer choices don't reflect all of the nuances of the situation, something the form designer didn't think of. Perhaps something important or unusual happens in the interview that the doctor needs to note. It's important that software be as flexible as pencil and paper - that they can "pick it up" and "set it down" whenever they want, that they can add answers or scribble notes wherever, etc, and all of this gets recorded, is available to others, and doesn't just "disappear" on them.

Much of modern data-collection interface design is about trying to constrain people - you must do X, Y, and Z, in this order, with some nicely laid out plan of how everything's supposed to be done, etc. But sometimes that's just not practical in the real world. We found that when we made the software have the same "features" as paper, while still collecting data, acceptance was quite good.

Be nice to your users. You can point out possible errors or omissions (so long as you're not being a pest about it), but don't constrain them, don't try to *make* the data be "perfect". Just trust that they'll record the data as best they can. And be ready to handle any imperfect or incomplete data because well, congrats, we live in the real world so sometimes data is just simply going to be imperfect.

Re:Doctors: Whiny bitches, all of 'em.

[ColdWetDog]

Well mine are somewhat different. I'm a physician and have been working with EHRs since the late 1990s. When we had 386 processors and liked it. Yep, there are asshole entitled doctors (and $your_favorite_whipping_person). Lots of physicians would like an EHR that would, you know, help out. Instead we get systems that are designed to 1) help the billing department (an important aspect of medicine, but not the most important) and 2) get little gold stars by following the Meaningless Abuse, er, Meaningful Use "guidelines'.

Medicine is not an easy subject to computerize. For one thing, the old saying 'whey you computerize chaos you end up with computerized chaos" is quite true. Much of medicine is still hunches, witchcraft and showmanship - things most computer systems really don't deal with well. The rest is completely driven to insanity by several decades of Medicare and Medicaid rulemaking on top of often completely contradictory rules by Congress. In it's current state, you can't possibly do everything correctly because you would run afoul of something along the way. I've often thought that if you tried to program an AI to follow Medicare rules it would eventually just unplug itself as the only rational approach.

And no, Obamacare didn't really change much - just added a few more insane rules to the giant pile.

Meaningful Use was one of those things that might have been a good idea if one person set it up and left it in a corner. But it morphed into a giant committee that had inordinate power over EHRs and singlehandedly did more to screw up the advancement of electronic health records than any other single decision by the US government.

There is a god. I will sacrifice a whole box of Rigatoni to His Noodliness in thanks.

Re:Doctors: Whiny bitches, all of 'em.

[ColdWetDog]

Yep, I spent all summer of 2013, and I mean all summer, trying to beat our POS EHR into some semblance of utility. It was a total failure and it looks like I will be spending the entire summer of 2016 trying to figure out how we disentangle ourselves from this mess. A complete was of a lot of time and money that could have been spent doing something useful.

And "Meaningful Use" was a big part of the reason that our vendor screwed the pooch. It wasn;t a very good system to begin with (Healthland Centriq), had been developed before Meaningful Use was a gleam in the committee's eye and the vendor spent precious (well, cheap Indian) developer hours trying to shoehorn MU requirements into the system instead of getting it to just work. And that little game was repeated all over the country.

EHR Developers are not EHR Daily Drivers

[ErichTheRed]

The state university health system that most of my doctors belong to started using EHR software in earnest about 6 or 7 years ago. It amazes me that the designers and developers of EHR software seem like they design stuff that's intentionally frustrating to use. I've seen worse UIs, but they tend to be for things like buzzword-compliant ITIL based service desk ticketing software, or things that are so proprietary that a functional GUI is not something the customers will pay for. Every time I've gone for an appointment, especially when I'm a new patient (even within the same health system,) the first 10 minutes of the appointment is a frustrated doctor asking question after question, followed by 6 keystrokes, 20 clicks, dropdown here, expand button there, etc. etc. etc. It's as if an offshore code factory was handed a spec, coded exactly to that, and no integration work was done to ensure it would be usable -- and I wouldn't be surprised if that was the case. You might say doctors are a pampered, privileged class who are used to having nurses and medical assistants to do all the "work" but from what I've seen the software is a mess. My dermatologist gave me a "tour" when he found out I was an IT guy -- if I were a doctor I'd be running back to the paper charts in a flash.

Contrast this with the industry I work in -- airlines. Yes, it's old, proprietary, ancient, slow dinosaur technology.at the core, but the GUIs are designed for maximum throughput. An experienced reservation agent can do a booking in under a minute without taking their hands off the keyboard, and everything in the application is actually designed to minimize cognitive load. As an example, I've never worked behind the counter on real passengers, but I can sit down in front of the GUI and understand the flow, look stuff up, etc. That's because the reservation system companies do actual time-and-motion studies and watch real people use the product. I highly doubt the EHR companies do this, nor do they have anyone on staff who uses their software regularly.