September 1, 2018

Doctors on EMR: we didn’t train to become data entry specialists

Doctor Shortages Explode Thanks To ObamaCare

A recent report from the Association of Medical Colleges projects doctor shortages of up to 121,300 within the next 12 years. That's a 16% increase from their forecast just last year. Not only are medical schools having trouble attracting doctors, but current physicians are cutting back on patient visits, retiring early or switching careers. An article in a recent issue of the Mayo Clinic Proceedings says that nearly one in five doctors plan to switch to part-time clinical hours, 27% plan to leave their current practice, and 9% plan to get an administrative job or switch careers entirely.  Another survey found that nearly two-thirds of doctors feel burned out, depressed or both.

Eight years ago, IBD/TIPP surveyed 1,376 practicing physicians across the country, asking them what they thought about the health reform bill Democrats had been putting together. The survey found that a surprisingly large share of doctors, 45%, "would consider leaving their practice or taking an early retirement" if Congress passed what ended up as ObamaCare.

One of the big drivers of doctor exits, by the way, is the Obama administration's "electronic health records" mandate, which was supposed to vastly improve the quality and efficiency of care. It's had the opposite effect. A Mayo Clinic survey found that the EHR mandate is reducing efficiency, increasing costs and paperwork hassles, and pushing more doctors to quit or retire early. A Harris Poll found that 59% of doctors say the current EHR system foisted on them by the Obama administration needs "a complete overhaul," and 40% say it imposes more challenges than benefits.    How Electronic Medical Records Exploded In Doctors’ Faces And Politicians Got Off Scot-Free

Physicians must reclaim the medical record

However, what was missing in the entire document was the actual “story” of the patient — who he is, the medical burden he suffers and its impact on his life, how he became sick, what we thought was wrong with him, how that understanding and what we did for him evolved over the course of his admission, and perhaps most importantly, what needs to happen next to help return him to his best quality of life. The thought struck me that with the increasing access that patients have to their own medical records, would he even recognize himself in this documentation of his hospitalization?

The nature of how we record our interactions with patients has profoundly changed in recent years, and not necessarily in positive ways. Most attribute this change to introduction of the electronic health record (EHR) which initially promised improved efficiency, legibility, and ability to transfer clinical information effectively across care settings. And while perhaps some of those advantages have come to pass, accompanying the expanded use of the EHR has been an marked shift away from medical documentation’s primary use as a patient care tool to one used for recording information for non-clinical purposes (such as for coding and billing).

Even those aspects of the EHR intended to make our jobs easier, such as templates, check boxes, and the cut-and-paste function, have also caused major changes in the quality and meaningfulness of our medical documentation, often making it discontinuous and less coherent by breaking any narrative into small, discrete, and often repetitive pieces. ... And perhaps most destructively, many are spending multiple hours of their own time daily completing documentation, which certainly doesn’t lend itself to physician well-being and is a huge contributing factor to physician burnout.

.... writing about our patients has always been a key clinical skill and one that remains important regardless of the evolution of the platform on which it occurs.... Writing about patients requires directed questioning and focused listening to capture the key components needed to develop a deeper and compelling understanding of who they are as a person. When coupled with the physical examination, the resulting narrative weaves together the physical and biographical aspects of the patient and provides the invaluable context in which medical care is being provided. Although patient management may ultimately be driven by data, it is often the story more than anything else that determines how well a patient is cared for. ... we didn’t train to become data entry specialists – we trained to take care of the medical needs of our fellow human beings, and that this requires more than what our current documentation systems allow.
Posted by Jill Fallon at September 1, 2018 12:52 PM | Permalink