Healthcare // Electronic Health Records
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2/11/2014
09:06 AM
David F Carr
David F Carr
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Doctors & EHR: Can This Shotgun Marriage Be Saved?

Lots of doctors hate EHR software. What makes the difference for those who are happier with it?

8 Healthcare Startups Catch Fire
8 Healthcare Startups Catch Fire
(Click image for larger view and for slideshow.)

There are many things about healthcare IT that I would like to understand or understand better. One of the most basic revolves around happiness and unhappiness, love and hate.

When I wrote a column on Why Doctors Hate EHR Software, I knew that was a gross oversimplification but hoped it would start a discussion. And it has. Most of the discussion it prompted from vendors was about how their product is different, and I don't doubt that physician satisfaction is different from one software package to the next. Reactions to the software can also be much different from one doctor to the next. Even where doctors hate the software with a true blue-hot passion, they may be working side by side with others who grumble about the software's quirks and cope, and yet others who think it's just fine.

Here are some of my lingering questions. I'm not pretending to make this a formal survey, but I'd like your feedback.

1. Who are the happiest electronic health record users?
Who are the people who accept the software for what it is and get the most value out of it? Is there a specialty or a personality type they have in common?

2. Do doctors just like to complain?
Some people like to complain. Maybe complaining makes them happy. I can think of writers and editors who fall into that category. Do doctors just like to complain? Their job is admittedly stressful, so they don't need software to give them any extra grief. But are they just extraordinarily difficult to make happy about anything?

If so, the software developers who manage to make them happy, even occasionally, deserve an extra pat on the back.

[Would Google + CliffsNotes equal happy doctors? See Can This Search Tool Make Doctors Love EHR?]

3. Do younger doctors have a different experience?
One common assumption is that it's the old, grumpy doctors who are least happy with the software. Is that really true? It reminds me of the meme that says all young people are social-media savvy, which is not necessarily true. Besides, those younger docs who are digital natives may not find EHR software lives up to their expectations.

4. Do nurses and other medical professionals have a more positive experience?
The discussion about EHR usability often revolves around those difficult-to-please physicians. Do nurses and others on the clinical team have the same complaints (or a whole different set of them)?

5. Does choice make a difference? Or the pace of change?
One thing I have heard from several sources is that EHR satisfaction is greater when the doctors felt like it was their choice, propelled by their own requirements at their own pace -- rather than something they were rushed into adopting to meet a government mandate. Agree or disagree?

(Source: ALJAppeal.com)
(Source: ALJAppeal.com)

6. How often do doctors see a real, clinical payoff from tracking patient data in EHR software? In what situations is that most likely to show up?
As part of a profile of Practice Fusion and its users, I heard from Dr. Allan Treadwell, a San Francisco internist who said using the software was additional work but that he saw the benefits when he got automated alerts about potential drug interactions, for example. Those are the sorts of clinical and patient-safety benefits that have been promoted as the point of implementing health IT. How often do they materialize?

7. How often does EHR software slow down the process of delivering care without any real clinical benefit?
One of the tradeoffs of filling out a data-entry form, rather than scribbling notes in a patient's file, is the need to fill in all the required fields and check the required checkmarks. This is sometimes justified as a virtue, in that it improves consistency. But physicians complain they spend too much time recording meaningless data like "condition normal, no change" that they would never have bothered to note in a paper file.

How much of the data tracking that occurs in an EHR is superfluous?

8. Do the benefits of this software show up on the billing and claims side of the equation, or in someplace other than the day-to-day delivery of care?
Many EHRs developed as an outgrowth of billing and claims-processing systems, with the goal of getting more of the required information captured at the point of care. Data captured from EHR systems can also be invaluable for research. Is EHR software paying off for the organization, just not where doctors can see it?

9. What aspect of EHR software most cries out for improvement?
Maybe some products do a little better than others with specific features, but where would you like to see dramatic improvements?

10. How well do the Meaningful Use Stage 2 requirements line up with the greatest needs for improvement?
The next wave of requirements from the federal government places additional demands on both software vendors and healthcare organizations. Will they result in more meaningful, productive use of healthcare IT? I'd like to hear your list of requirements for truly meaningful use.

Medical data breaches seem to show up on the 6 o'clock news almost every week. If you think it wouldn't happen to you -- or the financial impact will be minor -- think again. Download the Healthcare Data Breaches Cost More Than You Think report today. (Free registration required.)

David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio

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Joe Stanganelli
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Joe Stanganelli,
User Rank: Ninja
2/18/2014 | 12:37:20 AM
Re: Belts and Suspenders
@Alison: Yeah, but what will be the cost of the transition -- and, ultimately, his ROI -- on the sale?
lpop679
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lpop679,
User Rank: Apprentice
2/16/2014 | 11:24:06 PM
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ZibdyHealth01
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ZibdyHealth01,
User Rank: Apprentice
2/16/2014 | 6:53:46 PM
Re: All EHRs Aren't Created Equal
David,

Here is a relevant article by Kevin Pho...EMRs are just not made for patient care. These software packages are for billing first approach. http://www.usatoday.com/story/opinion/2014/01/19/kevin-pho-electronic-medical-records/4649043/
1Simon
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1Simon,
User Rank: Apprentice
2/14/2014 | 10:38:39 AM
Are Younger Doctors Better Suited for EHR?
An ideal EHR system should deliver top-level usability and facilitate greater efficiency for anyone—no matter his or her age or technological background. I personally have seen both younger and older physicians embracing EHR systems that make them more efficient. This is done by finding the sweet spot between functionality and simplicity. Even the most tech savvy digital natives don't want to deal with a complicated EHR system that makes accomplishing simple tasks more tedious and unfortunately there are systems guilty of that. The solution is to listen to the real users and be prepared to make continuous improvements.

EHR systems can be made easy-to-use and ideally are flexible enough that one client interface can offer seamless access to all the different record types via one intuitive interface. The goal is one system where all users can easily access records generated in any department using any file type. This will reduce time lost and frustrations among physicians while improving overall efficiency and making strides toward meeting meaningful use requirements."

 

And regarding getting physician participation in an EHR system:

Giving doctors a voice in selecting systems is also of vital importance.  Rather than being critical,  you can create champions for the new system, greatly aiding its adoption success.

 — Simon Wieczner, Snowbound Software
DarrellP725
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DarrellP725,
User Rank: Moderator
2/13/2014 | 8:08:30 PM
Re: Since dentists are not complaining about EDRs, they must be almost 100% satisfied. Right?
This just in: Dentrix acknowledges their error about encryption, but is not ready to give up on the misleading DentistryIQ ad.

An article titled, "Update: Does Dentrix need to send individual notification letters rescinding its 'encryption' claim?" was posted today by Dissent Doe on PHIprivacy.net.

http://www.phiprivacy.net/update-does-dentrix-need-to-send-individual-notification-letters-rescinding-its-encryption-claim/

While Rhett Burnham, Dentrix's Director of product management seems sincere in his plans to notify HIPAA-covered customers that G5 is not encrypted as advertised, that is little consolation for dental patients who don't yet realize that their dentists innocently failed to notify them of breaches of their unencrypted identities - months ago in some cases. Let's not forget that Justin Shafer warned Dentrix about this security weakness almost two years ago and was indignantly ignored by Dentrix officials.

As Dissent Doe suggests in her article, it's not over. Burnham tells her, "As you mention, we will not be able to remove or edit all old press releases or articles." Whom does that hurt, and whom does that help? Follow the money.

Until the DentistryIQ press release claiming that Dentrix G5 is encrypted is removed or corrected, dentists will always be misled into purchasing a faulty product, breaches of dental patients' identities will always go unreported, and Dentrix will always sell at least a few systems based on a lie. What's more, if DentistryIQ and Dentrix are unable to come to a monetary agreement that includes changing or deleting the undated press release, the encryption lie will always be current news.

For national security reasons alone, Rhett Burnham should weigh the cost of paying off DentistryIQ, versus the cost of a class action lawsuit brought by thousands of really pissed off dentists and dental patients blindsided by identity thefts - all involving Dentrix software their dentists were told was encrypted in a timeless ad.
DarrellP725
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DarrellP725,
User Rank: Moderator
2/12/2014 | 7:34:09 PM
Re: Since dentists are not complaining about EDRs, they must be almost 100% satisfied. Right?
Dear David Carr:

You said "I haven't done any research on the software for dentists and don't have much to add. It may be something for us to follow up on."

Please do. As you will see sooner or later, transparency is direly needed in dental IT. However, I should warn that searching for evidence-based value of EHRs in the secretive niche of dentistry is a tough and unpopular task. The rare pieces I shared yesterday - independent press releases written by the CEO of Clinicians Report and an anonymous American Dental Association author - are as close as you will come to peer-reviewed studies. As I said, it's quiet... too quiet.

The fact that EHRs in dentistry are far more expensive than paper dental records is only one reason unresponsive stakeholders are hiding. In addition, they have known for years that EDRs are simply more dangerous than paper records as well. What's more, false claims of encryption never before seen in EHRs (as far as I know), empower the harm. Even though Dentrix - the nation's most popular dental software - advertises on DentistryIQ that it is encrypted, the US Department of Homeland Security says it is not:

DentistryIQ - "The move to make Dentrix G5 an open platform for third-party applications was made possible by its new SQL database with encryption that improves performance while adding advanced security to patient data." - from "Henry Schein Dentrix G5," no byline, DentistryiQ, undated.

http://www.dentistryiq.com/articles/2012/03/henry--schein-dentrix.html

DHS - "Vulnerability Note VU#948155 - Henry Schein Dentrix G5 uses hard-coded database credentials shared across multiple installations," April 26, 2013, and "Vulnerability Note VU#900031 Faircom c-treeACE database weak obfuscation algorithm vulnerability," June 10, 2013.

http://www.kb.cert.org/vuls/id/948155

http://www.kb.cert.org/vuls/id/900031

False security is worse than no security. Agreed? And the more dentists who read on DentistryIQ that Dentrix is encrypted, the more breaches of dental patients' unencrypted identities will go unreported. This is not going to end well for dentists, patients or Dentrix. I've done everything I can to get the ad deleted, maybe someone who is not a dentist might have better luck with DentistryIQ and Dentrix officials.

Yea, David. Please look into it. If I can be of any help, let me know.

D. Kellus Pruitt DDS
ZibdyHealth
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ZibdyHealth,
User Rank: Apprentice
2/12/2014 | 4:47:02 PM
Re: No dumb questions
Hi Laurianne,

I did not say that patients are dying to manage their records. In most of the world with exception to 4-5 countries, patient manage their own records. It helps that records are on paper and everyone knows how to keep a folder full of papers. Healthcare apps make 40% of downloaded apps in Brazil.

If we keep making patient records so difficult to manage that one needs a Health-IT degree or MD then we failed from the start. I did mention here that we need records easy enough that my grandma should be able to manage. You remember how many smartphone and smartphone OS were there in the market prior to iPhone launch. We need to learn few things from Apple here.

I am the first one to accept that adoption of health records has been difficult and any company which solves this problem will own the market. Patients won't manage records unless they get some additional benefit from managing the records.

Laurianne
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Laurianne,
User Rank: Author
2/12/2014 | 4:00:44 PM
Re: No dumb questions
I disagree that patients are dying to manage their own records. Anyone else agree with me?
David F. Carr
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David F. Carr,
User Rank: Author
2/12/2014 | 2:54:36 PM
Re: Since dentists are not complaining about EDRs, they must be almost 100% satisfied. Right?
I didn't mean to ignore you, but I haven't done any research on the software for dentists and don't have much to add. It may be something for us to follow up on. I'm finding that there are many EHRs designed for specific healthcare specialties, all with their own quirks.
ZibdyHealth
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ZibdyHealth,
User Rank: Apprentice
2/12/2014 | 2:43:52 PM
Re: All EHRs Aren't Created Equal
David Carr,

 

"In sympathy with the software developer, we should also acknowledge that it's a tough challente to create a system that is easy yet sophisticated, addressing a complicated scientific discipline while serving other masters like regulators and insurance companies."

 

No one has served more than one master successfully for long time. We need to separate it out. Let patient manage their EMR....but from my personal conversations with many physicians ..there is a minorty group of physicians who feel that they created these records so they own it and they would like to get paid second time to share (give) records with patients. Talk about double dipping.
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