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Category: Hospital

Is Your EHR Stressing You Out?

When Mark Friedberg, MD, and his team at RAND Corporation surveyed physicians about their job satisfaction in 2013, they were surprised that one area of discontent kept coming up: electronic health records. As we’ve noted before, though doctors appreciate some aspects of using EHRs, the devices are also the culprit for much of their stress.

Sponsored by the American Medical Association and issued this fall, the survey of physicians at 30 medical practices in six states confirmed what other researchers have reported recently about EHR-related stress. Electronic medical records chip away at doctors’ job satisfaction and compound their stress for many reasons, including piling onto their workload, eroding the quality of their care, and making their daily practice less efficient.

“Four of five doctors don’t want to go back to paper records, because there are advantages to having electronic records. They really value the ability to retrieve patient information from another doctor in the practice or from home on the weekend,” says Friedberg, a health policy researcher at RAND.

“But EHRs are a source of stress and frustration for physicians. The big ones are usability and whether they match clinical workflow. They found they are trying to divide their attention between their patient and their computer.”

Stressful Messages

A major source of anxiety comes from EHRs’ messaging systems. Most lack a way to prioritize the scores of messages—from other doctors, patients, or insurance companies—that pour in during the workday. Doctors generally don’t have a staff person who goes through their messages, and they can’t tell which ones are urgent and which can wait.

Not being able to get access to a patient’s medical records from another institution is another frustration. Instead of quickly sharing files electronically, they must be faxed, which makes them unsearchable in an electronic record. It’s one of the key reasons many physicians invested in EHRs, and they are disappointed that the varied systems don’t talk to each other.

Less Time Saved

“Doctors also described their workday being longer, and that has to do with data entry. They might have dictated their notes previously or used a human transcriptionist, and now they are typing notes themselves or using dictation software, but it’s not accurate,” says Friedberg. “It’s not saving them time like they thought it would.”

A study published this fall in the Journal of the American Medical Informatics Association also found that EHRs heighten doctors’ stress. After surveying nearly 400 doctors and managers of 92 clinics, the researchers, led by Stewart Babbott, MD, from the University of Kansas Medical Center, reported that primary care physicians using EHRs with more functions report increased stress and less job satisfaction than doctors who use EHRs with lower functionality.

“Clinicians have limited time,” Heather Haugen said. Haugen is the corporate managing director of The Breakaway Group, a Xerox Company. She is co-author of “Beyond Implementation: A Prescription for Lasting EMR Adoption.”

“They respond well to training that can be accessed 24/7, and is presented in small, manageable chunks. They also prefer the convenience of individual, self-paced learning,” she said, referring to EHR training programs designed to lessen stress on the physician.

Too Much Information

The study highlights several reasons why physicians face mounting stress from EHRs. Several involved time pressure related to using the records. Though they appreciated the richness of patient data in EHRs, physicians have so much information they need to collect from patients during short office visits—including chronic disease management, health maintenance, quality measures, and other documentation. They find themselves racing through appointments to get through it all.

“Clinicians are often given more information than they need- resulting in information overload,” Haugen said. “While it is tempting show off every technological bell and whistle in a new HIT system, we urge clients to initially focus only on tasks required to develop proficiency (not mastery) for regular job performance.”

Another pressure point: trying to communicate with patients, interact with them, assess them, and treat them, all while simultaneously engaging with the EHR to give it all of its requested information. One possible solution: “Longer office visits to accommodate information overload in sites with fully functioning EMR, or designating ‘EMR catch-up’ time … during patient care sessions, deserve consideration,” the JAMIA study authors suggest.

As physicians get more accustomed to using EHRs, some of the stress might dissipate. But researchers from both studies believe highlighting areas of physician stress related to electronic records will give vendors a path to making them more usable—and less frustrating—for doctors.…

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Between an ER and Urgent Care: Urgency Centers

For many Minnesotans, the decision is easy: go to the hospital emergency room and wait for hours, or take their acute health problem to an urgency center. A new health care model that falls between urgent care and the emergency room, urgency centers have been cropping up across the Twin Cities in the past three years.

Urgency centers are similar to urgent care centers, but are staffed by working ER doctors instead of primary care docs as is usual. So Urgency Centers can handle more immediate crises, like broken bones, than urgent care centers. Think of them like a freestanding ER. Some even accept ambulances.

At least four health care systems have gotten in on the action, opening multiple urgency centers staffed by board-certified ER physicians. Most don’t accept patients by ambulance. Instead, they focus on efficiently and effectively treating the 70 percent of ER patients who aren’t usually admitted to the hospital. That means handling myriad issues, from severe headaches and broken bones to concussions and respiratory problems like asthma.

“We felt that health care needed another avenue where patients could access acute care, one that provides the triple aim of great quality, lower cost care, and an excellent patient experience,” says Kurt Belk, an emergency medicine doctor and medical director of three Urgency Rooms in the Twin Cities. “We’ve delivered on all three in that we are a significantly less expensive alternative to emergency rooms, and we are a lot more efficient in providing care.”

In addition to the Urgency Room—which plans to open two more locations in the next 12 to 18 months—North Memorial Medical Center operates one urgency center and recently broke ground on a second. Two other local health care systems operate stand-alone emergency rooms, which do take ambulances.

Belk and his co-workers at Emergency Physicians Professional Association, which staffs five local hospital ERs, started the Urgency Room in 2010. They wanted to provide physicians with a different work environment and more control over their operations. Open 14-hours a day, 365 days a year, the Urgency Room, and urgency centers in general, don’t have to follow some of the time-consuming regulations as a hospital. Providers also aren’t pulled away for critical traumas, heart attacks, or patients with mental illness or addiction—a culprit for increasing wait times.

Patients like urgency centers, too, because fees are often lower than hospitals. They also offer more mobile, consumer-friendly services, like registering from home to speed up intake time or going online to check on wait times. “Our average time from door to discharge is 77 minutes. For most ERs it’s in the 200s,” Belk says.

Another benefit is that patients’ medical records get sent electronically to their own physicians for follow-up care. To make record-sharing seamless, the Urgency Rooms adopted Epic—the same EHR software as other local health care systems, adds Belk.

Urgency centers aren’t sweeping the nation yet, but they are providing an avenue for ER physicians to enter the market. Historically, urgent cares have been the purview of primary care physicians, notes Alan Ayers, who serves on the board of the Urgent Care Association and is vice president of corporate development for Concentra, a Dallas-based health care provider in 38 states.

“They are reflective of the diversity that we see in urgent care,” Ayers says. “Urgent care is a entrepreneurial, physician-driven industry. In Minnesota, they found a successful model that meets medical needs when patients don’t quite need to go to the ER, but they have more acute concerns than would be treated at urgent care.”

Urgency centers might emerge nationwide as a less expensive model for acute care, which starts by keeping less-critical people out of the ER, says Ayers. They also help ERs function more efficiently so they aren’t bogged down with cases of flu, deep lacerations, or dehydration—all problems urgency centers handle well.…

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