Doctors are being driven daffy by electronic health records, or EHRs.
Updated: January 16, 2019 – 12:13 PM
Sally Pipes, for the Inquirer
That’s the takeaway from a recent report in the Journal of the American Medical Informatics Association. Seven in 10 Rhode Island doctors surveyed who used electronic health records said that the technology stressed them out. Those who reported health information technology-related stress were anywhere from 1.9 to 2.8 times as likely to burn out. In Pennsylvania, 45 percent of physicians report feeling burned out, according to a separate survey from Medscape.
They can thank the federal government for these professional headaches. A decade ago, the Obama administration pushed doctors to adopt electronic records in hopes they’d speed up the provision of care and improve health outcomes. Ten years on, these mandates have delivered much the opposite.
The federal mandate that doctors adopt electronic health records was included as part of the American Recovery and Investment Act — more colloquially known as the 2009 stimulus package.
The feds yielded a variety of carrots and sticks. Doctors that demonstrated meaningful use of the technology were awarded part of $17 billion in incentives. Doctors who didn’t risked having their payments from Medicare and Medicaid slashed.
President Obama boasted that the program would “cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests.” The idea was that a mass upgrade of the nation’s health IT would facilitate the sharing of information among physicians and hospitals — and ultimately lead to more accurate diagnoses and more effective and efficient treatment.
The information technology revolution had transformed so many other parts of the American economy. Why couldn’t it do the same for health care?
The government’s carrots and sticks worked. From 2009 to 2015, the share of hospitals using a basic electronic health records system increased from 12 percent to 84 percent.
They may have adopted electronic records. But that doesn’t mean the technology works — or that it’s improving patient care.
The programs on the market are often clunky, time-consuming, and insensitive to the complexities of modern medicine. Physicians, who already face suffocating administrative burdens, are logging ever-increasing amounts of data that have little clinical relevance. Time with patients is disrupted by an endless flood of alerts and messages.
Two-thirds of doctors say electronic records degrade their patient interactions, according to a survey from the Physicians Foundation. More than half of physicians report that the records reduce efficiency; more than a third say they diminish the quality of care.
Screen time has replaced face time. Only one-fourth of the average doctor’s day is spent face-to-face with patients. Half is devoted to electronic health records and other administrative tasks, according to a study published in the Annals of Internal Medicine.
Our country can ill afford to have physicians spending three-quarters of their time on things besides patient care. Our population will require more and more care as it ages. That’s among the reasons the Association of American Medical Colleges projects that the United States will be short as many as 120,000 doctors by 2030.
The shortage could grow even worse if doctors react to the burdens federal pressures have foisted upon them by leaving the profession. The Physicians Foundation found that roughly eight in 10 doctors had reported feelings of burnout. Nearly half of doctors are looking to change career paths.
Rolling back the federal electronic health records mandate won’t stop doctors and hospitals from incorporating health information technology into their practices and facilities. Instead, it will allow them — not the government — to decide how to balance patient care and technology use. In theory, clinicians will use technology to improve their ability to deliver high-quality patient care — rather than using technology simply to satisfy the government.
Doctors choose their profession because they want to heal people, not fill out paperwork. It’s time for the government to get out of the way and let physicians actually practice medicine.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is “The False Promise of Single-Payer Health Care” (Encounter 2018). @sallypipes.
Posted: January 16, 2019 – 12:13 PM
Sally Pipes, for the Inquirer
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According to a new study, U.S. doctors spend nearly 17 percent of their working lives on nonpatient-related paperwork — time that might otherwise be spent caring for patients. The findings also suggest that the more time doctors spend on such tasks, the unhappier they are about having chosen medicine as a career
This data comes from new research conducted by Drs. Steffie Woolhandler and David Himmelstein, internists in the South Bronx who serve as professors of public health at the City University of New York and are lecturers in medicine at the Harvard Medical School. The results of the study were published in October by the International Journal of Health Services.
The authors of the study analyzed data from the 2008 Health Tracking Physician Survey (the most recent data available) that collected information from a national sample of 4,720 physicians practicing at least 20 hours per week. The researchers determined that an average doctor spends more than eight hours per week performing administration functions.
However, of note is the fact that this does not include time spent performing patient-related tasks like writing chart notes, communicating with other doctors and ordering labs. Specifically, administrative tasks are defined as “billing, obtaining insurance approvals, financial and personnel management and negotiating contracts.”
Of the population surveyed, the doctors spent 168.4 million hours on these tasks in 2008. The authors estimate that the total cost of physician time spent on administration in 2014 will amount to $102 billion, and they pointed out that physicians who used electronic health records actually spent more time (17.2 percent for those using entirely electronic records, 18 percent for those using a mix of paper and electronic) on administration than those who used only paper records (15.5 percent).
“Although proponents of electronic medical records have long promised a reduction in doctors’ paperwork, we found the reverse is true,” the authors wrote.
The more time spent on these tasks meant physicians were less happy with their work than those who did less of this work. Psychiatrists spent the most time on administration (20.3 percent), followed by internists (17.3 percent) and family/general practitioners (17.3 percent). Pediatricians spent the least amount of time (14.1 percent) on nonpatient-related administrative tasks and also were the most satisfied group of doctors.
“While solo practice was associated with more administrative work, small group practice was not,”Woolhandler and Himmelstein concluded. “Doctors practicing in groups of 100 or more actually spent more time (19.7 percent) on such tasks than those in small groups (16.3 percent).”
They point out that the only previous nationally representative survey of this kind was carried out in 1995, and that study showed that administration and insurance-related matters accounted for 13.5 percent of physicians’ total work time. Other, less representative studies, also suggest the bureaucratic burden on physicians has grown over the past two decades.
“American doctors are drowning in paperwork,” said lead author Dr. Woolhandler. “Our study almost certainly understates physicians’ current administrative burden. Since 2008, when the survey we analyzed was collected, tens of thousands of doctors have moved from small private practices with minimal bureaucracy into giant group practices where bureaucracy is rampant.
“And under the accountable care organizations favored by insurers, more doctors are facing HMO-type incentives to deny care to their patients, a move that our data shows drives up administrative work. Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction.”
This study and its findings parallel that of another recent study in September that was conducted by The Physicians Foundation related to physician satisfaction with their careers. That study suggests that U.S. patients may face growing challenges accessing care if shifting patterns in medical practice configurations and physician workforce trends continue.
According to the study, titled “2014 Survey of America’s Physicians: Practice Patterns and Perspectives,” 81 percent of physicians describe themselves as either overextended or at full capacity, while only 19 percent indicate they have time to see more patients.
Of those physicians surveyed, 44 percent plan to take steps that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking nonclinical jobs, leading to the potential loss of tens of thousands of full-time-equivalents.
“America’s physician workforce is undergoing significant changes,” said Walker Ray, M.D., vice president of The Physicians Foundation and chair of its Research Committee. “Physicians are younger, more are working in employed practice settings and more are leaving private practice. This new guard of physicians report having less capacity to take on additional patients.
“These trends carry significant implications for patient access to care. With more physicians retiring and an increasing number of doctors, particularly younger physicians, planning to switch in whole or in part to concierge medicine, we could see a limiting effect on physician supply and, ultimately, on the ability of the U.S. healthcare system to properly care for millions of new patients.”
The survey is based on responses from 20,088 physicians across the U.S.
“The state of the physician workforce, and medicine in general, is experiencing a period of massive transition,” said Lou Goodman, Ph.D., president of The Physicians Foundation and CEO of the Texas Medical Association. “As such, the growing diversity of the physician workforce will reflect different perspectives and sentiments surrounding the state of medicine.
“While I am troubled that a majority of physicians are pessimistic about the state of medicine, I am heartened by the fact that 71 percent of physicians would still choose to be a physician if they had to do it over, while nearly 80 percent describe patient relationships as the most satisfying factor about practicing medicine.” Scott E. RuppMonday, November 10, 2014
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists and Healthcare Documentation Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement
That’s the takeaway from a recent report in the Journal of the American Medical Informatics Association. Seven in 10 Rhode Island doctors surveyed who used electronic health records said that the technology stressed them out. Those who reported health information technology-related stress were anywhere from 1.9 to 2.8 times as likely to burn out. In Pennsylvania, 45 percent of physicians report feeling burned out, according to a separate survey from Medscape.
They can thank the federal government for these professional headaches. A decade ago, the Obama administration pushed doctors to adopt electronic records in hopes they’d speed up the provision of care and improve health outcomes. Ten years on, these mandates have delivered much the opposite.
