Tuesday, January 30, 2018

Physicians Harassed by Overwhelming Levels of Messaging From Electronic Medical Records

In yet another example of the clerical overload caused by bad health IT, physicians find themselves drinking from a fire hose through cybernetics.  This, in the field of dermatology, let alone critical care specialties:

Physicians Overwhelmed by Messaging From Electronic Medical Records
MedicalResearch.com Interview with: Matilda W. Nicholas, MD, PhD
Duke Dermatology
January 29, 2018

MedicalResearch.com: What is the background for this study?
Response: I have found many physicians overwhelmed by the electronic messaging feature in Electronic Health Record systems (EHRs). I found there was very little published about this phenomenon, particularly for specialists. So, we set out to take a look at the volume and effect these systems have. 

MedicalResearch.com: What are the main findings?
 Response: We found that, on average, clinicians receive 3.24 messages per patient visit, for an average of about 50 messages per full day of clinic. The number of messages also correlated with poor reported work life balance for dermatologists.

MedicalResearch.com: What should readers take away from your report?
 Response: As previous studies have shown, physicians are spending much more time in non-direct patient care and less time with patients. This is bad for everyone involved. Targeting methods to decrease this burden would be important in improving patient care and physician wellbeing ... We are planning on examining the messages sent directly from patients more closely, hoping to target higher risk patients to decrease post and inter-visit messaging.

As at my Jan. 28, 2018 post "Medical Economics: Highly experienced physicians lost to medicine over bad health IT" at http://hcrenewal.blogspot.com/2018/01/medical-economics-highly-experienced.html and many, many others, cybernetics are proving a distraction from - and actually a deterrent to - the practice of good medicine.

With the increasing outcry of physicians and nurses against EHRs and the oppressive demands the systems place on them, and the burnout these systems cause (see the numerous posts on burnout at query link http://hcrenewal.blogspot.com/search/label/burnout), I'm increasingly of the opinion these systems are not fixable.

There is only so much that can be accomplished with surface changes to user interfaces, without substantive changes to physicians' work expectations. 

The true problem that nobody seems to want to deal with - the proverbial elephant in the living room -  is expectations of clinicians doing oppressive amounts of clerical work, in addition to their patient care responsibilities.

(Note that in this essay I am not addressing other critical drawbacks to this technology such as crashes, lack of security including growing record theft, ransomware attacks on EHR's, and so forth.)

In my view, the only solution to these problems are separation of clinicians from clerical duties (see my August 9, 2016 essay "More on uncoupling clinicians from EHR clerical oppression" at http://hcrenewal.blogspot.com/2016/08/more-on-uncoupling-clinicians-from-ehr_91.html), and the use of data-entry personnel, as I set up in the Invasive Cardiology Clinical Database at Christiana Care Health System in Delaware (http://cci.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=Cardiology%20story) so many years ago. 

Of course this will likely never happen, because it's an expensive labor proposition.

Based upon my EHR forensics/expert witness work since 2010, I also believe physicians can expect no help from the public or the government on this.  The issues seem above the public's heads (with the exception of those injured or killed by bad health IT, who - or whose heirs - seem to learn very fast about the drawbacks), and conflict with the bureaucratic goals for control of medical finance.

Physicians need to take control of their occupations, for there is no help coming from government or the public regarding cybernetic oppression. The only way repair of the profession can happen is through unionization, such as I saw in my work in the public transit industry.

If physicians are unwilling to take that step, then they will have to accept being servants to the bureaucracy, and being endlessly stressed, distracted and harassed by their cybernetic overlords.

-- SS

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