Why doctors are unhappy with their EHRs?

An EHR is actually a digital collection of a patient's health records created in one or more consultations in every care delivery system. Many physicians are not happy with their electronic health records. The top EHR vendors are improving various areas of their products’ workflow, usability, UI, load and response times along with the other features that are built to enhance both the user experience and the productivity. However, do the physicians, specialists, and nurses really utilize the EHR any longer than they used to do 5 years ago? Based on a latest study done by the American Medical Association (AMA) along with AmericanEHR Partners, only 34% of doctors stated that they have been pleased or very pleased with their electronic health record in 2014, as compared to 62% in the year 2010.

The study results states that 42% of the doctors believe that their electronic health records capability to enhance efficiency had been challenging to very challenging, 72% think that their electronic health record hardly made any difference to reduce their workload, 54% stated that their electronic health record raised the operating expenses, 43% reported that they had not got over with the workflow challenges regarding their electronic health record. To be eligible for meaningful use incentives, doctors are required to follow given workflows that are not really efficient. Probably users were pleased 5 years back prior to the arrival of the more difficult Stage 2 needs.

Many EHRs usually are not as attractive, intuitive and simple to navigate just as widely used websites such as Facebook & Amazon or even a lot of smartphone applications. Also the many tech-adverse medical professionals are quite used to the slicker interfaces which are traditional with mainstream applications. It could then be one of the reasons why they become annoyed by the EHR's relative clumsiness. Many of the EHRs are very pricey to use and maintain. Doctors usually complain about EHRs being ineffective, affecting the provider-patient relationship and also failing to minimize workflow. In spite of MU incentives, lots of physicians are still not able to have a positive ROI.

The study even explained a direct connection with physician satisfaction along a period of time a doctor utilized the EHR. Like for example, amongst the doctors who have been inducted into the system for 3 years or less, merely 25% claimed some amount of satisfaction. The amount of satisfaction rose to 50% in doctors who have made use of their EHR for 5 or more years. During the last 5 years, adoption of EHR has risen rapidly and also developed a significant growth of new EHR users. Since practices are moving towards digital world today, workflow usually decreases since physicians find it difficult to understand new software and also adapt workflows. Because of the difficulties in using an EHR, it is hardly unusual that early on users were not so satisfied. But if experienced users are usually more satisfied, it appears fair to believe that we are going to notice satisfaction ratings rise in the years to come.

Then again the concern of whether we should worry about physicians not being satisfied with their EHRs. Michelle Ronan Noteboom, Contributing writer for many publications and health IT vendors, mentioned in one of her articles that she is at opinion that doctor satisfaction do matter, although not as much as enhancing the standard of patient care. Patient care is going to be improved once all the providers get access to detailed and accurate documentation. Usually, the records of patient from a provider may integrate with the records by some other provider to make one longitudinal record which is easy to understand and gives a complete picture associated with patient's health history.

Certainly we're nowhere near to getting that goal however the chart notes which the physicians are usually generating in the EHRs these days are giving the foundations for the single, interoperable patient record. Doctors might reason that their usage of EHR has been doing very little to enhance patient care yet such point of view can be a little narrow-minded. Will it matter when physicians don't like their EHRs? Must we make an effort to identify the types of their unhappiness with EHRs and do everything possible which will make physicians happier? Otherwise must we direct your attention towards the patient and devote ourselves in doing whatever it requires getting the aim of the single, interoperable patient record which improves the care quality?

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What are the major issues in using Medical Devices

Medical devices do not work standalone any more. They are at one level part of the networks of providers who use them and at another that of all other networks of all other providers they get connected with; courtesy the phenomena of interoperability and Health Information Exchanges. Under such fast changing circumstances, the impact of incidents of hacking, malware and other cybercrimes related to the devices have the potential of taking gigantic proportions. Is there any one stakeholder who is to be blamed for the majority of the accidents that result out of medical devices? A thorough analysis done reveals that the outcome, which in some cases could be really serious, can have a genesis involving any of the concerned ones. For e.g. the manufacturers could be at fault for not issuing regular updates which they are expected to. Because each patch would require a review by the regulators, they might give it a skip altogether in order to evade the process of going through the grill every now and then. The hospitals might not also report all problems as and when they arise. A classic case in point could be devices running on old versions of operating systems which might get affected by malware but would not get updated with the latest version of an antivirus as it would require a review by the regulator. All such activities are not necessarily in the best interests of the patients at large.

A security breach, when it happens in a medical device is not just an instance of patient information getting jeopardized. Technically, from the perspective of a provider, it becomes a HIPPA liability. From getting the device to malfunction it can clearly put at risk the lives of patients. It is not uncommon to hear of incidents of hacking, malware and cybercrimes leading to disastrous outcomes. What is a matter of real concern is that as HITECH pushes forward with its EHR adoption drive, it will eventually lead to medical devices getting tightly connected to EHRs. It will thus increase the possibility of problems arising out of faulty medical devices taking gigantic proportions. Once the Stage 2 of Meaningful Use goes into effect, the widespread presence of interoperability and health information exchanges can result in one infected medical device corrupting distinct EHRs it eventually gets linked with.

For Healthcare facilities, it is highly important to ensure the following

• ensure that there is no unauthorized access made to medical devices or networks
• track and monitor medical devise and network activity continually for early detection of any infection.
• have in place antivirus and firewall which get updated regularly
• stay in touch with manufacturers to stay updated on any particular risk they are aware of
• have provision to isolate devices in the event of their getting infected
• ensure continuation of activities during adverse events also

Most of the medial devices are built in such a manner that anyone who manages to have access to the password can get into the firmware of the devices and potentially change it. Since cyber and intentional attacks are a reality, a loophole like this can easily be exploited; especially if it has something to do with implantable electronic medical devices such as heart defibrillators and insulin pumps. FDA, on realizing this, has made it mandatory starting next year to have in place an agreement which would mean that only the device makers have the required access to alter the programming logic.

Broad guidelines issued to manufacturers require them

• to limit device access
• ensure that individual components have a high degree of protection
• build provision for quick recovery and retention in the event of breakdowns
• be quick to build security for devices keeping in mind the environment they operate in

Many start-up ventures are quite bullish on the potential medical devices have. This has led to a good amount of innovation in this field. Wearable technology is one area which is seeing a lot of traction with projections of the market reaching approximately $6 billion by the year 2016. However, since getting the regulatory sanctions is a critical element in the equation, and the process is expected to be a tough one, venture funds have not flown in at a desired pace yet. Healthcare software development teams can help you customize medical devices as well as build interactive dashboards for you to analyze the data.

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Major hurdles to Healthcare IT adoption

The Healthcare industry is currently undergoing a metamorphosis which is unprecedented. All the efforts being put in to digitize data is expected to bring in significant changes to the manner in which care is provided. Health Information Technology for Economic and Clinical Health Act was enacted under the American Recovery and Reinvestment Act of 2009, has pushed for the adoption of electronic health records. This has resulted in efforts directed towards innovation in this industry. The intent is to move towards using more evidence-based tools in helping physicians provide better services to their patients. All this is finally expected to result in a smarter healthcare model. However, the entire story looks pretty promising till the issues at hand are considered. The biggest hurdle at this moment, which has the capacity to undermine the entire initiative, is the pace at which the adoption is taking place. The changes in approach which need to be brought in require acceptance and widespread use to ensure that the real benefits are passed on to the patients. Unfortunately there is a lot of inertia amongst physicians against adoption of information technology in their operations. Government is doing its bit by trying to enforce them, through incentives first and planned penalty later, to accept the change. But the real benefits can only be derived if there is a change of heart in the present generation of physicians and the various tools made available at their disposal are used to their fullest extent. The medical schools are doing their bit in making it mandatory for the students to use software tools and devices as part of their curriculum. This will automatically make it possible for them to extend it to their practices because of the familiarity which would have developed. The problem here is that such a phenomena will have a lag time. To ensure that the current population is not denied the benefits or is not made to wait for decade, it is the unwilling bunch of experienced practicing physicians who have to change.

In the current healthcare model the focus is on quantity. Physicians, to run their setups profitably, have to see a large number of patients on a daily basis. They are also badgered by the continual interference of payers who want to call the shots on how patients should be treated. All this has rendered the model effective and unyielding from both the physician as well as the patient perspective. Accountable care Organization is one of the new models which is taking shape as a consequence of these developments. This ties the provider payment to the quality of care and reduction of care cost for an identified population. They are responsible to the patients as well as the payer for the appropriateness, quality and efficiency of care that they provide. They are driven by 3 primary objectives:

• Improved Care
• Improved Health
• Lower per-capita Cost

However, setting up an ACO involves a considerable amount of startup cost and large annual expenses for maintenance. This is where implementation of info systems can be of tremendous benefit – both in terms of reducing the cost as well as improving the quality of care. It is effective IT solutions which can ensure that the physicians receive the best possible information at the right time to enable them to achieve their goals. All this can be done ensuring confidentiality of patient information throughout the processes. But implementation of IT has also had its fair share of challenges which are not completely removed yet. For e.g. an ACO generally has a large number of Primary Care physicians under its wing. each of the setups generally have their home grown EMRs which generally are seen to lack all the functionalities needed to make them comply with Meaningful Use mandates . On handling this issue the next one to surface is generally that of lack of interoperability. As more and more physicians start joining the group ensuring both the above factors is a must. Another issue which came to the forefront was the differing speed of communication at healthcare setups which indirectly affected how fast physicians driven by need could communicate. Clinical software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

We provide healthcare software development services and also have deep experience in healthcare application testing. If you would like to know more about our healthcare domain expertise, please visit us at Mindfire Solutions.

Measures to handle Health IT hazards

Implementation of the Medicare and Medicaid EHR incentive programs has led to widespread adoption of EHRs everywhere. The trigger to all this was with the Obama government encouraging the adoption of Health IT by passing the Recovery Act in 2009. In the year 2011, the Medicare and Medicaid EHR incentive programs made it possible for physicians, hospitals, and other eligible providers to draw incentives for adopting and meaningfully using certified electronic health records. Health IT, besides all the benefits that it is supposed to bring forth, also needs to ensure safety of patients. Understanding the relevance of this area, the federal government has established a communications infrastructure to capture data about IT-related patient safety events. This is expected to hugely benefit the providers since it will result in the right intervention to handle issues when they arise. Thus new systems, when they get implemented, should without fail take into account the safety of patients. Two things hold the key to achieve this; more engagement from the Patient’s end and provision for exchange of patient information among providers. Surveys conducted have indicated some common occurrences of problems which can broadly be categorized to fall under the following heads:

• Information that is very coarse : generic statements
• Information that's too fine : being very specific reduces chances of considering alternatives
• Missing reality : only reports and numbers do not necessarily indicate the actual situation
• Multiplicity : results / analysis from various sources suggesting conflicting information

These are problems which physicians encounter when they deal with Information systems in real time. What needs to be done here is to have a provision for giving feedback to system developers on a regular basis to close the loopholes. Physicians need to be empowered to suggest improvements when they observe problems. Not providing feedback and being operationally efficient in following what the systems prompt can in the long run prove to be a big pitfall for the industry.

Health IT is expected to bring about tremendous benefits to patients care. However since it involves complex technologies, there are high chances of mistakes occurring in its roll out. Information errors comprise a major chunk of the potential hazards of Health IT. From data mismatches to interoperability failures between devices and systems to distractions caused by smartphones and devices, all these have the potential to undo or spoil a lot of the positives of health IT implementation. If we take the last point into account, the event does not seem to be as fatal as the effect it ends up having. In today’s world of BYOD culture, physicians carry their own smartphones and tablets to work. It is quite obvious to have a lot of apps available in these devices in addition to the ones which are required to work with. Since a lot of these apps have live updates etc. it is quite normal to get distracted by them if one were using the device during patient visits with the apps switched on. Apart from the fact that it may lead to mistakes and missing out on relevant information, focusing more on the device might lead to not noticing vital clues in patients affecting the quality of care. The medical schools are trying to address the matted by devising special courses to help the future physicians learn about ways to integrate technology into their workflow without getting distracted or affected in ways which might prove to be detrimental.

Experts in the industry are suggesting ways by which the concern of safety in Health IT can be addressed. One such recommendations is to device a framework which can be rolled out in three phases and get combined with EHR implementation and related Meaningful Use requirements. The important thing to keep in mind is to incorporate safety into training of Healthcare providers and also into certification of software products. The software developers involved in developing these complex systems also need to be involved and explained their need to share responsibility for the safety. Finally measures should be taken to ensure that physicians find it easy and convenient to share their feedback and concerns whenever they want to. Nothing can be more vital than their feedback. Healthcare software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

We provide healthcare mobile app development services. To know more about the expertise of our Healthcare software developers, please visit Mindfire Solutions.