What does the apparently widespread dissatisfaction of physicians in practice, with electronic health records (EHRs) mean for the eventual success or failure of EHRs, in the context of the essential need for them to succeed in patient care organizations? And what can—and should—medical informaticist leaders in those organizations be doing right now to change the narrative around MD EHR dissatisfaction?
Those questions were at the heart of the discussion during the course of the CMIO Roundtable, held Tuesday afternoon at HIMSS18 in Las Vegas. John Halamka, M.D., CIO of Boston’s Beth Israel Deaconess Medical Center, led a lively session that involved four brief presentations by panelists, and then a wide-ranging discussion, and audience question-and-answer session, in front of an audience that was overwhelmingly composed of clinical informaticists.
Halamka was joined by Michael I. Hodgkins, M.D., vice president and CMIO at the Chicago-based American Medical Association (AMA); Natalie M. Pageler, M.D., CMIO at Stanford (Calif.) Children’s Health; and Taylor Davis, vice president of innovation at the Orem, Ut.-based KLAS Research.
(l. to r.) Davis, Pageler, Hodgkins, Halamka, on panel
Hodgkins went first, and spoke about the broad national trends in the area of physician satisfaction/dissatisfaction with EHRs—and what needs to be done about that. “We didn’t have much control over the EMR,” Hodgkins said. “Remember 2008, when they we relooking for shovel-ready projects, and they decided that every EMR was a shovel-ready project? The current problem? We’ve all heard about burnout. And the AMA has been doing biopsies on burnout for years. In 2014, the number was 40 percent; in 2016, that number was already about 50 percent.”
The implications of the reality of high percentages of EHR-embittered physicians are many, Hodgkins said. “Burned-out physicians do a poor job; they create more patient safety problems,” he said. “A year ago, the AMA hosted ten of the CEOs of the leading integrated health systems, and they published a white paper, and declared burnout the most important health crisis of our time,” he noted. “Just to quantify it for you, the CEOs of these health systems basically said that a burned-out physician costs them between $500,000 and $750,000 a year. Think about that—in terms of replacement costs, lost productivity, etc. So, however you want to measure it, in terms of physicians leaving the field, or patient care issues, your organization needs to pay attention to this. And studies from the AMA and Mayo or the AMA and Dartmouth, studies have shown that for every hour that physicians spend on direct patient care, they spend two hours on documentation and administrative issues; and that doesn’t even include so-called ‘pajama time.’”
Hodgkins continued, “Between 2011 and 2014, somebody did the math and said there was a 1-percent loss of productivity as the result of EHR use; and that sounds very conservative, really. That’s the equivalent to the graduating class of seven medical schools during the same timeframe. Think about the loss of people leaving as a result of burnout. Think about that from a workforce perspective, and from a patient care perspective. And we have been struggling with this… There are now 200,000-plus or so health apps, and 320 mobile apps [emerging] every day, by some estimates. All this sets us up for a whole new wave of potential problems that can generate even more burnout among physicians, unless we address the issues early and quickly. 200,000-plus apps. There’s no FDA oversight of that space; it’s a Wild West. And those apps generate reams of new data.”
In that regard, Hodgkins said, “The AMA feels very strongly that physicians and clinicians need to be involved in the development of these apps. We did a survey in 2016 and found that in general, in spite of their experience with the EHR, 75 percent of physicians thought they could potentially benefit from this new crop of digital health solutions; they recognize that it’s hard to manage chronic health problems like hypertension, in the clinic.”
What Stanford Children’s Health is doing to improve MD EHR satisfaction
Despite all the challenges, the leaders of some patient care organizations are actively working to improve the situation. Dr. Pageler, the CMIO at Stanford Children’s Health, told the audience that she and her colleagues have been working hard to enhance physicians’ satisfaction with EHRs and with their work. Among their strategies: “We have a very extensive education and personalization program; we call it Home For Dinner,” she testified. “Three components were involved that allowed us to gather information about providers. We used our EMR’s data to obtain an efficiency profile” with regard to how efficiently physicians appeared to be documenting. “We did a survey to get their own perspective on what they’re doing with the EHR. And finally, we did observation sessions with individual physicians, with [help desk] trainers going out and observing physicians” doing their documentation. Those sessions clearly gave us a lot of information on what MDs were doing, but also on what we could do to improve workflows in the clinics.”
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