Docs may be using IT, but they don't love it

March 10, 2009 | Molly Merrill, Associate Editor

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TAMPA, FL – A recent survey finds that although more physician leaders are using healthcare information technology, they still find it clunky and unresponsive to their needs.

The survey, by the American College of Physician Executives, polled 1,000 ACPE members and provides new findings from a similar study that ACPE conducted in 2004.

The findings include:

• More than 64 percent of respondents said they use electronic medical records, up from 33 percent in 2004.

• About 44 percent said their organization uses computerized order entry, while only about 33 percent used CPOE five years ago.

• More than 38 percent said they use pharmaceutical bar coding, up from 20 percent in 2004.

Though the increase in technology has risen since the 2004 survey, the new survey revealed that physicians' attitudes have not improved.

One physician said adopting electronic medical records has been "the worst aspect of my 25 years in medicine. It has ruined doctor productivity, produced lower quality care and encouraged notes that are false to the point of fraud."

Respondents complained the systems are still too clunky, too hard to use and too poorly developed.

One respondent likened implementing a computer system to ordering a sleek Corvette and being delivered a box filled with Corvette parts.

The survey revealed that the biggest source of frustration is a lack of input from physicians when designing and implementing healthcare information technology systems. Many said involving clinicians at the planning stages would pre-empt many of the problems that crop up later.

"There seems to be too little physician involvement in planning. There is no well-thought-out plan of how technology can be utilized to optimize workflow or improve efficiency. Systems are chosen according to administrative criteria rather than what physicians need to get the job done," said one respondent.

According to the survey, Albert Villarin, MD, chief medical information officer for the Albert Einstein Healthcare Network in Philadelphia, believes the healthcare industry is still experiencing so many difficulties because of the cost issue.

"Many institutions can't afford to buy the level of quality and integrity with a global system for an entire network. We're talking hundreds of millions of dollars in a large market," he said.

Reader Comments (3)Login to Post a Comment

chris@ctek says: No Love for IT

March 16, 2009 | 2:27PM GMT

I agree with most of the statements made here, but there are examples of healthcare organizations making great strides in bridging the gap between clinical staff and IT, while greatly reducing the pain associated with technology use at the point of care. I acknowledge that a lot of the positive press seems like administrative “spin” or marketing hype, yet I can say from my own experience that there are proven ways doctors and nurses can collaborate with IT to find effective cures for most of what ails electronic access today.

When select medical staff personnel are willing to act as “technology advocates” and provide constructive workflow insight to technology individuals, who are truly acting as physicians liaisons, not just because their title says that, genuine solutions begin to take shape. In addition, when IT shops are progressive and courageous enough to partner with outside firms that have focused expertise and skill sets they may not possess, these solutions can be brought to bear in a fraction of the time and at pennies on the dollar compared to the initial EMR roll-out. At a glance, solutions of this type can provide the following benefits:

• Access to patient records in seconds, not minutes
• Time savings of up to two hours in daily rounds or shifts
• Customized workflows that follow you
• Shorter discharge times and faster billing
• Space, cost and energy savings by deploying less devices at the point of care

This is not intended to sound like a commercial, it is intended to be a true solution the problem. What’s available may not solve all the issues, but I’ve heard doctors and nurses say it has greatly improved their work experience. The biggest hurdle is the unwillingness of healthcare professionals and IT staff to come together to create the best care environment possible. Somebody has to be the first to extend the olive branch.

Chris Nooe
Coretek Services
www.coretekservices.com

scotsilv says: Mission Hostile User Experience

March 11, 2009 | 11:54AM GMT

People in my field, Medical Informatics, have been writing this for a long time.

In my case, a decade. See my site at http://tinyurl.com/hit-misadventure and my recent posts on health IT's mission hostile user experiences at http://tinyurl.com/hostileuserexper .

In other cases, people in this field have been writing on this for decades.

As far back as 1969, EMR and Medical Informatics pioneer Donald A. B. Lindberg, M.D., now Director of the U.S. National Library of Medicine at NIH, made the following observation. He wrote that "computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems…in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information" (Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21).

Only an industry lost in arrogance and unaccountability, and physicians demoralized into a state of (as one lawyer termed it) "learned helplessness" could create such a scenario.

Physicians should refuse to use Health IT that has not undergone documented, rigorous user experience testing and that might have hundreds or thousands of unremediated defects and deficiencies that healthcare systems may be contractually obligated not to disclose.

Interestingly, at yesterday's Health Affairs-sponsored health IT summit in Washington, DC, the only speaker who even mentioned the deficient health IT user experience and the need to improve it was self-described "only a software guy" of Microsoft, Peter Neupert. He mentioned the issue almost in passing during his talk.

When I spoke to him afterward, he did not seem to understand the criticality of the point he made, even when I reminded him of how much time and resource Microsoft devotes to improving the user experience of its operating systems.

In fact, the sine qua non of health IT is the enabler of healthcare, the clinician. Health IT that presents a poor user experience is not optimally helping healthcare enablers, healthcare facilitators (i.e., everyone else in healthcare who does not see patients), payers, and the "customers" of healthcare, namely, all of us.

S. Silverstein
MedInformaticsMD

Foundation for Integrity and Responsibility in Medicine (FIRM)
http://hrenewal.blogspot.com

anonMD says: Interface design

March 10, 2009 | 6:54PM GMT

The one thing physicians want, and IT programmers and purchasers hate, is the ability to write freehand input. Ideally, docs want to set up their own templates, personalized according to their style of patient interviewing and which can then be varied according to the patient's info and findings, and chenges over time in exam techniques.

Hospital administrators hate that notion, because they want to be able to pigeonhole everything into checkboxes and boolean statements so that they can "drill down" later with data mining software. Since the hospital administrators pay the bills, they get what they want, except that they often fail to realize that they start a GI-GO cycle in the process.

The process is similar with e-prescribing. Hospital's often customize the software to fit a specific formulary, without allowing exceptions. Physicians don't function that way - drugs can and often are used off-label and different pts, with or without different combinations of diseases, respond unequally to the same drug.

The worst case scenario is when the software forces the physician to lie, and it occurs with some frequency. Since physicians are so malpractice "aware", they will write notes, when possible, explaining that the computer entries are not correct. These notations are malpractice time bombs, waiting for the wrong attorney to go digging deep into the record to find a problem which paints the hospital, and the software, in a very negative light.

Quality patient care and cheap hospital operations present conflicting realities. Neither side wins when the software doesn't make concessions to each.