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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.
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I have stage 4 cancer and spend a few hours at the doctor's office every month. The phlebotomists spend a solid minute selecting my record, marking off all the tests, verifying id, insurance, etc. The nurses go down the list of 50 prescriptions I have, asking me if I'm still taking them, even when I say nothing has changed. They're all very polite and nice, but the whole system fails at easy things should be easy, hard things should be do-able design. You can tell that no one who designed the system ever actually performed the tasks at hand (or they were bound by absurd requirements). And all that isn't including the massive bureaucracy of insurance or scheduling that will sink days of your time pressing buttons on your phone trying to talk to an actual person.
In my experience american health care is an inefficient, bureaucratic mess manned by very friendly medical professionals.
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
Also, you need your tax prepare only once a year, while doctors get a steady stream of patients. In reality you pay to the healthcare industry probably approximately $20,000 in the form of your family insurance premiums and copays. Tax accountant can only get from you your $300 per year.
The human body doesn't change much in a year, nor does medical technology. The IT spending a doctor has to spend isn't so much to improve patient care so much as to align with Federal and insurance company requirements.
IMHO, the tax dude has to deal with bigger changes year over year than my doctor does. My doctor is dealing with insurance and the feds, which have nothing to do with my health. My tax dude is dealing with dumass changes to the tax law. Odds are, if something is really wrong with me then the changes the doctors have to deal with won't affect anything other than who pays for them, or which department of who pays for them. OTOH, having a tax dude who can save me $1k/yr (which my guy has done for 12 years) affects my life more than an insurance classification.
My point is, doctors can no longer view patient outcome as their #1 goal. The goals now are:
1) don't get sued
2) if you get sued prove you did every test imaginable
3) If you don't get sued ensure you billed properly
4) Hope for the best in getting paid
5) Patient? Who? Oh yeah, hope they got fixed.
the constant battles on the part of doctors to get paid by insurance companies who's single goal is to not pay. In no other part of my life are my goals (getting care) and the service provider's goals (not paying for that care) so diametrically opposed. I've got family members with nasty health complications from easily treatable problems that were let go because the doctor didn't want to order tests in case they came back negative. If a test comes back negative the doctors never get paid.
Come to think of it I see this in one other place. B2B transactions. In so many of them business A won't pay the invoice for business B until A needs B's services again. I read somewhere Don Trump is famous for that, but having worked for small businesses it's so common he could just be going with the flow.
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Here is the root problem: America spends 18% of GDP on healthcare. Other developed countries spend 6-9%, yet mostly have better health outcomes. So if we become as efficient as them, 1/2 to 2/3rds of healthcare workers will be redundant. What interest do they have in destroying their own jobs? Our healthcare system will not fix itself from the inside. They have absolutely no incentive to do that.
It depends on their tech setup. One heathcare provider has a workstation in every room, and it takes the doctor about 1 minute to review patient records and a couple more minutes to update it after the exam is over. Another heathcare provider takes notes and transfers them all at the end of the day. Yet another still uses paperwork and is very much not organised.
It depends on their tech setup. One heathcare provider has a workstation in every room, and it takes the doctor about 1 minute to review patient records and a couple more minutes to update it after the exam is over. Another heathcare provider takes notes and transfers them all at the end of the day. Yet another still uses paperwork and is very much not organised.
I don't want to use explictives, but they are warranted to the most extreme degree possible.
This 1 minute talk, it takes that long to login..if the system is polite, then to open the chart, then to find the actual note, then to load the CT scan...
There are multiple hard studies that show 33% reduction in efficiency that cannot be recouped.
Patients just love when you stare at a computer instead of talking to them....
This is crazy, I fight with my nurses every day. They tell me I have to input codes, I have to reconcile X, or Y or whatever.
F. That! I talk to my patients. I deal with them, and I deal with that screaming on the back end, but I'm not typical. I fight to talk to people like I would want to be talked to if I was a patient. I am burnt out, I can't fight forever. They will wear us down, your care will suffer. You let this happen, you asked for it through shitty laws that paid doctors 20% more to be part of a hospital system. You will suffer and you asked for it.
Practicing Surgeon MD
This was your statement:
Pakistan and India both have private medicine. If they're coming here from Pakistan and India, it's not because those countries have universal health care.
And why don't you see doctors from the UK, Canada, Sweden, Denmark, etc etc moving here to make those sweet sweet private $$$? If universal public health care is so horrible for doctors, why didn't they flock here before the ACA?
You are welcome on my lawn.
It's 18% because health is a side benefit of an insurance system.
No, "better healthcare outcomes" is a measurment anomaly.
The fact that the average is dragged down because a large percentage of the US population doesn't get adequate health care is not a "measurement anomaly". It's an epic failure.
It's like a C average student claiming: "I'm really a straight-A student! I got As in all the classes I didn't flunk. (And BTW, for some reason my education cost twice as much as that of any other student.)"
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.
Not really, no. Countries with socialized medicine use the same drugs, the same machines and doctors with the same skills. They just bargain harder to get decent prices on in all. Some wealthy people do choose to fly to the U.S. but that's more about getting to the front of the line faster for elective procedures than anything else.
But even if you're correct, healthcare you can't afford might as well not exist. In that sense, the U.S. has practically non-existent healthcare.
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.
So, the US spends 18% of its GDP on healthcare, but that only covers part of the population. Meanwhile those countries who only spend 6-9% of GDP on healthcare manage to cover everyone. So, that 18-6 cost disparity is actually understated
This is your argument that quality of care in the US is actually the best in the world?
I'm not really sure I care that a US millionaire can get outstanding care, if he can only do so at the cost of forcing the rest of the country to get 3rd-world quality care. I'm sure appropriately rich people in those other countries also get better than local average care. It's ridiculous to compare the quality of care available to the few Americans who can afford it to the quality of care available to an average 'socialized' medicine citizen.
We've had tort reform in some states. The effects seem to indicate that the cost of malpractice is responsible for a few percent of our healthcare costs.
I suspect what's driving our healthcare costs is that good healthcare isn't cost competitive. Our healthcare for most of us is covered by insurance companies through work. We change jobs frequently. Yet health problems can take years to have serious (and costly) effects. It's not cost competitive to prevent a problem that another company will likely end up paying for.
It's like the difference between owning a car you know you'll replace in five years and owning a car you will replace in twenty-five years - you're going to be much more diligent about preventing problems in the car you'll own for five times as long, because you'll be paying for the costly effects of poor maintenance.
Burn down the private healthcare industry and start over. As a society, we need to get back in touch with the basic fundamentals of what constitutes healing and caring for one another.
TFTFY
Nothing, absolutely nothing, has driven modern medicine so far away from the business of healing as has the insurance industry. Google the term "managed care", and weep for the days when physicians and other caregivers decided how to treat their patients. Worried about "government death panels" that decide who gets life saving care and who doesn't? Congratulations, sucker. That blatant misdirection worked on you too. In the U.S. we spend more (far more) and get less (by any credible metric) than any other industrialized nation when it comes to health care. To blame the physicians for this is absurd.