IT Practice Consulting – Health IT Report –
September 2017
“AMA Calls For EHR Overhaul, Drafts Priority Framework”
Introduction
New research from the University of Wisconsin and the American Medical Association (AMA) indicates that primary care physicians (PCPs) dedicate over half of their workday to electronic health records (EHRs). Originally published in the Annals of Family Medicine, “the retrospective cohort study of 142 family medicine physicians” collected over 118 million EHR event logs, or records of system access, to analyze the time allocation and frequency of electronic tasks. Researchers determined that family physicians completed over six hours of EHR activities each day, nearly two-thirds of which were “delegatable” clerical tasks that coincided with job dissatisfaction and physician burnout. In a public statement, AMA President David Barbe, MD said the findings reflected physicians’ existing concerns that “data entry tasks associated with EHR systems are significantly cutting into available time for physicians to engage with patients.” The AMA endorsed similar conclusions in a recent press release, in which the organization condemned a culture of “poorly designed and implemented” health information technology and offered a comprehensive framework for EHR reprioritization.
Read the entire AMA report in the Annals of Family Medicine: Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations
AMA on “Tethered to the EHR,” Methodology and Conclusions
According to the official report, university researchers analyzed the Epic systems of 142 primary care physicians in southern Wisconsin to determine a correlation between “EHR time allocation and usage patterns” and physician burnout rates. The study examined three years of Epic event logs, “automated tracking features that monitor the accessing and performance of the EHR interface,” to compare the frequencies of indirect (asynchronous) and face-to-face (synchronous) activities in family care practices. Researchers concluded that participating physicians spent half of their viable work hours – equivalent to 6 hours a day – completing any of the trackable Epic event log activities, including patient documentation, order entry, billing and coding, and system security. Simply put, “primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care.”
Established EHR critics, including the American Medical Association (AMA) and the American Medical Group Association (AMGA), responded to the findings with demands for an industry-wide reevaluation of the benefits, usability, and long-term goals of current health information technologies. Notably, the AMA results echoed a 2016 study of family medicine, internal medicine, cardiology, and orthopedic practitioners, which also concluded that physician EHR exercises accounted for twice dedicated workload of doctor-patient interactions. The authors further speculated that the growing market of EHR implementation, and subsequent decrease in time allocations for direct patient care, contributes to observed physician “work–life imbalance, dissatisfaction, and a burnout rate exceeding 50%.” In summary, University of Wisconsin and AMA professionals advised family care practices to delegate burdensome administrative tasks to support staff and encourage face-to-face patient communications.
Read more AMA research for EHR implementation here: Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy
AMA on “Types and Click Tasks,” EHR Priority Framework
On September 11th, the American Medical Association (AMA) issued a conciliatory statement regarding the future of healthcare information technology, titled “Type & Click Tasks Drain Half the Primary Care Workday.” The controversial report claimed that the “AMA shares physicians’ frustration” stemming from failed EHR systems, which disrupt effective workflows and offer incomplete performance evaluations.
AMA President David Barbe, MD raised his own concerns over mounting evidence that EHR initiatives can damage patient engagement: “Poorly-designed and implemented EHRs have physicians suffering from a growing sense that they are neglecting their patients and working more outside of clinic hours as they try to keep up with an overload of type-and-click tasks.”
Fortunately, the AMA also provided a tentative framework for the reconfiguration and prioritization of EHR policies; the main components reflect the organization’s strong emphasis on physician-centric strategies:
- Enhance physicians’ ability to provide high-quality patient care
- Support team-based care
- Promote care coordination
- Offer product modularity and configurability
- Reduce cognitive workload
- Promote data liquidity
- Facilitate digital and mobile patient engagement
- Expedite user input into product design and post-implementation feedback
Read the executive summary for the AMA EHR Priority Framework here: Improving Care: Priorities to Improve Electronic Health Record Usability
Final Thoughts
After years of leading public discourse on EHR implementation and incentive programs, the AMA claims that it “recognizes the potential value of electronic health records” and acknowledges the significant role of information technology in preventative healthcare. Clinicians seeking to balance EHR initiatives with distinguished patient care can participate in STEPS Forward, an “ambitious online practice transformation series [the AMA] launched last year that offers modules to help physicians learn their risk factors for burnout…and reignite professional fulfillment.” Similarly, the New York eHealth Collaborative (NYeC) spearheads the Statewide Health Information Network for New York (SHIN-NY) program to install and maintain secure EHR infrastructures for qualified entities statewide.
Health information technology professionals are vital to the advancement of patient-focused healthcare and can offer insider perspectives on the complex world of coordinated care, interoperable standards, and Meaningful Use performance audits. Contact IT Practice Consulting (ITPC) today to receive a comprehensive EHR evaluation and advice tailored to your organization’s needs!