Tag Archives: EHR

patient engagement technology and medical tablets

EHR and it’s Evolution into CHR: A Critical Look at Cutting-Edge Technology in Healthcare

Epic CEO, Judy Faulker, recently expressed her view how Electronic Health Records are evolving into Comprehensive Health Records—a term that evaluates more than just a specific window of sampling an individual’s health from doctor visits. CHR is a term that may be invented as the new EHR, incorporating more data and analysis of a patient that stems from their in-clinic or hospital visits and their time outside of a medical facility too. Foraging into a new technology frontier that implies a near-constant evaluation of a person’s well-being may sound like an answer that physicians have been looking for, but anyone who is ever a patient (all of us) could be under the scrutiny of patient tracking technology that could be always on, always tracking. Yes, the benefit is physicians can understand the entire gamut of a patient’s health by seeing comprehensive snapshots of activity from day to day, but do the costs outweigh the benefits? Are we already in the pathway of the “Big Data” steamroller? Let’s take a critical look.

Are We Already Headed Down this Path?

Many individuals are already familiar with utilizing in-home tracking devices and food intake monitoring, so the “at home” concept of tracking health isn’t new. Wearable fitness trackers coupled with diet and exercise apps are near ubiquitous in society today. There are also several medical grade devices like blood sampling devices or blood pressure monitors to see how trackable vitals are measured outside of the doctor’s office and clinics. But now that CHR is becoming a reality for EHR corporations, there are implications to consider about how this data would be collected into a central repository. If CHR will incorporate the data from consumer-grade devices into an EMR system, how will this data transfer occur? Would EHR software developers have to build integrations for the hundreds of various fitness apps and wearables that are available on the consumer market.  Would we need to entrust app developers and wearable manufacturers with the responsibility of building those integrations? We could see EHR software developers create their own consumer apps and wearables, but that raises even more questions. Would software developers even want to enter the arena of app development and medical device manufacturing? And if they did, how do get a patient to willingly utilize something they may not want to?

CHR and Big Data: How Accurate is the Information?

A patient may be under the scrutiny of a doctor for monitoring their food intake for diabetes, and it’s likely a common thing some individuals may “cheat” on their diet—maybe someone once logged a dinner of chicken and vegetables when instead they indulged a large burger and fries. That second iced mocha of the day might get “forgotten” when it comes time to update their food log. The same propensity to “cheat” when recording time spent at the gym lifting weights, or doing yoga can creep in if we are entrusting the patient to log their own activity. So manual input data needs to be examined and taken lightly if it’s to be wrapped into CHR. Plus, there’s the question of accuracy of wearable devices—many aren’t as devices used in hospitals, clinics and doctors offices. How accurate is a pedometer? How accurate is a sleep tracking device you can purchase off the shelf? Can that be incorporated into a medical health profile? And furthermore, even if the comprehensive data is used for analysis for health, can that be considered an invasion of privacy?

Is the CHR Data Secure Enough?

With potentially thousands of different devices tracking different variables such as food intake, steps taken, heart rate, and other measurable factors, there’s a concern of how all that data might be transferred to EMR systems. Since hospitals have begun implementing BYOD practices among their staff, securing has become a massive point of concern. Medical grade computers are specifically designed with a number of privacy safeguards built into them to protect patient data. Now imagine the security risks if data is being transferred from millions of unsecured consumer devices. We’ve discussed at length in the past that patient medical records are even more valuable on the black market than an individual’s financial data. Now you have to consider millions of new vulnerabilities for hackers to try and exploit. So how would a transfer happen? Wireless transfer? Patient web portals? If CHR is to incorporate an unknown breadth of data, will HIPAA laws need to be rewritten to account for vulnerabilities that can’t be controlled by a healthcare facility or a doctor’s office?

CHR Data and the Implications of Insurance

Insurance companies evaluate a patient’s medical history gauge what their premiums should be. It’s a given that if someone smokes, healthcare is more expensive for them. If we are to enter a new era of healthcare data, can insurance companies utilize more comprehensive methods of evaluating someone’s health? If a patient claims that they run three times a week, and yet their pedometer shows no activity outside of walking, will that reflect on their bill? How far does the willingness go to track aspects of someone’s life? CHR is prepped to track not only how we treat ourselves, but our social lives too. Will all these medical and social effects on our well-being be reflected in insurance companies and their premiums? While the intent of CHR would be to compile the most comprehensive view of an individuals health, the information could very easily be used to create more “high risk” pools by insurance companies, and could even price some users out of the market completely.

These are just a handful of questions to ask as the encroaching concept of CHR starts to hit EMR companies. They’re evolving, perhaps for the better of our lives and health, but there are strong implications of privacy, accuracy, security, and unfortunately impact on wallets too. For now, EMR systems have not yet seen that evolution, and quite frankly they shouldn’t until these questions are answered. We’d love to hear your thoughts as well. Please comment below and let us know what you think about CHR.


 

Prevent Physician Burnout with Health IT That Lifts The Burden

EHR can help providers. A lot has been said about how exactly EHR can help everyone in the health care. However, when providers implement EHR the physician productivity and patient satisfaction suddenly drop. The factor often unaccounted for is how the new technology blends with the end users, and the time it takes for the new technology to prove its ROI. We are several years into implementing the EHR systems across the country, but the numerous surveys continue ringing the alarm on the physician burnout that is at an all-times high. EHR and increased computerization are among the top 3 causes of burnout, as reported by the physicians.

HIT Paradox

The study funded by the American Medical Association (AMA) shows how physicians are overloaded with bureaucratic and clerical work that is not related directly to patient care:

For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work,” according to Annals of Internal Medicine. “During the office day, physicians spent 27% of their total time on direct clinical face time with patients and 49.2% of their time on (electronic health records) and desk work.”

According to the 2016 Medscape Lifestyle report, the burnout among US physicians “has reached a critical level.” The severity of the burnout was measured on the scale of 1 (lowest) to 7 (severe). Most specialties rated the severity of their burnout at 3.85 – 4.74.

The top 3 causes of burnout (again, on the scale of 1 to 7) are:

  • Too many bureaucratic tasks – 4.84
  • Spending too many hours at work – 4.14
  • Increasing computerization – 4.02

A Mayo Clinic NEJM Catalyst Insights Council survey polled clinical leaders and executives on the same issue. 96% of respondents agree that physician burnout is a serious or moderate problem, which remains largely unaddressed inside the organizations. As the top reasons to address the problem, the respondents cite decreased quality of care (63%), the effect on the attitude of the rest of the team (38%), and physician suicide (8%).

Here, again, the top causes of physician burnout are:

  • Increased clerical burden due to the use of EHR – 62%
  • Increased productivity requirements/expectation – 51%

Ironically, EHR is the reason the productivity expectations increased. The use of EHR is reported to disrupt the established workflow, forcing the physicians to “carry their workload into off-hours, or “pajama time.”

Why You Should Care

  • The burnout causes errors and poses a direct threat to the lives and well-being of both physicians and patients. Most likely, the surveys do not reflect the full picture because they are based on volunteer respondents’ answers. What about those who refused to participate? They are likely to avoid the subject of burnout because a) it can raise questions regarding their ability to deliver at their workplace; b) fear of being stigmatized (as any mental issue tends to lead to stigma).
  • The staff engagement in any new strategy a provider is deploying to cut costs or ensure compliance is fruitless without the physicians’ buy-in.
  • The physician burnout is a symptom of the loss of enthusiasm for work, emotional exhaustion, depersonalization, sense of low personal accomplishment, feelings of cynicism, a decreased level of compassion and involvement with patients and staff.
  • The domino effect of the physician burnout can and does have a devastating effect on health care. According to the US Bureau of Labor and Statistics’ Real Sector Growth, health care has a -0.6% decline in productivity every year.
  • Physicians with a high level of burnout choose part-time practice, early retirement or leaving for other industries (pharma, insurance) as a way out. With the medical staff shortage on the one hand and the growing population on the other, providers can not afford to lose clinical talent.

Technology IS The Solution When Done Right

HIMSS17 saw a number of sessions featuring success stories of providers using innovative solutions to address the physician burnout and increase productivity.

Perfecting the Mobile Solution” demoed how Palmetto Health-USC addressed the issue of physician burnout (due to the clerical/EHR documentation overload) by adopting a mobile solution. Relying on a Windows 10 medical tablet with a digitizer stylus, the provider was able to not only improve physician productivity but also alleviate the physician burnout.

Benefits of a medical tablet, as reported by Palmetto executives:

  • Improved patient-doctor communication, eye to eye contact
  • Doctors review charts before going into the room → more dedicated visit and saved 2-3 minutes per visit
  • Faster note completion and triage, ability to take history from patient in the hallway effortlessly
  • Ability to document anywhere
  • Improved workday and productivity
  • Decreased patient wait times
  • Small technology footprint
  • No negative impact on workflow
  • Reduced login times, improved security
  • Reduced eye fatigue from looking at the tablet
  • Improved efficiency with dual screen mode
  • Easy to move with or without cart
  • Easy to share and clean the device

Benefits of a medical tablet, as reported by physicians:

  • Provider satisfaction – 71%
  • Device easy to use 83%
  • Reduced time spent after work documenting 64%
  • Faster documentation 46%
  • Improved access to health records 54%
  • Improved security of patient records with reduced need to print, secure network, fingerprint access
  • Improved patient communication and education at bedside 54%
  • Improved workflow and reduced login times 64%
  • Reduced transcription costs
  • Fewer desktops needed

The factors that contributed to the successful implementation of the mobile solution at Palmetto:

  • Larger screen, digitizer stylus, support for full-size mouse and keyboard
  • Extended battery life
  • Corporate shared device (not BYOD)
  • Dragon dictation support
  • EHR-ready
  • Ability to manage/support the devices on-site
  • User-friendly interface with manageable learning curve (Win 10)
  • Support for high-quality medical imaging and X-ray image printing
  • Fast and secure logins with biometric reader/RFID SSO/Smart Card or CAC

A similar experience was reported at the HIMSS17 “Mobile Innovation and Telehealth in Emergency Care” session featuring the outcomes of Emergency Telehealth and Navigation program (ETHAN). The medical tablets running ETHAN used by the ambulance teams help the Houston Fire Department reduce the overload of the very ambulance teams and increase their productivity by 44 minutes (from 83 in regular teams), and reduce the flow of low-acuity patients to the overcrowded ERs.

If the team’s assessment of a patient is that of a low acuity, they initiate a video conference with a remote physician. The latter makes an assessment and offers alternatives to an ambulance ride to the ER. We covered it in detail here.

Conclusion

An EHR-ready Windows medical tablet with RFID SSO, fingerprint, CAC/Smart Card and barcode reader, antimicrobial casing, hot-swap batteries, rugged case, carrying handle and strips does alleviate the physician burnout caused by technology because:

  • It is easy to use – familiar Windows interface, minimum learning curve. Security is made simple requiring minimum user effort.
  • It is safe – antimicrobial casing kills the pathogens, IP65 sealed bezels enable cleaning with liquid chemical solutions for ultimate disinfection.
  • It is reliable – with durable, military-grade battery or hot-swap batteries that let you swap them without powering off the device and losing data.

Another way to reduce the negative effect of technology on physician and nurse burnout is to use maneuverable and lightweight non-powered medical carts with ergonomic medical computers with hot-swap batteries, which provide the full-shift uptime and flexible charging options. This configuration eliminates the nurses’ strain of having to charge the cart or the laptop frequently. It also reduces the cost of IT because our hot-swap batteries are durable unlike those of your regular powered medical carts that need frequent replacements.

P.S. While the AMA and other professional organizations might get busy lobbying to reduce regulations regarding clerical work, the providers and HIT vendors must work towards interoperability and ease of use of their solutions. Check out our Key Takeaways from HIMSS17 here.