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Physicians Frustrated with EHRs, but Most won’t Replace Systems

October 10, 2016
by Rajiv Leventhal
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Not surprisingly, Epic leads all vendors as the EHR market for acute care facilities is consolidating quickly

Another report on physicians’ frustrations with electronic health records (EHRs) points to challenges with the systems’ usability and functionality. However, providers don’t see great alternatives on the market, according to market researcher peer60.

The survey from August included more than 1,000 physicians who gave their perspective on the state of the market. Three-quarters of respondents were in ambulatory settings, while the remaining quarter were in the acute care space. Eight-five percent of respondents indicated that they have an EHR, and not surprisingly, the majority of the “have-nots” in terms of EHR adoption are small clinic organizations that often believe they don’t need an EHR (or just can’t afford one).

When it comes to acute care participants, the market leaders were also not surprising: Epic (50 percent), Cerner (21 percent) and Allscripts (9 percent) each distinguished themselves by garnering a significant amount of support. Epic has not been able to box out its competitors entirely, according to the report. Meanwhile, in the ambulatory EHR market, Epic (18 percent) had almost three times the installs among participants than the next closest supplier, Allscripts (7 percent), the findings revealed.

What’s more, the market for acute EHR replacement is small, but some opportunity yet remains. Nine percent of acute facilities are actively looking to replace their current EHR. Scores found in this study are just the industry standard with no significantly better options available (like in the airline industry), the researchers noted. They said, “Given the amount of money involved in a single EHR deal, this still represents significant potential for new revenue; But the market is clearly settling down with few facilities interested in making a change in any given year.”

The report further stated that Epic customers are holding onto its clients, while Allscripts and Cerner are “playing a little bit of defense.” It said, “Epic continues to pick up market share, though its numbers here are probably helped by the skew toward larger acute facilities. Still, there is no doubt which company leads this market right now,” the report said.

For Cerner, its mindshare (30 percent) is materially above its current market share (21 percent), so the potential for growth exists. This growth appears to be driven in large part by community hospitals as opposed to integrated delivery networks (IDNs), the researchers said, pointing to some of the key IDN battles Cerner has won such as Intermountain Healthcare and the Department of Defense. “Indeed, Cerner has become very competitive in this segment of the market, and all signs point to Cerner giving Epic a real run for its money,” it said.

Similarly in the ambulatory market, most providers aren’t planning replacements; just 11 percent reported having plans to ditch their current EHR supplier. “However, if things stay as they are, physician dissatisfaction will metastasize to encompass the majority of the organization and replacement rates will almost certainly increase in coming year,” the report said.

The findings further showed that 98 percent of Epic users and 89 percent of Cerner users in the acute care space reported that they are not looking to replace their systems. Meanwhile, the acute care replacement market among medium to large organizations looks to be a two horse race between Epic (61 percent) and Cerner (30 percent). On the ambulatory side, the top suppliers for potential replacements is more spread out, through Epic (34 percent) and Cerner (19 percent) still rank as the top two. athenahealth (17 percent) ranked third.

And for those in the acute care space who are looking to leave their current provider, a trend is emerging: ease of use (71 percent) is the biggest and most important feature followed quickly by additional functionality (58 percent). “These challenges make clear that the problems causing acute facilities to change suppliers are not confined to those actively looking. Rather, the frustration with usability and lack of functionality is industry-wide,” the report stated. Similarly on the ambulatory side, 67 percent of providers put usability as the top challenge, and 58 percent put missing functionality.

Going forward, a top priority (30 percent) among physicians is having access to better patient satisfaction data. Accountable care (25 percent) and alternative payment models (22 percent) came in second and third, respectively.

“For now, the story is that caregivers are almost universally unsatisfied with their EHR system, yet they have very few expectations of anything better on the horizon, which is confirmed by a very low replacement rate,” the report concluded.

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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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