Now EHR data entry 50% of primary care doctors’ workday: AMA, University of WI report

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/09/EHR-burden-Robert-Wachter.jpg” thumb_width=”200″ /]Where’s the doctor? Typing away! A fact of life doctors have agonized on over the past ten years–even great advocates like Robert Wachter, MD above at NYeC last year–is the clerical burden of EHRs and patient data entry. A late 2016 time and motion study in the ACP Annals of Internal Medicine (AMA, Dartmouth-Hitchcock, Australian Institute of Health Innovation) noted a mere 49.2 percent of ambulatory physicians’ time spent on EHR and desk work. Mayo Clinic (above) has been tracking both the burnout and the burden as 50 percent (above).

Now we have a new three-year study published in the Annals of Family Medicine led by the University of Wisconsin Medical School tracking EHR data entry as 52 percent: 5.9 hours of an 11.4 hour workday. This includes allied clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounting for 2.6 hours, close to 50 percent of the 5.9 hours daily.

Is there a way out? The study’s recommendations were:

  • Proactive planned care
  • Team-based care that includes expanded rooming protocols, standing orders and panel management
  • Sharing of clerical tasks including documentation, order entry and prescription management
  • Verbal communication and shared inbox work
  • Improved team function.

Much of this sounds like burden shifting to deal with the EHR, not a redesign of the EHR itself, but the commentary in AMA Wire makes it clear that it was shifted in the first place by the EHR designers from other staff to the doctor for direct entry. Other time savings could be realized through moving to single sign-on (versus dual entry passwords) to advanced voice-recognition software. (UW release)

The earlier ACP study excerpt in NJEM Journal Watch has physician comments below the article and they blast away: (more…)

Dr Topol’s prescription for The Future of Medicine, analyzed

The Future of Medicine Is in Your Smartphone sounds like a preface to his latest book, ‘The Patient Will See You Now’, but it is quite consistent with Dr Topol’s talks of late [TTA 5 Dec]. The article is at once optimistic–yes, we love the picture–yet somewhat unreal. When we walk around and kick the tires…

First, it flies in the face of the increasing control of healthcare providers by government as to outcomes and the shift for good or ill to ‘outcomes-based medicine’. Second, ‘doctorless patients’ may need fewer services, not more, and why should these individuals, who represent the high-info elite at least initially, be penalized by having to pay the extremely high premiums dictated by government-approved health insurance (in the US, ACA-compliant insurance a/k/a Obamacare)–or face the US tax penalties for not enrolling in same? Third, those liberating mass market smartwatches and fitness trackers aren’t clinical quality yet–fine directionally, but real clinical diagnosis (more…)

A snapshot of telehealth and telemedicine in rural America

Telehealth and telemedicine (virtual consults) are moving forward in large and largely rural Nebraska and neighboring Iowa. The Nebraska Medical Center not only has an executive director for telehealth (not buried in an HIT department) but also no less than 13 initiatives in process from stroke to cancer care. Video networks connect rural hospitals with medical centers. The VA’s leadership in this geographic area has been crucial, with over 550 patients in home telehealth in Nebraska – Western Iowa and additional telemedicine programs for psychiatry, wound care, nutritional counseling and infectious diseases. Videoconferencing equipment in hospitals and public health centers, installed in a mid-2000s program, is being repurposed for video consults. Interestingly, its use in this region is not new. For 10 years, a University of Nebraska Medical Center (UNMC) psychiatry associate professor has been having routine video psychiatric consults with elderly nursing home patients. Telemedicine’s first use in Nebraska was also psychiatric–55 years ago–by a University of Nebraska Medical Center dean using undoubtedly black-and-white two-way video. Doctor’s home visit is back — kind of — as telehealth flourishes nationwide (?–Ed.), Omaha World-Herald

A highlight from ATA 2013 Fall Meeting: Psychiatric appointments as a ‘data-file’

In a conversation at a recent Health 2.0 NYC event, this Editor asked Doug Naegele what was the most surprising topic at the recent American Telemedicine Association conference in Toronto. Doug has graciously contributed this short article. He is the founder of Infield Health, a firm dedicated to increasing health outcomes and reducing total cost of care by putting discharge instructions on mobile phones. 

At the ATA Fall Meeting in Toronto last month, Dr. Peter Yellowlees gave a presentation on his work at University of California-Davis around telepsychiatry. I was struck by a few of his discussion points:

1. It may be helpful to see psychiatric consults as ‘data files’ and not events that require mandatory real-time evaluation.
2. If we accept that these consults can be described as data files, then they can be forwarded to remote psychiatrists for viewing, evaluation, and treatment recommendations much in the same way radiological scans are remotely evaluated. (more…)

Apps that put you on the couch

Despite the light tone of this Editor’s headline, telepsychiatry and telementalhealth or ‘mood’ apps aren’t frivolous in the least. The US Department of Defense (DOD) National Center for Telehealth and Technology (T2) T2 Mood Tracker and BioZen are two smartphone apps for biotherapeutic feedback [TTA 14 Feb]. Virtual consults are also not brand new–but controversial, as some have used Skype which the TeleMental Health Institute in a recent Psychiatric News article has scored on privacy (as in no).  Four new entrants are taking a different approach, with different models and HIPAA-compliant video consults.

  • TalkSession is first establishing itself as an authority for providers via an online forum and digital magazine–then as a booking source for online therapy.
  • Talktala is hosting online chats and forums moderated by therapists, and for more advanced services will charge users a $30/month subscription fee.
  • iCouch allows users to search for therapists, and then via computer or iPhone visit online through the site’s HIPAA-compliant system. Interestingly 30-40 percent of its current client base is international and has 165 therapists worldwide. (International visits are an interesting loophole in practice.)
  • Breakthrough is only for California residents at present, but plans to expand to Texas and other states. Patients again connect with a network of certified mental health professionals and conduct appointments via chat, email, phone or HIPAA-compliant video. Unlike the others, it has gained insurance coverage for its therapists’ services, shows real-time therapist availability and plans to enable on-demand, off-hour services.

Web therapy: 4 startups overcoming mental health taboos with technology (GigaOm)  Hat tip to David E. Albert, M.D. of AliveCor.

Short takes for Thursday

Curious about the further adventures of the HAPIFork that debuted at CES 2013 and got a whole slew of awards? Spend a minute moment (audio 0:51) at lunch with two Health 2.0 writers and inventor Jacques Lépine. Don’t eat too fast or it will buzz–and you can see your eating patterns on HAPIFork’s online dashboard via Bluetooth to mobile or cable to PC. It finally made it to Kickstarter (20 percent to their goal) and $89 will get you one in September…..What is the Synergistic Physio-Neuro Platform (SynPhNe–pronounced ‘symphony’)? A new stroke rehabilitation system from Singapore’s Nanyang Technological University for patients which have lost the use of an arm. The arm band monitors muscle movements through guided exercises, and if one can’t be completed, uses the sensor readings to determine why, and then explains it to the user so that they can improve. Gizmag….DARPA’s ARM (Autonomous Robotic Manipulation) is a heavyweight set of two robotic arms to perform coordinated actions and manipulate objects on task-level commands. Currently in test, potential is in heavy moving or dangerous situations including defusing unexploded IEDs. Have Two Arms, Will Work (Armed With Science)….Skype ‘n’ psych a no-no, according to Marlene M. Maheu, PhD, head of the TeleMental Health Institute, due to privacy concerns with the popular online video platform–and even secure telemedicine platforms may have liability problems for psychiatric use. Psychiatric Times.