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According to a new study published in Health Affairs, electronic health record logs show that physicians are spending less time on face-to-face patient interactions and more time on so-called desktop medicine. Desktop medicine refers to digital tasks providers must complete, such as communicating with patients through online portals, refilling prescriptions, ordering tests, corresponding with staff, and reviewing test results.
The study spanned from 2011-2014 and followed 471 primary care physicians. Over the course of the study, physicians logged more than 31 million EHR transactions for more than 765,000 patients. On average, physicians spent about 3.08 hours per day on face-to-face patient interactions and 3.17 hours on desktop medicine.
If physicians are transitioning into using EHR systems for the majority of their work day, it would be logical to streamline these systems to make it as easy as possible for physicians and other health care professionals to enter and access data on their patients whenever necessary. This is not always the case, as hospitals’ EHR systems have been subject to human error and hacking, leading to a lack of security for patient medical records.
After the Health Information Technology for Economic and Clinical Health (HITECH) Act became law in 2009, the federal government committed $300 million to aid health care facilities in adopting a nationwide health information exchange system. CMS also offered more than $35 billion in incentive payments for EHR adoption through its meaningful use program. Now, nearly 10 years later, there is not an easy, widespread exchange of health information—despite nearly universal adoption of EHR systems.
In 2009, only 12.2 percent of non-federal acute care hospitals had implemented a basic EHR system. By 2015, this number leapt to 83.8 percent, with 96 percent possessing a CMS certified EHR system. Though small, rural, and critical access hospitals have consistently lower rates of EHR adoption compared to all hospitals, these rates have risen significantly since 2011. Critical access hospitals went from a 20 percent rate of EHR adoption in 2011 to an 80 percent adoption rate in 2015, with small and rural hospitals reporting similar increases.
Fig 1 EHR adoption for non-federal critical access hospitals compared to all hospitals in 2011 and 2015. Data from HealthIT.gov.
Non-federal psychiatric hospitals continue to report the lowest rates of EHR adoption. In 2008, only 7 percent of psychiatric hospitals reported EHR adoption compared to 12 percent of general medicine hospitals. In 2015, psychiatric hospitals reported only a 15 percent adoption rate compared to 84 percent of general medicine hospitals.
In spite of the general increase in EHR implementation, there are still barriers for patients and care providers.
There are a variety of EHR vendors for hospitals and providers to choose from, making it easier for a system to fit a facility’s needs. It is this variety, however, that makes it difficult for individual patient data to follow them from provider to provider. If a patient seeks care outside of their network, the attending physician needs patient consent to have the relevant information faxed over, which wastes both time and money.
While this procedure is only a nuisance for most patients and providers, it can cause a much greater impact in emergency situations—like for patients affected by Hurricane Harvey. If a patient is seeking emergency care outside of their network due to displacement, precious time is wasted seeking consent from a patient to request faxed data from multiple care providers, some of which may have lost power or have only spotty internet access due to flooding.
One issue, reported by Politico in June, is the claim that EHR vendors are making clinical registry contribution difficult or prohibitively expensive. This is happening despite encouragement by the CMS meaningful use program for providers to contribute to clinical registries. Additionally, the HITECH Act states that individuals have the right to transmit their data from an EHR to a location of their choosing for little to no cost—in other words, protected health information cannot be monetized by EHR developers.
HIPAA also states that patients have a right to their own electronic health records, and provides justification as to why EHR developers should not be able to prevent protected health information from being exchanged. This kind of information blocking, including the imposition of financial barriers to health information transition, is considered exploitation and is not allowed.
A system called Pulse is seeking to subvert some of these issues, at least in emergency situations. Pulse is a data-sharing EHR network that can be turned on during a crisis—environmental or otherwise. Connections can be activated based on geography, and only for a specific period of time. This would be useful for the Gulf Coast now, during hurricane season, or for states in tornado alley during the late spring and early summer. Any registered care provider in the specified geographic location could access a patient’s information and receive records from every clinic and hospital where the patient had received care. For now, it is primarily being beta tested on the west coast.
Below are the most popular EHR systems by number of implementations in 2016 and 2017 (so far).
Fig 2 Top EHR vendors of 2016; data from Definitive Healthcare
Fig 3 Top vendors of 2017 (so far); data from Definitive Healthcare.
Visit the Definitive Blog to read more about MACRA EHR standards and other CMS programs.
Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,700 hospitals, 1.4 million physicians, and numerous other healthcare providers. Our database features detailed clinical information on physicians and physician groups, including procedure analytics, payments, and participation in CMS programs.
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