Disclosures

bull Co-Inventor

bull HughesRiskApps

ndash httpwwwHughesRiskAppsNet

bull Speaker

ndash Myriad Genetics

bull Breast Cancer Surgeon

Documentation in the Era of Pay-for-Performance Information Technology and EHR Update

EHRs are Document Management Systems

hellipa computer system used to track and store electronic documents

Definition From Wikipedia

The EHR organizes huge numbers of documents linked to individual patients and makes them accessible anywhere

EHR

Generic Interface Mostly a Glorified Filing Cabinet (Document Management System)

Minimal Database

Meds Allergies

Minimal Generic Clinical Decision

Support

EHR vendors have great expertise in Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

And yet the government has given EHR vendors full control of Health Information Technology

ldquoMeaningfulrdquo Use bull $36000000000 of your and your

childrenrsquos money

ndash hellipto hospitals and eligible professionals to adopt and meaningfully use electronic health records

In defining who gets paid and who gets penalized the government is centrally dictating what functionality

EHRs will have

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

Documentation in the Era of Pay-for-Performance Information Technology and EHR Update

EHRs are Document Management Systems

hellipa computer system used to track and store electronic documents

Definition From Wikipedia

The EHR organizes huge numbers of documents linked to individual patients and makes them accessible anywhere

EHR

Generic Interface Mostly a Glorified Filing Cabinet (Document Management System)

Minimal Database

Meds Allergies

Minimal Generic Clinical Decision

Support

EHR vendors have great expertise in Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

And yet the government has given EHR vendors full control of Health Information Technology

ldquoMeaningfulrdquo Use bull $36000000000 of your and your

childrenrsquos money

ndash hellipto hospitals and eligible professionals to adopt and meaningfully use electronic health records

In defining who gets paid and who gets penalized the government is centrally dictating what functionality

EHRs will have

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

EHRs are Document Management Systems

hellipa computer system used to track and store electronic documents

Definition From Wikipedia

The EHR organizes huge numbers of documents linked to individual patients and makes them accessible anywhere

EHR

Generic Interface Mostly a Glorified Filing Cabinet (Document Management System)

Minimal Database

Meds Allergies

Minimal Generic Clinical Decision

Support

EHR vendors have great expertise in Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

And yet the government has given EHR vendors full control of Health Information Technology

ldquoMeaningfulrdquo Use bull $36000000000 of your and your

childrenrsquos money

ndash hellipto hospitals and eligible professionals to adopt and meaningfully use electronic health records

In defining who gets paid and who gets penalized the government is centrally dictating what functionality

EHRs will have

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

EHR

Generic Interface Mostly a Glorified Filing Cabinet (Document Management System)

Minimal Database

Meds Allergies

Minimal Generic Clinical Decision

Support

EHR vendors have great expertise in Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

And yet the government has given EHR vendors full control of Health Information Technology

ldquoMeaningfulrdquo Use bull $36000000000 of your and your

childrenrsquos money

ndash hellipto hospitals and eligible professionals to adopt and meaningfully use electronic health records

In defining who gets paid and who gets penalized the government is centrally dictating what functionality

EHRs will have

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

And yet the government has given EHR vendors full control of Health Information Technology

ldquoMeaningfulrdquo Use bull $36000000000 of your and your

childrenrsquos money

ndash hellipto hospitals and eligible professionals to adopt and meaningfully use electronic health records

In defining who gets paid and who gets penalized the government is centrally dictating what functionality

EHRs will have

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

EHR vendors lack expertise inhellip bull Usability

ndash Context specific interfaces

bull Clinical Decision Support

bull Population Health

bull Workflow solutions

bull Interoperability

bull Structured data

bull And ndash hellipmost everything else except Document Management

And yet the government has given EHR vendors full control of Health Information Technology

ldquoMeaningfulrdquo Use bull $36000000000 of your and your

childrenrsquos money

ndash hellipto hospitals and eligible professionals to adopt and meaningfully use electronic health records

In defining who gets paid and who gets penalized the government is centrally dictating what functionality

EHRs will have

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

ldquoMeaningfulrdquo Use bull $36000000000 of your and your

childrenrsquos money

ndash hellipto hospitals and eligible professionals to adopt and meaningfully use electronic health records

In defining who gets paid and who gets penalized the government is centrally dictating what functionality

EHRs will have

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

Meaningful Use Objective Provide each patient with a visit summary that provides

relevant and actionable information and instructions Medication list allergies vitals reason(s) for visit procedures and other instructions

based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

If the certified EHR cannot populate all of these fields then at a minimum

Medication list allergies vitals reason(s) for visit procedures and other instructions based on clinical discussions that took place during the office visit problem list immunizations or medications administered during visit summary of topics coveredconsidered during visit time and location of next appointmenttesting if scheduled list of other appointments and tests that the patient needs to schedule with contact information recommended patient decision aids laboratory and other diagnostic test orders testlaboratory results and symptoms

Because EHRs certified by the government lack functionality a visit summary does not need to include a summary of the visit

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

Too much hype and cheerleading from the government and administrators

A lot of wishful thinking bullEHRS willhellip bullEHRs shouldhellip bullWhen EHRs dohellip bullEHRs have tremendous potentialhellip

Reality check

EHRs

bull The Promise

ndash Increase efficiency

ndash Decrease MD workload

ndash Decrease staff workload

ndash Improve quality of care

ndash Decrease cost

ndash Share data with other hospitals

ndash See Notes anywhere

EHRs

bull The Promise

ndash Increase efficiency

ndash Decrease MD workload

ndash Decrease staff workload

ndash Improve quality of care

ndash Decrease cost

ndash Share data with other hospitals

ndash See Notes anywhere

bull The reality EHRs

ndash Decrease efficiency

ndash Increase MD workload

ndash Decrease some staff

ndash Increase workload of remaining staff

ndash Quality decreased

ndash Increase cost

ndash Lack of interoperability or even intraoperability

ndash See Notes anywhere

Decrease efficiency

bull Before using an EHR I routinely saw 30-32 patients a day Now I am exhausted at 20-25 because of the EHR

Dr Nan Nuessle (DrNanN) ndash HITsm Spotlight

EHRs

bull The Promise

ndash Increase efficiency

ndash Decrease MD workload

ndash Decrease staff workload

ndash Improve quality of care

ndash Decrease cost

ndash Share data with other hospitals

ndash See Notes anywhere

bull The reality EHRs

ndash Decrease efficiency

ndash Increase MD workload

ndash Decrease some staff

ndash Increase workload of remaining staff

ndash Quality decreased

ndash Increase cost

ndash Lack of interoperability or even intraoperability

ndash See Notes anywhere

Decrease efficiency

bull Before using an EHR I routinely saw 30-32 patients a day Now I am exhausted at 20-25 because of the EHR

Dr Nan Nuessle (DrNanN) ndash HITsm Spotlight

Decrease efficiency

bull Before using an EHR I routinely saw 30-32 patients a day Now I am exhausted at 20-25 because of the EHR

Dr Nan Nuessle (DrNanN) ndash HITsm Spotlight

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

Medical interns spent

ndash 12 of their time talking to patients

ndash 40 of their time doing electronic paperwork

J Gen Intern Med 2013 28(8)1042-7

Increase cost

bull More complete coding means higher charges

Increase cost

bull More complete coding means higher charges

ndash Office of the Inspector General report warns that electronic medical records could contribute to Medicare fraud

Increase MD workload

ndash Shift work from lower paid employees to higher paid MDs

bull If you type your own notes you can get rdi of transcriptionists

bull If you enter your own billing information on each patient you can get rid of a billing data entry clerk

bull hellipSo if you clean your own exam rooms you can get rid of your houeskeepers

ndash Mouse clicking and data entry to no purpose

Increase workload of remaining staff

bull Rooming a new patient helliptakes over 10 minutes because of all the data entry involved

ndash used to take 2-4 minutes

An Interview with Dr Nan Nuessle (DrNanN) ndash HITsm Spotlight Posted 31 Oct 2012 1002 AM PDT

Increase cost

bull More complete coding means higher charges

Increase cost

bull More complete coding means higher charges

ndash Office of the Inspector General report warns that electronic medical records could contribute to Medicare fraud

Increase MD workload

ndash Shift work from lower paid employees to higher paid MDs

bull If you type your own notes you can get rdi of transcriptionists

bull If you enter your own billing information on each patient you can get rid of a billing data entry clerk

bull hellipSo if you clean your own exam rooms you can get rid of your houeskeepers

ndash Mouse clicking and data entry to no purpose

Increase workload of remaining staff

bull Rooming a new patient helliptakes over 10 minutes because of all the data entry involved

ndash used to take 2-4 minutes

An Interview with Dr Nan Nuessle (DrNanN) ndash HITsm Spotlight Posted 31 Oct 2012 1002 AM PDT

Increase cost

bull More complete coding means higher charges

ndash Office of the Inspector General report warns that electronic medical records could contribute to Medicare fraud

Increase MD workload

ndash Shift work from lower paid employees to higher paid MDs

bull If you type your own notes you can get rdi of transcriptionists

bull If you enter your own billing information on each patient you can get rid of a billing data entry clerk

bull hellipSo if you clean your own exam rooms you can get rid of your houeskeepers

ndash Mouse clicking and data entry to no purpose

Increase workload of remaining staff

bull Rooming a new patient helliptakes over 10 minutes because of all the data entry involved

ndash used to take 2-4 minutes

An Interview with Dr Nan Nuessle (DrNanN) ndash HITsm Spotlight Posted 31 Oct 2012 1002 AM PDT

Increase MD workload

ndash Shift work from lower paid employees to higher paid MDs

bull If you type your own notes you can get rdi of transcriptionists

bull If you enter your own billing information on each patient you can get rid of a billing data entry clerk

bull hellipSo if you clean your own exam rooms you can get rid of your houeskeepers

ndash Mouse clicking and data entry to no purpose

Increase workload of remaining staff

bull Rooming a new patient helliptakes over 10 minutes because of all the data entry involved

ndash used to take 2-4 minutes

An Interview with Dr Nan Nuessle (DrNanN) ndash HITsm Spotlight Posted 31 Oct 2012 1002 AM PDT

Increase workload of remaining staff

bull Rooming a new patient helliptakes over 10 minutes because of all the data entry involved

ndash used to take 2-4 minutes

An Interview with Dr Nan Nuessle (DrNanN) ndash HITsm Spotlight Posted 31 Oct 2012 1002 AM PDT

Lack of interoperability or even intraoperability

bull EHRs cannot share data outside of a hospital system ndash I have never received electronic EHR notes

bull How can EHRs share data between hospitals when EHRs canrsquot even talk to themselves ndash If path report in EHR says breast cancer 2 cm node

negative staging and problem list are blank bull Read report

bull Open staging section and enter stage 1

bull Open problem list and enter breast cancer

What do EHRs have to do with documentation for pay for performance Almost nothing

TRACS

STS

ACS-Bariatric Surgery Center Network

NSQIP

Cancer Registry

STS

TransplantUNOS

Emergency Surgery

VSGN

SVS Vascular Registry

Mastery of surgery

Courtesy of Matt Hutter

Outcomes databases Almost all data is manually entered

The Party Line How to increase EHR adoption

bull Regulations that require EHR use

bull Less pay for not using the EHR

bull Extra pay for using the EHR

The Party Line How to increase EHR adoption

bull Regulations that require EHR use

bull Less pay for not using the EHR

bull Extra pay for using the EHR

In every other industry software is adopted voluntarily because it adds value

Conclusion bull EHRs have value as Document Management

Systems

bull Good HIT can improve medical care

bull EHRs being sold for purposes beyond document management ndash Increase cost

ndash Increase workload

ndash Decrease efficiency

ndash Decrease quality of care

Charles Babbagersquos Analytical Engine bull The British government

bull Began funding in 1823

bull Pulled the plug in 1842

ndash ₤17000 ($82151820 today)

bull Without receiving a working engine

Charles Babbagersquos Analytical Engine

bull The British government

ndashBegan funding in 1823

ndashPulled the plug in 1842

bull ₤17000 ($82151820 today)

ndashWithout receiving a working engine

You could say it was the first failed government IT projectldquo (BBC)

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

What do EHRs have to do with documentation for pay for performance Almost nothing

TRACS

STS

ACS-Bariatric Surgery Center Network

NSQIP

Cancer Registry

STS

TransplantUNOS

Emergency Surgery

VSGN

SVS Vascular Registry

Mastery of surgery

Courtesy of Matt Hutter

Outcomes databases Almost all data is manually entered

The Party Line How to increase EHR adoption

bull Regulations that require EHR use

bull Less pay for not using the EHR

bull Extra pay for using the EHR

The Party Line How to increase EHR adoption

bull Regulations that require EHR use

bull Less pay for not using the EHR

bull Extra pay for using the EHR

In every other industry software is adopted voluntarily because it adds value

Conclusion bull EHRs have value as Document Management

Systems

bull Good HIT can improve medical care

bull EHRs being sold for purposes beyond document management ndash Increase cost

ndash Increase workload

ndash Decrease efficiency

ndash Decrease quality of care

Charles Babbagersquos Analytical Engine bull The British government

bull Began funding in 1823

bull Pulled the plug in 1842

ndash ₤17000 ($82151820 today)

bull Without receiving a working engine

Charles Babbagersquos Analytical Engine

bull The British government

ndashBegan funding in 1823

ndashPulled the plug in 1842

bull ₤17000 ($82151820 today)

ndashWithout receiving a working engine

You could say it was the first failed government IT projectldquo (BBC)

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

The Party Line How to increase EHR adoption

bull Regulations that require EHR use

bull Less pay for not using the EHR

bull Extra pay for using the EHR

The Party Line How to increase EHR adoption

bull Regulations that require EHR use

bull Less pay for not using the EHR

bull Extra pay for using the EHR

In every other industry software is adopted voluntarily because it adds value

Conclusion bull EHRs have value as Document Management

Systems

bull Good HIT can improve medical care

bull EHRs being sold for purposes beyond document management ndash Increase cost

ndash Increase workload

ndash Decrease efficiency

ndash Decrease quality of care

Charles Babbagersquos Analytical Engine bull The British government

bull Began funding in 1823

bull Pulled the plug in 1842

ndash ₤17000 ($82151820 today)

bull Without receiving a working engine

Charles Babbagersquos Analytical Engine

bull The British government

ndashBegan funding in 1823

ndashPulled the plug in 1842

bull ₤17000 ($82151820 today)

ndashWithout receiving a working engine

You could say it was the first failed government IT projectldquo (BBC)

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

The Party Line How to increase EHR adoption

bull Regulations that require EHR use

bull Less pay for not using the EHR

bull Extra pay for using the EHR

In every other industry software is adopted voluntarily because it adds value

Conclusion bull EHRs have value as Document Management

Systems

bull Good HIT can improve medical care

bull EHRs being sold for purposes beyond document management ndash Increase cost

ndash Increase workload

ndash Decrease efficiency

ndash Decrease quality of care

Charles Babbagersquos Analytical Engine bull The British government

bull Began funding in 1823

bull Pulled the plug in 1842

ndash ₤17000 ($82151820 today)

bull Without receiving a working engine

Charles Babbagersquos Analytical Engine

bull The British government

ndashBegan funding in 1823

ndashPulled the plug in 1842

bull ₤17000 ($82151820 today)

ndashWithout receiving a working engine

You could say it was the first failed government IT projectldquo (BBC)

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

Conclusion bull EHRs have value as Document Management

Systems

bull Good HIT can improve medical care

bull EHRs being sold for purposes beyond document management ndash Increase cost

ndash Increase workload

ndash Decrease efficiency

ndash Decrease quality of care

Charles Babbagersquos Analytical Engine bull The British government

bull Began funding in 1823

bull Pulled the plug in 1842

ndash ₤17000 ($82151820 today)

bull Without receiving a working engine

Charles Babbagersquos Analytical Engine

bull The British government

ndashBegan funding in 1823

ndashPulled the plug in 1842

bull ₤17000 ($82151820 today)

ndashWithout receiving a working engine

You could say it was the first failed government IT projectldquo (BBC)

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

Charles Babbagersquos Analytical Engine bull The British government

bull Began funding in 1823

bull Pulled the plug in 1842

ndash ₤17000 ($82151820 today)

bull Without receiving a working engine

Charles Babbagersquos Analytical Engine

bull The British government

ndashBegan funding in 1823

ndashPulled the plug in 1842

bull ₤17000 ($82151820 today)

ndashWithout receiving a working engine

You could say it was the first failed government IT projectldquo (BBC)

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

Charles Babbagersquos Analytical Engine

bull The British government

ndashBegan funding in 1823

ndashPulled the plug in 1842

bull ₤17000 ($82151820 today)

ndashWithout receiving a working engine

You could say it was the first failed government IT projectldquo (BBC)

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED

Robert G Hill Jr MD Lynn Marie Sears MBA Scott W Melanson MD

bull ER Docshellipspent 43 of their time entering data into a computer

bull Total mouse clicks approach 4000 during a busy 10-hour shift

Am J Emerg Med 201331(11)1591-4

In the wake of the 2003 and 2011 duty hours regulations how do internal medicine interns spend their time

Block L1 Habicht R Wu AW Desai SV Wang K Silva KN Niessen T Oliver N

Feldman L

bull Medical interns spent

ndash 12 of their time talking to patients

ndash 40 of their time doing electronic paperwork

J Gen Intern Med 2013 28(8)1042-7

Quality neutral to negative

The EHR has tremendous promise as a means of decreasing workload

decreasing cost and improving quality of care

EHR HIT has tremendous promise as

a means of decreasing workload decreasing cost and improving quality

of care

Quality neutral to negative

The EHR has tremendous promise as a means of decreasing workload

decreasing cost and improving quality of care

EHR HIT has tremendous promise as

a means of decreasing workload decreasing cost and improving quality

of care

The EHR has tremendous promise as a means of decreasing workload

decreasing cost and improving quality of care

EHR HIT has tremendous promise as

a means of decreasing workload decreasing cost and improving quality

of care

EHR HIT has tremendous promise as

a means of decreasing workload decreasing cost and improving quality

of care

The original stethoscope was a short tube made of wood with a central channel not dissimilar to an empty toilet paper roll It had minimal functionality and was barely better than putting your ear on the patients chest httpwwwantiquescientificacomwebstethoscopemonaurallaennechtm

As such I think that it is a great analogy for todays EHRs They are barely better than paper Like an empty toilet paper roll they show teh promise of what might be by barely delivering that promise Had government gotten involved they may have created Meaningful use for the stethoscope telling the Doctor that everything must be done with the stethoscope and that no alternative instruments techniques or senses could be used (The way the administration often says that specialty specific software that has tremendous functionality must be replaced with the rudimentary or absent functionality of the EHR The equivalent is if some Office of the National Stethoscope Coordinator in the 1820s told Doctors to use stethoscope for everything Stopping them from using their nose (Smelling the urine) their eyes (Seeing skin lesions) or their hands (Feeling for an enlarged liver) Laennecs ides had promise as do EHRs But spending $40000000000 to mandate the use of empty toilet paper rolls seems like a bad idea

More Work More Patients Less Time

bull Strain on community oncologists working to overcome the barriers of poor usability of EHR with resultant reduced productivity coupled with the increased requirements for documentation for MU2 the cost of investment in the infrastructure and the inability to bill after 1012014 without implementation of ICD-10

Marilou Terpenning MD FACP

Purpose of this Talk

bull What EHRs are

bull What EHRs can be

Using Hereditary Disease as an example

Purpose of this Talk

bull What EHRs are

bull What EHRs can be

Using Hereditary Disease as an example

Divine Intervention Saint Isidore of Seville (560-636 AD)

bull Named Patron Saint of the Internet and computer technicians in 1997 by Pope John Paul II

What is the future role of EHRs Dr Robert Rowley

More Work More Patients Less Time

bull Strain on community oncologists working to overcome the barriers of poor usability of EHR with resultant reduced productivity coupled with the increased requirements for documentation for MU2 the cost of investment in the infrastructure and the inability to bill after 1012014 without implementation of ICD-10

Marilou Terpenning MD FACP

Purpose of this Talk

bull What EHRs are

bull What EHRs can be

Using Hereditary Disease as an example

Purpose of this Talk

bull What EHRs are

bull What EHRs can be

Using Hereditary Disease as an example

Divine Intervention Saint Isidore of Seville (560-636 AD)

bull Named Patron Saint of the Internet and computer technicians in 1997 by Pope John Paul II

What is the future role of EHRs Dr Robert Rowley

Purpose of this Talk

bull What EHRs are

bull What EHRs can be

Using Hereditary Disease as an example

Purpose of this Talk

bull What EHRs are

bull What EHRs can be

Using Hereditary Disease as an example

Divine Intervention Saint Isidore of Seville (560-636 AD)

bull Named Patron Saint of the Internet and computer technicians in 1997 by Pope John Paul II

What is the future role of EHRs Dr Robert Rowley

Purpose of this Talk

bull What EHRs are

bull What EHRs can be

Using Hereditary Disease as an example

Divine Intervention Saint Isidore of Seville (560-636 AD)

bull Named Patron Saint of the Internet and computer technicians in 1997 by Pope John Paul II

What is the future role of EHRs Dr Robert Rowley

Divine Intervention Saint Isidore of Seville (560-636 AD)

bull Named Patron Saint of the Internet and computer technicians in 1997 by Pope John Paul II

What is the future role of EHRs Dr Robert Rowley

What is the future role of EHRs Dr Robert Rowley

Therersquos a strong case to make that meaningful use forces a doctor to use an EHR inappropriately Every

person at ONC calls this blasphemous and every doctor is likely to agree that meaningful use causes more work

and does little to improve care

bull Meaningful Use Program a SuccesshellipDepending on How You Measure Success

bull January 22 2014 I Written By John Lynn John Lynn is

bull Unlike the intuitive ease of touch-based smartphones and tablets electronic medical records are generally antiquated programs that are cumbersome to use Providers often spend more time checking boxes with a mouse to satisfy onerous billing and administrative requirements that do little to help patients

KevinMD Kevin Pho MD

bull For instance it takes me more than 50 mouse clicks all while scrolling through dozens of screens to document a straightforward office visit for a sinus infection Refilling a single prescription electronically which I do over a hundred times a day takes more than 10 clicks

KevinMD Kevin Pho MD

Stages of Meaningful Use

Stage 1

Data capture and sharing

Stage 2

Advanced clinical processes

Stage 3

Improved outcomes

1 Capturing health information in a coded format

2 Using the information to track key clinical conditions

3 Communicating captured information for care coordination purposes

4 Reporting of clinical quality measures and public health information

1 Disease management clinical decision support

2 Medication management

3 Support for patient access to their health information

4 Transitions in care

5 Quality measurement

6 Research

7 Bi-directional communication with public health agencies

1 Achieving improvements in quality safety and efficiency

2 Focusing on decision support for national high priority conditions

3 Patient access to self-management tools

4 Access to comprehensive patient data

5 Improving population health outcomes

Outcomes DB

TRACS

STS

ACS-Bariatric Surgery Center Network

NSQIP

Cancer Registry

STS

TransplantUNOS

Emergency Surgery

VSGN

SVS Vascular Registry

Courtesy of Matt Hutter

Data Collection Efforts

But the most dramatic unanticipated costs were associated with the need to increase staff coupled with a loss in physician productivity ldquoWe used to see 32 patients a day with one tech and now we struggle to see 24 patients a day with four techs And we provide worse carerdquo said one survey respondent

ldquoPoor EHR usability time-consuming data entry interference with face-to-face patient care inefficient and less fulfilling work content inability to exchange health information between EHR products and degradation of clinical documentation were prominent sources of professional dissatisfactionrdquo the report says

Medical Economics EHR survey probes physician angst about adoption use of technology

bull For instance it takes me more than 50 mouse clicks all while scrolling through dozens of screens to document a straightforward office visit for a sinus infection Refilling a single prescription electronically which I do over a hundred times a day takes more than 10 clicks

KevinMD Kevin Pho MD

Stages of Meaningful Use

Stage 1

Data capture and sharing

Stage 2

Advanced clinical processes

Stage 3

Improved outcomes

1 Capturing health information in a coded format

2 Using the information to track key clinical conditions

3 Communicating captured information for care coordination purposes

4 Reporting of clinical quality measures and public health information

1 Disease management clinical decision support

2 Medication management

3 Support for patient access to their health information

4 Transitions in care

5 Quality measurement

6 Research

7 Bi-directional communication with public health agencies

1 Achieving improvements in quality safety and efficiency

2 Focusing on decision support for national high priority conditions

3 Patient access to self-management tools

4 Access to comprehensive patient data

5 Improving population health outcomes

Outcomes DB

TRACS

STS

ACS-Bariatric Surgery Center Network

NSQIP

Cancer Registry

STS

TransplantUNOS

Emergency Surgery

VSGN

SVS Vascular Registry

Courtesy of Matt Hutter

Data Collection Efforts

But the most dramatic unanticipated costs were associated with the need to increase staff coupled with a loss in physician productivity ldquoWe used to see 32 patients a day with one tech and now we struggle to see 24 patients a day with four techs And we provide worse carerdquo said one survey respondent

ldquoPoor EHR usability time-consuming data entry interference with face-to-face patient care inefficient and less fulfilling work content inability to exchange health information between EHR products and degradation of clinical documentation were prominent sources of professional dissatisfactionrdquo the report says

Medical Economics EHR survey probes physician angst about adoption use of technology

Stages of Meaningful Use

Stage 1

Data capture and sharing

Stage 2

Advanced clinical processes

Stage 3

Improved outcomes

1 Capturing health information in a coded format

2 Using the information to track key clinical conditions

3 Communicating captured information for care coordination purposes

4 Reporting of clinical quality measures and public health information

1 Disease management clinical decision support

2 Medication management

3 Support for patient access to their health information

4 Transitions in care

5 Quality measurement

6 Research

7 Bi-directional communication with public health agencies

1 Achieving improvements in quality safety and efficiency

2 Focusing on decision support for national high priority conditions

3 Patient access to self-management tools

4 Access to comprehensive patient data

5 Improving population health outcomes

Outcomes DB

TRACS

STS

ACS-Bariatric Surgery Center Network

NSQIP

Cancer Registry

STS

TransplantUNOS

Emergency Surgery

VSGN

SVS Vascular Registry

Courtesy of Matt Hutter

Data Collection Efforts

But the most dramatic unanticipated costs were associated with the need to increase staff coupled with a loss in physician productivity ldquoWe used to see 32 patients a day with one tech and now we struggle to see 24 patients a day with four techs And we provide worse carerdquo said one survey respondent

ldquoPoor EHR usability time-consuming data entry interference with face-to-face patient care inefficient and less fulfilling work content inability to exchange health information between EHR products and degradation of clinical documentation were prominent sources of professional dissatisfactionrdquo the report says

Medical Economics EHR survey probes physician angst about adoption use of technology

Outcomes DB

TRACS

STS

ACS-Bariatric Surgery Center Network

NSQIP

Cancer Registry

STS

TransplantUNOS

Emergency Surgery

VSGN

SVS Vascular Registry

Courtesy of Matt Hutter

Data Collection Efforts

But the most dramatic unanticipated costs were associated with the need to increase staff coupled with a loss in physician productivity ldquoWe used to see 32 patients a day with one tech and now we struggle to see 24 patients a day with four techs And we provide worse carerdquo said one survey respondent

ldquoPoor EHR usability time-consuming data entry interference with face-to-face patient care inefficient and less fulfilling work content inability to exchange health information between EHR products and degradation of clinical documentation were prominent sources of professional dissatisfactionrdquo the report says

Medical Economics EHR survey probes physician angst about adoption use of technology

But the most dramatic unanticipated costs were associated with the need to increase staff coupled with a loss in physician productivity ldquoWe used to see 32 patients a day with one tech and now we struggle to see 24 patients a day with four techs And we provide worse carerdquo said one survey respondent

ldquoPoor EHR usability time-consuming data entry interference with face-to-face patient care inefficient and less fulfilling work content inability to exchange health information between EHR products and degradation of clinical documentation were prominent sources of professional dissatisfactionrdquo the report says

Medical Economics EHR survey probes physician angst about adoption use of technology

are other key findings from the national survey 73 of the largest practices would not purchase their current EHR system The data show that 66 of internal medicine specialists would not purchase their current system About 60 of respondents in family medicine would also make another EHR choice 67 of physicians dislike the functionality of their EHR systems Nearly half of physicians believe the cost of these systems is too high 45 of respondents say patient care is worse since implementing an EHR Nearly 23 of internists say patient care is significantly worse 65 of respondents say their EHR systems result in financial losses for the practice About 43 of internists and other specialistssubspecialists outside of primary care characterized the losses as significant About 69 of respondents said that coordination of care with hospitals has not improved Nearly 38 of respondents doubt their system will be viable in five years

Medical Economics EHR survey probes physician angst about adoption use of technology

Articles published on Breast Cancer

Genetics

Genetics amp family history

functionality in the EHR

4335 articles in 2012

Rudimentary family history No structured genetic test results pedigrees or CDS

Rudimentary family history No structured genetic test results pedigrees or CDS

Minimal knowledge Exponential knowledge growth

EHR

Breast MedOnc Interface

Breast Surgery Interface

Mammography Interface

Pathology Interface

RT Interface

Specialty Specific

CDS

Specialty Specific

CDS

Specialty Specific

CDS

Specialty Specific

CDS

Specialty Specific

CDS

bull This month an Office of the Inspector General report warned that electronic medical records could even contribute to Medicare fraud by making it easier for providers to duplicate documentation and make it appear that they performed more services than they actually did

KevinMD Kevin Pho MD

EHR

Breast MedOnc Interface

Breast Surgery Interface

Mammography Interface

Pathology Interface

RT Interface

Specialty Specific

CDS

Specialty Specific

CDS

Specialty Specific

CDS

Specialty Specific

CDS

Specialty Specific

CDS

bull This month an Office of the Inspector General report warned that electronic medical records could even contribute to Medicare fraud by making it easier for providers to duplicate documentation and make it appear that they performed more services than they actually did

KevinMD Kevin Pho MD

bull This month an Office of the Inspector General report warned that electronic medical records could even contribute to Medicare fraud by making it easier for providers to duplicate documentation and make it appear that they performed more services than they actually did

KevinMD Kevin Pho MD

bull This month an Office of the Inspector General report warned that electronic medical records could even contribute to Medicare fraud by making it easier for providers to duplicate documentation and make it appear that they performed more services than they actually did

KevinMD Kevin Pho MD

Upcoding

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED Robert G Hill Jr MD

Lynn Marie Sears MBA Scott W Melanson MD

bull An American Journal of Emergency Medicine study found that emergency physicians spent 43 of their time entering data into a computer compared with only 28 of their time spent talking to patients During a typical 10-hour shift a doctor would click a mouse almost 4000 times

bull The mean percentage of time spent on data entry was 43 (95 confidence interval 39-47) The mean percentage of time spent in direct contact with patients was 28 The pooled weighted average time allocations were 44 on data entry 28 in direct patient care 12 reviewing test results and records 13 in discussion with colleagues and 3 on other activities Tabulation was made of the number of mouse clicks necessary for several common emergency department charting functions and for selected patient encounters Total mouse clicks approach 4000 during a busy 10-hour shift

KevinMD Kevin Pho MD

4000 Clicks a productivity analysis of electronic medical records in a community hospital ED Robert G Hill Jr MD

Lynn Marie Sears MBA Scott W Melanson MD

bull An American Journal of Emergency Medicine study found that emergency physicians spent 43 of their time entering data into a computer compared with only 28 of their time spent talking to patients During a typical 10-hour shift a doctor would click a mouse almost 4000 times

bull The mean percentage of time spent on data entry was 43 (95 confidence interval 39-47) The mean percentage of time spent in direct contact with patients was 28 The pooled weighted average time allocations were 44 on data entry 28 in direct patient care 12 reviewing test results and records 13 in discussion with colleagues and 3 on other activities Tabulation was made of the number of mouse clicks necessary for several common emergency department charting functions and for selected patient encounters Total mouse clicks approach 4000 during a busy 10-hour shift

KevinMD Kevin Pho MD

J Gen Intern Med 2013 Aug28(8)1042-7 doi 101007s11606-013-2376-6

In the wake of the 2003 and 2011 duty hours regulations how do internal medicine interns spend their time

Block L1 Habicht R Wu AW Desai SV Wang K Silva KN Niessen T Oliver N

Feldman L

bull Doctors in training have it worse Researchers at Johns Hopkins University School of Medicine found that medical interns spent 12 of their time talking to patients or about eight minutes a day per patient but more than 40 of their time on a computer filling out electronic paperwork

KevinMD Kevin Pho MD