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Technology Is Making Doctors Feel Like Glorified Data Entry Clerks (fastcompany.com)
An anonymous reader writes from a report via Fast Company: The average day for a doctor consists of hours of data entry. Since the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 took effect in January of 2011, which incentivized providers to adopt electronic medical records, hospitals have spent millions, sometimes billions, on computer systems that weren't designed to help providers treat patients to begin with. The technology was supposed to reduce inefficiencies, make doctors' lives easier, and improve patient outcomes, but in fact it has done the opposite. "Frankly, the main incentive is to document exhaustively so you cover your ass and get paid," says Jay Parkinson, a New York-based pediatrician and the founder of health-tech startup Sherpa. The systems are flooding doctors with important and utterly meaningless alerts. One of the biggest problems is that the systems have made it very difficult for doctors to share information between one another, which is what the systems were intended to do all along. Why? "Because it doesn't help the bottom line of the biggest medical record vendors or the hospitals to make it easy for patients to change doctors," reports Fast Company. Since it often takes weeks, or months for data to be sent to and from facilities, that, according to Consumers Union staff attorney Dana Mendelsohn, increases the chances of doctors ordering duplicate tests. All of this reduces the time doctors have with their patients. A recent study shows that the average time doctors spend with their patients is about eight minutes and 12% of their time, down from 20% of their time in the late 1980s. "This group is 15 times more likely to burn out than professionals in any other line of work," reports Fast Company. "And much of the research on the topic concludes that 'documentation overload' is a key factor." To help alleviate this pain, medical groups are working to reduce the data-entry burden for doctors, so they can in turn spend more of their time with patients.
My primary card doctor is reasonably young and when I started seeing her, she keyed in notes about treatment plans and such right into the office computer. So I know she's comfortable with computers and that's she's a fast typist.
About two years ago, when she came into the exam room, she was followed by a young person with a laptop whom she introduced as "my scribe!" Her scribe was constantly tapping away at the laptop, taking notes and entering orders and so forth.
I don't honestly know whether this is good, bad, or indifferent, but it certainly is evidence that the burden of data has become so overwhelming that doctors need assistants specifically to help with that.
She works for a gigantic megapractice that is proud of being a Patient Centered Medical Home and an Accountable Care Organization and all that good stuff, so I think they are following current "best practices."
Geezer reminiscence on. When I was a kid, the doctor's office had a big lab, where they had microscopes and hemocytometers and did their own lab work, and a small business office. Now the labs are gone--they send all the lab work out. The business offices occupy a third of the floor space, because they need room for people waiting all day long on hold to talk to insurance companies. And they have to hire scribes to help the doctor with the data entry. Maybe it's progress.
"How to Do Nothing," kids activities, back in print!
Usually because of bad UI. All knowledge has been replaced with codes and it's our job to learn the codes to find anything. ...and tomorrow the codes will change, because fuck you.
Jesus fucking christ, didn't we invent "Search" to solve these problems?
If you want to get a visceral appreciation for the complexity of medical billing today, check out the Medicare Claims Processing Manual.
It almost seems like you can't merely get an administrative assistant, but you need someone with an A.A. in medical billing.
The thing that really left me aghast was the move from ICD 9 to ICD 10 (diagnosis codes and descriptions). Those #$&!!?! policy geniuses completely abandoned the ICD 9 codes and instituted all new ICD 10 codes. There was a big infrastructure around ICD 9. There is plenty of overlap in the codes, so it's a recipe for mass confusion. It's stunning that there was not even any attempt to have even a scintilla of backward compatibility.
It is almost like there are no senior database or programming architects involved in any of these decisions regarding medical IT. From what I've seen, it seems to me that it's purely non-technical policy staff driving this stuff. You have to get senior database and programming and UI architects in some of these decisions to reintroduce some sanity and control over the complexity of the solutions.
So, yeah. I've come through my training early in the era of EMR's and have seen this clusterfrack evolve over nearly a decade and a half. I've worked with more than half a dozen EMR's over the past 15+ years, and have not only not seen anything more than improvements in appearance (because in large institutions and hospitals the paper-pushers that are actually going to approve an EMR can really only go by how it looks, since they rarely truly understand what doctors need from a record system), and I would go as far as to say many EMR's are becoming actively more difficult to work with, demanding more repetitive entry of questionably valuable data, more and more "billing" specific entry, and, as noted above, more and more URGENT ALERTS that only rarely are actually relevant to my patient.
As also noted above, patient interactions have become the absolute smallest fraction of my work. I spend easily 2-3 times the amount of time I spend seeing and talking to patient in documenting those interactions, and new patients can far-to-often take an hour or more to document "adequately" in many EMRs I have had to deal with. I have colleagues that work from 7A to 6-7P, go home, and then after a few hours with their family, they resume "charting" until 10PM, 11PM, or even later. I've even had emails sent after 1AM from colleagues when I know they were in clinic that day, and have clinic the next day. And these are not periods of "unusually heavy utilization" like flu or RSV season, this is their typical clinic. Visit documentation, lab orders, lab confirmations, insurance issues, finding results in the system. It's disgusting that I spend so little time actually BEING A DOCTOR. It's even more disgusting that I'm told the problem is I'm not "using it right," or that I need to "be more efficient with my documentation," but every time I've requested assistance with "using it right" or improving efficiency (god what an infuriating phrase), I've been either blown off or had someone come by to "listen to my concerns" but never actually stayed to OBSERVE practical use, so nothing continued to change.
The core problem is, I have YET to see an EMR designed by people who actually have gotten down-on-the-ground with medical providers. None of these programers have followed us around, have watched the nurses, have shadowed the medical assistants, and so of course none of them can really meet our needs! Can you imagine the absolute HELL that would be raised if this is how coding was done, for example, in the aerospace industry? If the guy responsible for setting up the pilot's computer never set foot in a cockpit?
I've struggled with bad and worse EMRs (on top of other issues admittedly), and personally I've partially given up. I've left my full-time sub-specialty practice. I'm considering part-time now, though even that would be close to 40 hours a week. Frankly I'm tempted to leave medicine altogether, though I really don't want to give up patient care. As corny as it probably sounds to the /. crowd, I *love* (most of) my patients. I loved being able to help people figure out how to live with chronic issues, helping them get healthy and stay that way, talking with families about their fears and helping them come to terms with major diagnoses or deal with worse... It's an honor and a privilege to have been given this much TRUST by people, and I've done my damnedest to be worthy of that privilege. However, modern medicine has become so obsessed with documentation, and EMRs have become the worst reflection of this documentation, that medicine is becoming ever more toxic a field to work in.
TLDR version; EMRs are not user friendly (they are fairly Admin and billing friendly, though), they are not getting better, and they (in my humble experience) are demanding more and more time for less and less benefit, and in many ways they have become a problem WORSE than the problem they were intended to solve. This is not a "doctors hate technology" problem, this is a "doctors are not being given
I once switched doctors because he spent most of every consultation oriented towards his screen and keyboard, entering symptoms, treatments, and medication into my medical record, and little time speaking with me face-to-face.
So you switched because your doctor focused on medical issues rather than providing you with emotionally comforting talk therapy?
You are not alone. If you look at doctor review sites, by far the biggest reason for low ratings is a rude receptionist. The 2nd biggest reason is doctors that avoided chit-chat. Actual quality of treatment and medical outcomes are rarely even mentioned.
No doctor can review a medical file in one minute.
I watched my doctor do exactly this with a real folder filled with paper just two weeks ago.
Most doctors are pretty smart guys who've spent decades reading books, charts,etc. and otherwise learning to ingest large amounts of information in the quickest, most efficient manner they can.
Linux, you magnificent bastard, I read the fucking manual!
Eh, you have shitty software it sounds like. Mine works better, I can get results in 4 clicks if the patient is on my schedule, fewer if I made a result an alert on the patient when I reviewed it. 5 seconds tops? 15 if the patient isn't on my schedule so I have to figure out how to spell her name to search for her.
That said, the government's meaningful use bullshit can't just leave well enough alone. Send prescriptions electronically, get test results electronically, medical care is now 1000% better than before. You want interoperability? You want us to stop ordering the same tests over and over? Get Quest to send me my patients' bloodwork for the last five years. Get the pharmacy to send me every prescription for the last year. 1000% easier than trying to get my ob/gyn system to talk to your cardiology system. Does your software even have a spot for my patient's cervical dilation? Even if it did, do you even give a fuck? After 9 hours of labor I sure as hell don't care what her heart wall thickness is. Just tell me if she's going to croak if I augment, please.
My doc asked me about family history of a condition. I told her my mom had surgery for the condition roughly a year ago. She started typing in the date, and paused:
"It requires an exact date. I can't enter an approximation. Can you by chance remember your mom's exact surgery date? They don't like dates that are off in case they want to research it.", she asked. (My mom is under the same provider.)
After pondering a bit, I suggested she see if there is a "notes" fields to indicate it's only an approximation.
"Hmm, let me see...", she replied.
After about 5 minutes of digging between screens, she said, "Okay, here's the doggon note section."
Table-ized A.I.
No doctor can review a medical file in one minute.
I watched my doctor do exactly this with a real folder filled with paper just two weeks ago.
No, you watched a doctor scan a folder filled with paper for specific pieces of information. He did this first by recognizing the sheets of paper in order to identify ones that might have a diagnosis or prescription, then looking for the specific lines where that diagnosis should be written. If you think he absorbed the history of your blood pressure, weight, or all of the test results that might be relevant to your current condition, you're deifying a person just because his job is complicated.
Medical charts are like syslogs. You can read through them, and with some practice get pretty good at recognizing 'important' messages, or messages that fit with your personal expectation of how systems fail, but it's much faster and more accurate to have grep do it. This was, in fact, one of the big reasons to digitize those records. Software will miss a lot less than a human doctor who's been awake for 20 hours and is seeing his 25th patient of the morning. Let software compile and prioritize past diagnoses and prescriptions. Let software build a graph of body weight, blood pressure, and blood glucose going back for years. Let software summarize all that data and present it in a compact summary that's easy to absorb and easy to drill into more detail on the bits that turn up.
That's generally not what they have. What they have is record-keeping software that satisfies the bureaucratic requirements of the insurance companies and medicare. Its purpose is less for diagnostics and care; more for billing. It's what you get when you let accountants practice medicine.
It sounds like public universal health care is not the disaster for doctors that some would have us believe.
You are welcome on my lawn.