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Department of Defense Delays Initial EHR Rollout to February 2017

October 12, 2016
by Heather Landi
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The Department of Defense announced on October 11 a revised deployment schedule for the rollout of its new commercially available electronic health records (EHR) system with an initial rollout now slated for February 2017.

The DoD, through its Defense Healthcare Management Systems Program Executive Office (PEO DHMS), announced the new EHR system, known as Military Health System (MHS) Genesis, is now scheduled to go live at just one facility, Fairchild Air Force Base in Washington, in February, according to a report by Federal News Radio 1500 AM’s Jared Serbu.

Back in April, as previously reported by Healthcare Informatics, the DoD announced that the massive project to modernize the Military Health Systems’ EHR system would launch at the end of this year. At that time, DoD officials said the MHS Genesis program would begin at four Pacific Northwest hospitals at the end of 2016, followed by a pre-planned, programmed installation expected to be completed over a several-year period.

The report by Federal New Radio’s Serbu cited remarks made by program officials Tuesday that the new MHS Genesis, a $4.3 billion upgrade to the military’s current health record system, would launch at only one base in February and will then roll out to three other Washington State hospitals by June 2017.

However, the plan for full, worldwide deployment remains unchanged, that will take until 2022.

DoD officials first forecast the delay a month ago. At that time, Stacy Cummings, program executive officer of PEO DHMS, told reporters, “We challenged ourselves to a very, very aggressive schedule because we know this system is going to work and it’s going to improve health care. When we identified issues we decided to take the time we needed to get it right. We think the users we’re supporting deserve that, and the few months we’re investing right now is going to enable us to get it right on day one.”

Cummings said, a month ago, the problems were discovered during tests involving DoD and its prime contractor, Leidos, that simulated various health care scenarios and measured the ability of the software, made primarily by Cerner, to respond to them. “During the testing of those scenarios, we found that the data exchange wasn’t happening in the way that we intended,” she said. “But these are technical issues, they’re solvable, and we have confidence that we will solve them.”

According to the Federal News Radio report yesterday, Cummings reiterated the need for a revised schedule for more work on the interfaces between DoD’s legacy health IT systems and the modern EHR platform.

“It also provides additional time for the program team and our vendor to implement clinical capabilities, complete cybersecurity risk management and test these capabilities prior to initial deployment,” she told reporters during a brief conference call Tuesday, according to the report.

Serbu also wrote, “Cummings said the longer delay at the other Pacific Northwest sites—Oak Harbor Naval Hospital, Joint Base Lewis-McChord and Naval Hospital Bremerton—would allow for the early addition of features that hadn’t been planned for inclusion in the EHR until much later in the five-year roll out of Genesis. Those include voice recognition technologies and blood transfusion management.”

“Those additional capabilities aren’t requirements at Fairchild, but they are at the other three sites,” Cummings said. “So in order to have the best possible user experience for our clinicians and beneficiaries, this made the most sense for long-term program success.”

The delay also is in line with a DoD Inspector General audit report back in May that called out the DoD’s December rollout schedule as unrealistic. In that report, the DoD IG cautioned about potential delays involved with developing and testing the interfaces needed to interact with legacy systems and ensuring the new EHR system is secure against cyberattacks.

“We agree that we set a very aggressive schedule for ourselves, and that schedule included significant concurrency, meaning we were doing several different things at the same time around contractor-led tests, government-led tests, cybersecurity risk management, and moving quickly into deployment,” Cummings said, according to Serbu’s reporting. “So what we’ve done in this modified schedule is give us time to fix any defects we identify. The re-plan we’re announcing does take into account all of the risks that were identified by the IG, but also those risks that were identified by us.”

As Healthcare Informatics reported on July 29, 2015, a consortium of three companies—Leidos, Cerner Corporation, and Accenture Federal, last summer won the DoD EHR Modernization Program contract, covering more than 9.5 million DoD beneficiaries and the more than 205,000 care providers who support them.

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Survey: Physicians Sour on Value-Based Care Metrics, EHRs

September 19, 2018
by Rajiv Leventhal, Managing Editor
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They new research has several key findings related to value-based care, health IT and burnout

More than 50 percent of U.S. physicians who receive value-based care compensation said they do not believe that the metrics the reimbursement is tied to improve the quality of care or reduce costs, according to a new survey.

The research comes from The Physicians Foundation, an organization seeking to advance the work of practicing physicians and helps them facilitate the delivery of healthcare to patients. The Foundation’s 2018 survey of U.S. physicians, administered by Merritt Hawkins and inclusive of responses from almost 9,000 physicians across the country, reveals the impact of several factors driving physicians to reassess their careers.

Specifically, the new survey underscores the overall impact of excessive regulatory/insurer requirements, loss of clinical autonomy and challenges with electronic health record (EHR) design/interoperability on physician attitudes toward their medical practice environment and overall dissatisfaction—all of which have led to professional burnout.

The research revealed several key findings, including that value-based compensation is directly connected to the overall dissatisfaction problem, which is tied to metrics such as EHR use, cost controls and readmission rates, etc. Forty-seven percent (compared to 43 percent in the 2016 survey) of physicians have their compensation tied to quality/value, but when physicians were asked if they believe that value-based payments are likely to improve quality of care and reduce costs, 57 percent either disagreed or strongly disagreed that this is the case, while only 18 percent either agreed or strongly agreed that it is.

As one responding physician put it: “We are no longer in the business of healthcare delivery, we are in the business of ‘measures’ delivery.” More than 13 percent of physicians are not sure if they are paid on value.

What’s more, the research found that 88 percent of physicians have reported that some, many or all of their patients are affected by social determinants. Conditions such as poverty, unemployment, lack of education, and addictions all pose a serious impediment to their health, well-being and eventual health outcomes. Only one percent of physicians reported that none of their patients had such conditions.

Additional notable findings from the research included:

  • 18.5 percent of physicians now practice some form of telemedicine
  • 80 percent of physicians report being at full capacity or being overextended
  • 40 percent of physicians plan to either retire in the next one to three years or cut back on hours—up from 36 percent in 2016
  • 32 percent of physicians do not see Medicaid patients or limit the number they see, while 22 percent of physicians do not see Medicare patients or limit the number they see
  • 46 percent of physicians indicate relations between physicians and hospitals are somewhat or mostly negative

Coupled altogether, 78 percent of physicians said they have experienced burnout in their medical practices, according to the survey’s findings. And the results show that one of the chief culprits contributing to physician burnout is indeed the frustration physicians feel with the inefficiency of EHRs.

“The perceptions of thousands of physicians in The Physicians Foundation’s latest survey reflect front-line observations of our healthcare system and its impact on all of us, and it’s sobering,” Gary Price, M.D., president of the Foundation, said in a statement. “Their responses provide important insights into many critical issues. The career plans and practice pattern trends revealed in this survey—some of which are a result of burnoutwill likely have a significant effect on our physician workforce, and ultimately, everyone’s access to care.”

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Brigham Health’s 3-Pronged Approach to Reducing EHR’s Contribution to Burnout

September 18, 2018
by David Raths, Contributing Editor
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Focus is on individualized training, reducing unnecessary clicks, voice recognition tools

Research studies have found that “burnout” is nearly twice as prevalent among physicians as among people in other professions.  Physician surveys have found that 30 to 60 percent report symptoms of burnout, which can threaten patient safety and physician health. With EHR documentation ranked high among aspects of their work physicians are dissatisfied with, Brigham Health in Boston has taken a three-pronged approach to reducing the pain.

Brigham Health, which is the parent organization that includes Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital and the Brigham and Women’s Physicians Organization, rolled out its implementation of Epic in 2015. In a Sept. 18 presentation that was part of the Harvard Clinical Informatics Lecture Series, Brigham Chief Information Officer Adam Landman, M.D., said the organization’s initial EHR physician training was eight hours of classroom training on where to find things in the EHR instead of focusing on workflows and how to use the EHR to support it.  “Our experience was not the best,” Landman admitted.  They followed up with tip sheets, a help desk and a swat team to do service calls, but providers only rated those interventions as somewhat helpful, so Brigham informaticists re-doubled their efforts to:

• Improve the EHR;

• Provide one-on-one training in the clinical setting; and

• Offer voice recognition software and training.

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Landman said IT teams at Brigham feel a sense of urgency about reducing the burden of EHR documentation. “Burnout is an epidemic, and the EHR is a component of this,” he said, adding that the changes are not just a one-year cycle but must involve continual iterative improvements. “We need to be more aggressive about making changes,” he said.

He described some efforts to reduce notifications and remove clicks from the medication refill process. They also removed a hard stop when discontinuing a medication. Those three changes alone reduced the number of clicks per month by 950,000 across the health system.

They also worked to reduce clinical decision support alerts with very low acceptance rates by turning them off. Three alerts with very low acceptance rates were turned off. “If we thought they were important, we would fine tune them to increase the acceptance rate,” Landman stressed. “That is part of clinical decision support lifecycle management. But we will continue to iterate to reduce the number of unnecessary clicks.”

A year and a half ago, Brigham also created a one-to-one support program, in which an expert trainer would meet the physicians in their practice and help them with their work flow. A pilot project involved four specialties, including general surgery. Each session was 90 minutes to two hours long, and providers were offered one or more follow-up sessions, as well as optional training on speech recognition. After seeing some negative feedback on their initial classroom training, the one-to-one sessions were met with a very positive response. Almost 95 percent said it was valuable, and 95 percent said they thought their efficiency with the EHR would improve following the training. Based on that early success, the training effort is now being rolled out to much larger groups of physicians at Brigham and across the Partners HealthCare network.

In another attempt to improve documentation turnaround time, Brigham has made voice recognition tools and training available to physicians. They made two-hour training sessions mandatory for those interested in adoption, with additional personalization sessions also available. Informaticists partnered with departments to build department-specific order sets. (Brigham also started offering 15-minute e-learning sessions for residents.) More than 90 percent of surveyed physicians said the training met expectations, and 70 percent said they would be willing to have additional training, Landman said. Currently 5,000 physicians across Partners are trained to use voice recognition tools with the EHR.

Landman also cited a study that compared U.S. and international use of Epic that saw a huge disparity in length of documentation notes. The U.S.-based users’ notes were nearly four times longer on average than those of their international counterparts. Epic users overseas tend not to complain about the burden of documentation, he noted. This has to do with how the provider notes are used in billing, he said, adding that CMS is working on proposals to change billing requirements that may alleviate some of the documentation burden for physicians.

In closing, Landman urged informatics colleagues to think about working on EHR optimization research and studying the impact of policy and technology changes. “New technology tools can seem fun and exciting, but for physicians who see up to 100 patients per day, they can be quite overwhelming,” he said. “We don’t want physicians spending half their time doing administrative work.”

 

 

 

 

 


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