Doctors Report Loss of Practice Time After EHR Implementation

Our continuing research done by                      appears to corroborate earlier studies about decreased efficiency and decreased patient volume with the implementation of electronic health records.

Doctors say they waste on average up to four hours per week when using electronic health records, according to a research letter in JAMA Internal Medicine, U.S. News & World Report reports. 

Research Letter Details

For the research letter, researchers from the National Library of Medicine's Lister Hill National Center for Biomedical Communications analyzed the results of a survey conducted in December 2012 by American College of Physicians (Leonard, U.S. News & World Report, 9/8).

The survey consisted of 19 questions and received responses from 411 internal medicine attending physicians and trainees who worked in an ambulatory practice and used an EHR system (McDonald et al., JAMA Internal Medicine, 9/8).

Findings

A difference was noted between practicing clinicians and trainees (residents).

The research letter, which was presented Monday at the National Library of Medicine, found that the mean loss of time for physicians was 48 minutes per day, compared with a mean loss of 18 minutes per day for trainees (U.S. News & World Report, 9/8).

Specifically, the research letter found that after EHR implementation:

• 89.8% of respondents said at least one data management function was slower;
• 63.9% of respondents said the time spent taking notes increased;
• 33.9% of respondents said the time spent finding and reviewing patient data took longer; and
• 32.2% of respondents said they spent more time reading other clinicians' notes (JAMA Internal Medicine, 9/8).

The authors wrote, "We can only speculate as to whether better computer skills, shorter (half-day) clinic assignments with proportionately less exposure to EMR time costs, or other factors account for the trainees’ smaller per-day time loss" 

Author:  Our experience is that trainees are often using a particular EMR for the first time, which does not require an 'unlearning experience" and that trainees (who are younger were brought up with computers during high school, elementary school, and college), in addition to their immersion in social media.  Some or all of these traits explain the difference in the findings.

Accelerator Launchpad picks five digital health startups | mobihealthnews

Mobile app development continues to accelerate at an ever increasing rate.  It becomes difficult to segregate the bad from the mediocre and good ones.  Here are a few new hopefuls.

Our Next several posts will summarize many hopeful startups as 2014 progresses as predicted.

Accelerator Launchpad picks five digital health startups | mobihealthnews

San Francisco-based accelerator Launchpad Digital Health funded its first five companies this week.

Through the accelerator, the companies receive between $200,000 and $500,000, office space in San Francisco, and advising with legal, accounting, and risk management issues. Launchpad focuses on companies that are working on wellness, remote monitoring, electronic health records, data analytics, and independent living support.

AddApp aims to provide users with context about their daily life. The app integrates data from other apps and devices that the user owns and puts the data into context. Some examples of insights that AddApp provides includes pointing out what gives the user a good night of sleep, showing users which days they are most active, and how they can run farther.

Lyfechannel develops programs for patients who have chronic diseases. The programs are designed to help patients who were recently diagnosed with a chronic disease and need additional help as they begin their care regimen like changing eating habits or getting used to a medication regimen. The program focuses on diabetes, pre-diabetes, COPD, smoking cessation, and heart health. According to an SEC filing, Lyfechannel raised $200,000.

Medable helps healthcare professionals, like physicians and payors, make apps that connect physicians and patients, store medical information safely, and follow the appropriate regulations. Providers can also use the app they make to communicate with each other. The company has built an API so that developers can build the program on Medable’s cloud platform.

QueueDr helps doctors add more appointments to their schedule if they have free time. A doctor’s office will use the platform to send texts to patients telling them about an open appointment slot so that that patients can get in to see the doctor earlier.

Sense.ly has developed a “virtual nurse” that provides follow-up care to patients, focusing mostly on those that have chronic diseases. The company offers patients an avatar that analyzes the patient’s condition and provides insights into what steps patients should improve their health. Earlier this month, MobiHealthNews reported that Sense.ly is set to come out of beta later this year.

EHRs Linked to Higher Revenue, Lower Patient Volume

Friday, September 5, 2014

RELATED TOPICS:

• EHRs and PHRs

Electronic health record implementation can result in reduced patient volume but can increase revenue over the long term, according to a study published in theJournal of the American Medical Informatics Association, Becker's Hospital Review's "Hospital CIO" reports (Gregg, "Hospital CIO," Becker's Hospital Review, 9/3).

For the study, researchers from Drexel University compared patient volume and reimbursement at 30 ambulatory practices in the two years after EHR implementation with the practices' pre-implementation baseline (Pedulli, Clinical Innovation & Technology, 9/4).

Study Findings

The study found that practices' reimbursements increased "significantly," even as their number of patient visits declined (Durben Hirsch, FierceEMR, 9/2). Specifically, practices on average submitted claims for 94 additional ancillary procedures per quarter after implementing an EHR system, while patient volume decreased on average by about 108 patients per quarter ("Hospital CIO," Becker's Hospital Review, 9/3).

The researchers wrote they did not find any indication of "upcoding or increased reimbursement rates to explain the increased revenues" (Clinical Innovation & Technology, 9/4).

They noted that their finding of increased revenues "is reassuring and offers a basis for further EHR investment," while their finding of decreased patient volume indicated that EHR systems were increasing practices' efficiency.

They recommended that any practices continuing to see declines in patient volume two years after implementing EHR systems should add analytics functionality to their EHR system to "focus on seeing the right patients" (FierceEMR, 9/2).

HHS: Federal Exchange Site Hacked, No Personal Data Stolen

The inevitable 'hack' occured in July according to HHS officials.  It involved the Federal Health Insurance Exchange, health.gov .

On Thursday, HHS officials announced that a hacker in July breached part of HealthCare.gov and uploaded malicious software, the Wall Street Journal reports (Yadron, Wall Street Journal, 9/4).

A team of investigators discovered the breach on Aug. 25 during a routine security scan. I suppose HHS and federal IT infrastructure have their own "Malwarebytes" to detect and clean their systems,  regularly.  I know that good IT practices require this type of routine maintenance.

Perhaps the hackers broke in to see if they could improve health.gov for the Dept. of HHS. I am sure many were willing to help there.  Probably any videogamer could improve the web site.  It's been a whole year for things to improve, and the next enrollment period begins in about one month.

According to an HHS official, the attack appears to be the first successful breach of the website, through which millions of U.S. residents have purchased health insurance coverage since fall 2013.

Details of the Hack

Investigators found no evidence that enrollees' personal data were taken in the attack. Rather, the hacker accessed a server used to test code for the website (Wall Street Journal, 9/4).

Common malware was uploaded to the test server and designed to incapacitate other websites, a method often referred to as a "denial of service" attack. Government officials say the malware was not intended to steal consumers' data (Viebeck/Hattem, The Hill, 9/4).

"Our review indicates that the server did not contain consumer personal information; data [were] not transmitted outside the agency, and the website was not specifically targeted," HHS said, adding, "We have taken measures to further strengthen security" (O'Donnell, USA Today, 9/4).

I feel relieved

It's about like someone breaking into your house and leaving a 'stink bomb' rather than taking your large screen T.V.

Reaction

Rep. Darrell Issa (R-Calif.) -- chair of the House Oversight and Government Reform Committee -- in a statement said the revelations were "unsurprising" amid previous concerns about the website's security. He added that the administration repeatedly had "dismissed concerns about the security of HealthCare.gov, even as it obstructed congressional oversight on the issue." Issa also called on CMS Administrator Marilyn Tavenner to testify alongside GAO officials before the committee on Sept. 18 (Hattem, The Hill, 9/4).

Meanwhile, Rep. Diane Black (R-Tenn.) called on the Senate to join the House in passing the Health Exchange Security and Transparency Act (HR 3811), which would require the federal government to notify individuals if their personal information has been breached (Black release, 9/4). (A one paragraph-regulations)  I thought that was already covered by HIPAA.

Let us hope that things will get better (don't hold your breath)