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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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Why Are EHR Adoption Rates so Low for Dentists?

Despite all the efforts to move health IT forward across all health care spectrums, a large gap still exists: the dental industry.

Adoption of interoperable electronic health record (EHR) systems among dental professionals is dismally low. Many either use basic systems that are not capable of exchanging information outside the practice, or still rely on paper charts. Without interconnectivity, dentists operate inside their own information silos, relying on the patients to communicate important health information that could inform decisions on things such as medication ordering or care plans. And the patients’ general health providers do not have access to diagnostic information that originates at the dentist’s office, such as gum disease, that could impact that patient’s general health.

This digital divide between dentists and general health providers has worsened in recent years as EHR adoption among medical doctors has grown exponentially, thanks to the meaningful use incentive program. Meanwhile adoption among dentists has remained stagnant. But there is evidence those trends may be changing.

Mike Uretz describes what is happening as the “déjà vu of EHRs.” Dentists have faced the same barriers to EHR adoption that medical doctors faced about 10 years ago. But they are now experiencing the same drivers their M.D. counterparts experienced when the medical industry reached its health IT tipping point, said Uretz, executive director of dentalsoftwareadvisor.com, an online resource that tracks innovations in the dental software industry.

One of the biggest barriers to widespread adoption is a lack of incentives to invest in the technology. The majority of dental practices are small mom and pop shops operating on tight budgets without enough surplus for capital investments. And those that have the funding and the desire to go paperless are finding very few options when it comes to systems that meet the unique workflow needs of a dental practice.

EHR adoption among dentists has mostly been limited to large practices and dental service organization members, said Dr. Samson Liu, vice president of clinical affairs at Heartland Dental Care, one of the largest dental service organizations in the U.S.

Liu and colleagues from across the country launched Dentists for Oral Health Innovation in the fall of 2013. The organization’s goal is to expand access to high-quality, cost-effective oral health. A major focus of the organization’s mission is to expand the use of technology. The American Dental Association has also been working on the advancement of dental EHR technology. Its Standards Committee for Dental Informatics has developed a “wish list” of dental EHR functions that practices should look for in a system.

Uretz said he has seen momentum building across the country for dentists to adopt. He said part of that is due to the growing belief that oral health is an important part of overall health. It used to be rare for primary care doctors to exchange data with specialists. They later realized the need to communicate, and the rise of health information exchanges and EHR interoperability made it possible. Now, more medical professionals and dentists are realizing the importance of exchanging information with each other, and are seeking the technology to make those connections possible.

The federal government has also expressed an understanding of how important it is for dentists to be part of the overall health care continuum. But the programs aimed at increasing health IT adoption have not been very favorable to dentists.

Technically, dentists are eligible to qualify for the meaningful use incentive program, but few are participating due to the difficulty. The Dept. of Health and Human Services acknowledges how difficult it is for dentists to qualify. As of early 2011, there were no standalone dental EHRs certified for meaningful use, but a few general EHRs had dental modules. Besides the lack of certified systems, it’s difficult for many dental practices to meet the eligibility criteria.

To qualify, 30 percent of a dentist’s patients must be covered by Medicare. Since Medicare does not cover most dental procedures, very few dentists could qualify for the Medicare meaningful use program.

Data from The Centers for Medicare and Medicaid Services shows the minimal impact the meaningful use program has had on adoption at dental practices. As of October 2013, there were a total of 286,771 eligible professionals who registered for the meaningful use incentive program; dentists accounted for only 346 of total registrants. Only 194 dentists have actually received incentive money so far.

Industry insiders have their eyes on Minnesota, which earlier this year became the first state to adopt a mandate that dentists use EHRs. It’s not yet clear what impact the mandate will have, as the law did not include fines or any other enforcement teeth.

Uretz believes it will not solely be state and federal legislative mandates or incentive programs that promote EHR adoption. It will also be a combination of the accountable care concept moving in to dentistry, and the rising demand from patients, he said.

“The cork’s out of the bottle and there’s a big movement now,” Uretz said. “The dental profession is part of the overall organic health care system. You cannot ignore being part of that system.”…

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