While working on a 2-year pilot project in a Federally Qualified Health Center, we had the opportunity to experience the organization transitioning from one EHR system to another. Being a software company ourselves, we were able to watch that process from a perspective that may have been a little different than our other healthcare colleagues.
The entire transition between EHRs was a complete nightmare that led to a great deal of strife in the company (and our pilot.) We watched morale drop, workflow diminish and more than one provider and some employees left to find other employment.
History of Healthcare Information Technology
Despite the fact that Electronic Health Records have been around since the 1960s, as of 2016 only 62% of primary care providers had adopted EHR systems that meet meaningful use requirements. Since the early 1990s, there has been a call for overall adoption of EHRs but it wasn’t until the incentives provided as part of the 2009 American Recovery and Reinvestment Act (ARRA), that we have seen a noticeable increase in utilization. Unfortunately, the quick increase brought on by these incentives also highlighted a lot of problems. For example a study published in Mayo Clinic Proceedings found that the digital aspect of primary care, like maintaining electronic health records, was linked to physician burnout. Our experience working in healthcare and seeing the daily frustrations of providers and staff corroborates the study’s findings.
EHR technology initially started as a way to increase reimbursement through better billing practices and productivity. That technology has gradually morphed into today’s modern EHR which ideally promises better productivity, data capture for population health, and better patient care. Even big brother bought into this idea and dedicated billions of tax dollars that have been awarded as incentives through (ARRA/HITECH). Not only is EHR technology still promoted, but the passage of MACRA basically requires Medicare providers to use a qualified EHR by 2019 or face up to a 9% penalty.
Healthcare Technology Evolution Hindered
Unfortunately, the promise of Electronic Health Records technology has been hindered by software programs that are complicated, cumbersome and difficult to maneuver. Studies have shown that providers spend 50% or more of their time working on tech-related issues. This means that less than half of their time is devoted to providing actual patient care. Much of this can be attributed to providers being forced to double-chart and more recently struggling with EHR systems that don’t effectively correlate the documentation required to meet quality measures. For example, if a physician documents a quality-related response correctly, but does so in a field or page not specifically recognized by the EHR for that quality measure, then it doesn’t count toward their measures.
There are software programs available for practically anything you can think of related to healthcare, but this just adds one more layer on top of the necessary EHR documentation. Many of these non-EHR programs work extremely well, but are hampered by the lack of interoperability with EHRs which rarely allow outside programs to share data. When they do allow operability, they frequently charge exorbitant sums to do so making it unaffordable for both the practice and software company. Probably the most hindering element of modern EHR services is that except for limited CCD reports, most EHR’s don’t share data with each other and that limitation brings about a whole plethora of additional problems.
All of us have had patients come in and say “It’s all in your computer” yet we were unable to find any of the relevant information because they were seen at a different facility or clinic. Sometimes patients have used a home monitoring device and want to share that information with their provider but there is no way to capture that information in a meaningful way. We have seen lots of hype and promise from healthcare IT, but very little has actually come to fruition. Too much data is just as worthless as too little data, since Electronic Health Records don’t organize data formulated outside their system, very little of this data is usable by healthcare providers.
Information Technology Fatigue
Needless to say, these issues have given healthcare based technology a black eye. The fact is, healthcare workers are burned out and fatigued by technology. This a serious concern considering that we need technology more than ever to solve the always evolving problems facing our national healthcare system.
Our company has been especially affected by this technology failure. We have a vested interest in understanding this phenomenon and have been forced to examine and get to the bottom of the problem. Navigating this issue is what led to our pilot studies and through that study, as well as discussions with various other healthcare providers, we have identified this problem as Information Technology Fatigue (IT Fatigue.) Our efforts are now in figuring out how to minimize the affects of IT Fatigue so providers and staff can focus on what they do best: patient care.
IT Fatigue is a major debilitating problem in healthcare. Not only because it contributes to burnout and overall stress and strife among providers and staff, but also because it deters providers from utilizing new technologies that could help them solve serious issues and concerns such as quality improvement measures, improving preventive services and improving patient outcomes. In other words, IT Fatigue leads the providers away from solutions that could ultimately decrease their burdens. For many, if not most, all technology has been lumped together in one pile and just considered bad technology.
What Can Be Done?
When speaking with colleagues about IT fatigue, the discussion usually goes toward a frustrated responsive question, “What should be done, just get rid of technology in healthcare altogether?” The answer is, of course, No. We must admit there is a problem, then we need to take the steps necessary to improve the technology. While in the trenches, it is often easy to forget that in other aspects of technology adoption, these problems are addressed through a more natural adoption process starting with early adopters and working out a lot of the issues before the majority adopts the technology. It is true that EHR technology followed a similar adoption process but when the incentives and requirements kicked in, the pace of adoption drastically increased without the natural time to address improvement and performance issues along the way. There is no blame to focus on anyone, especially all of the technology companies that are trying hard to keep up with demand, but before we progress much further we must pause, assess and fix the existing problems.
Holding Medical Technology To A Higher Standard
Perhaps holding technology companies to a higher standard, such as going through a modified form of evidence based research to show the offering is actually beneficial to the practice and the patient, would be appropriate before thrusting it into the healthcare system. It is imperative that technologies have adequate time to mature and improve, especially if that technology is involved in the care of patients. Following the technology adoption process (from early adopters to majority use) should be expected, and even demanded in the healthcare technology field. We should also consider that allowing a few large companies to monopolize this process is premature. Google didn’t become the primary search engine worldwide because it had the support of government funds, it became a success because it had the best and easiest system developed through the technology adoption process. (Remember Yahoo, Ask Jeeves, and Archie?) Even now, Google is continuously being improved to stay in the forefront. That is the same process we need in healthcare.
Let’s consider shifting the process and encouraging Uncle Sam to switch its incentives away from rewarding inefficient software companies to supporting those that increase operability and ease of use. If EHRs were rewarded for being more efficient or for supporting innovative software from smaller more nimble companies we could have a healthcare IT system designed for the future and more integrated for ease of use. With that approach, it is very likely that we’d see a decrease in IT Fatigue. Of course, what is certain is that if we don’t fix these issues soon, we could create a disaster that may eventually undo the benefits of healthcare technology that we have worked so hard and spent so much to create.