The Physician Productivity Hit

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1 WHITE PAPER The Physician Productivity Hit Addressing the Efficiency Failures and Design Flaws of EHR Systems in Medical Practices

2 Abstract Immediate and dramatic loss of productivity is one of the most significant challenges that medical practices face following EHR implementation. The unintuitive user interface design, inefficient interfaces and rigid workflows have been shown to significantly hinder physicians abilities to fulfill their primary objective--patient care. With the implementation of EHRs, the administrative burden has shifted from support staff to physicians, impeding patient satisfaction, backing up current patient visits and reducing a practice s ability to accept new patients. And yet, these administrative tasks are essential daily tasks, from both revenue and compliance standpoints. The Problem Usability is defined by the International Organization for Standardization (ISO) as the effectiveness, efficiency, and satisfaction with which the intended users can achieve their tasks in the intended context of product use. Anecdotal support for the early usability failures of EHR comes from Cedars-Sinai Medical Center in Los Angeles. The hospital developed a $34 million EHR and launched it in Physicians who had previously documented using paper charts were suddenly required to go through nearly a dozen screens and respond to numerous alerts for even common orders. Usability issues with the unintuitive, over-complicated interface caused more than 400 doctors to demand its removal within three months of its launch. 1 2

3 And yet, years later, these usability issues have not been addressed. In 2009, the Healthcare Information and Management Systems Society (HIMSS) noted EHR adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. The key reasons: not only initial costs and lost productivity during EMR implementation, but the lack of efficiency and usability of EHRs currently available. 2 In September 2011, the U.S. National Institute of Standards and Technology of the Department of Commerce released a study on EHR usability and found that physicians were reporting an even greater number of issues, suggesting that EHR company attempts to address clunky interfaces have only made usability issues proliferate 3 : Some EHR workflows do not match clinical processes and create inefficiencies Poorly designed EHR screens slow down the user and sometimes endanger patients Large numbers of files containing historical patient information are difficult to search, navigate, read efficiently, and identify trends over time Warning and error messages are confusing and often conflicting Alert fatigue (both visual and audio) from too many messages leading to users ignoring potentially critical messages Frustration with what is perceived as excessive EHR user interaction (mouse clicks, cursor movements, keystrokes, etc.) during frequent tasks. In an interview 4, Howard R. Weeks, MD, Assistant Professor of Child & Adolescent Psychiatry at the Child & Adolescent Psychiatry department of a large academic institution noted that their department took a productivity hit immediately. It reached the point where patient notes were not being completed for up to 30 days after a patient had been discharged. The reported end result across all practices: physician frustration and increasing levels of noncompliance. In 2012, a study from KLAS 5 found that half of practices that already own an EHR are looking to replace their existing system because they can t get the support they need or the functionality they expected. Case Study Physicians at the Child & Adolescent Behavioral & Mental Health Services unit of a large university hospital wanted to leverage the power of their EHR without compromising patient care or billing cycle efficiency Challenges: Streamline the complexity of the existing EHR Reduce patient documentation time Increase administrative and regulatory compliance Solution Seamlessly integrate TalkChart into the already-existing EHR Personalize the implementation for each individual physician Provide comprehensive, hands-on training for ongoing customization Result Workflows are streamlined Significant reductions in documentation noncompliance Errors and missing information decreased Drop of 30-60% in dictation costs Increase in number of patients and quality of visits The on-the-fly adaptability of TalkChart transformed how physicians worked with their EHR and managed patient care. Notes are delivered to the EHR faster, the insurance authorizes the stay faster, patient care improves when treatments are approved faster, and doctors get paid for their time. 3

4 Addressing the Problem The usability issues of current EHRs need to be addressed head-on. Doctors need ways to reinstate or even boost productivity levels, improve turnaround time, and significantly reduce errors--to harness the original promise of the EHR system. At its core, an EHR solution should essentially allow the user and the EHR to do what they each do best. Complying with regulatory issues and getting paid is the essential core of the administrative work doctors are required to complete. But conventional EHRs are designed to meet the complex documentation needs of all physicians across all disciplines, enforcing a specific workflow that follows the rails set in place by the programmers who designed the system. This results in a complex system that offers densely populated screens, multitudes of icons and stacked menus to address every possible contingency, and endless checkboxes. They are intended to automate the system and speed a physician s documentation, but study after study shows those dramatic increases in dissatisfaction across practices and specialties. Current EHRs are not user-preference centric. They do not recognize the vast array of differences in physician workflows, not only between specialties but within a single practice. One doctor may type, another dictate, another may still rely on paper documentation. And the only way to fully address usability issues is to design a system that takes into account and fully supports the device the user prefers, the input mode he or she is using, and be agile enough to facilitate switching between these modalities as the situation changes. The ultimate function of EHR software is to make accurate data entry as simple as possible at the point of patient service. Current EHRs are not up to the task. This results in a complex system that offers densely populated screens, multitudes of icons and stacked menus to address every possible contingency, and endless checkboxes. 4

5 The TalkChart Solution TalkChart is designed specifically to address the documented usability issues of EHRs. A web-based, structured electronic documentation platform that seamlessly integrates into existing EHRs, the TalkChart interface makes rigid, inflexible EHR systems fully adaptable. Workflow and Flexibility. TalkChart allows a physician to take advantage of the most efficient way to complete a task at any given time. A physician utilizes whatever combination of methods is more efficient for a particular encounter, be it direct typing, voice recognition, on-demand dictation, previous visit history, or individually personalized common phrases and shortcuts. Customizable User Interface. The TalkChart interface is designed to be easy to look at and easy to use. It s intuitive out of the box, but each TalkChart implementation is customized and personalized to each individual practitioner. Physicians are given the power to easily add the common phrases they use every day on the fly and save those changes immediately, without having to submit a support request. This makes the interface customizable on an as-needed basis. Metrics. The TalkChart dashboard is an innovation in productivity metrics. It is a reporting system that allows not only administrators but also physicians to analyze patient documentation efficiencies. The easy-to-use metrics allow macro comparisons among physicians, but also offer the ability to drill down into the data and compare the efficiency between a combination of physicians and workflows. This 5

6 allows physicians to analyze their workflow patterns against colleagues by measuring the time spent per note type, how much they are dictating versus not, the cost efficiency of documentation, and how many patients they are seeing. Auditing and Compliance. With the ability to pull in history as a data element, versus copy and pasting or cloning previous notes, physicians gain an extra level of compliance. Since patient history is added deliberately to a new note, rather than history being duplicated from an old note, audit and regulatory compliance is maintained. Conclusion EHRs are cumbersome, inflexible and not changing any time soon. TalkChart s unique software solution essentially transforms the current EHR system into a fully customizable productivity solution. Doctors work the way that suits them best, spend more time with their patients, stay compliant, and get out the door on time every night. How can TalkChart help you transform your EHR system productivity? Learn more now. Contact: EvolveMed Andrea Jaques, Business Development Manager Phone: x

7 1 Ceci Connolly. Cedars-Sinai Doctors Cling to Pen and Paper. Washington Post. March <http://www. washingtonpost.com/wp-dyn/articles/a mar20.html> 2 HIMSS EHR Usability Task Force. Defining and Testing EMR Usability. Healthcare Information and Management Systems Society (HIMSS), June <http://www.himss.org/files/himssorg/content/files/himss_ definingandtestingemrusability.pdf> 3 National Institute of Standards and Technology. Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records. September <http://www.nist.gov/healthcare/usability/upload/draft_ EUP_09_28_11.pdf> 4 Personal Interview. Howard R. Weeks, MD, Assistant Professor of Child & Adolescent Psychiatry. 5 KLAS Research. Ambulatory EMR 2012: Market Splitting Under Adoption Pressure. June <http://www. klasresearch.com/klasreports> 7

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