The Frequent Roadblocks, Detours & Cost Overruns Caused by EHRs

EHR Burden

The technology that was initially designed to help physicians and improve patient care is now an enormous burden to those same physicians and may prevent the delivery of timely patient care. That’s the position of the American College of Physicians (ACP) that was recently published in the Annals of Internal Medicine. It is pretty close to a wholesale condemnation of the burdens that Electronic Health Records (EHR) are placing on physicians, patients and the healthcare system as a whole:

  1. “The growing number of administrative tasks imposed on physicians, their practices, and their patients adds unnecessary costs to the US healthcare system, individual physician practices, and the patients themselves.
  2. “Excessive administrative tasks also divert time and focus from more clinically important activities of physicians and their staffs, such as providing actual care to patients and improving quality, and may prevent patients from receiving timely and appropriate care or treatment.
  3. “In addition, administrative tasks are keeping physicians from entering or remaining in primary care and may cause them to decline participation in certain insurance plans because of the excessive requirements.
  4. “The increase in these tasks also has been linked to greater stress and burnout among physicians.”

Statistics reported by the ACP show a picture of burdensome record keeping and time away from the patient:

  • Physicians in the emergency department spend 43% of their time on data entry.
  • During a busy 10-hour ED shift, charting functions and documenting patient encounters involve 4000 mouse clicks.*
  • It takes 10 minutes to ask mandatory one-size-fits-all questions.
  • It takes 30 minutes to get authorization for an MRI.
  • Clinicians and their staff spend an average of 3 to 5 hours a week on billing and insurance-related (BIR) activities.
  • They spend up to 15 hours a week on quality measurement and reporting.
  • The related cost effects of BIR time were found to be approximately 12% to 14% of revenue, or about $68,000 to $85,000 per year per full-time equivalent (FTE) physician.
  • For every hour a physician spends with a patient, an additional 2 hours is spent on EHR and other “desk” work.

Add to that the need to report different measures to different health plans with different reporting requirements and you end up with a mountain of data entry that has nothing to do with direct patient care.

When the Health Information Exchange (HIE) was launched, it was the promise land of patient safety, management and care. However, many different landlords have moved into the territory and they want to use EHR for their own purposes, complicating its use and expanding data entry time:

  • Payers now see EHR as the source of billing documentation.
  • Public health organizations see it as a way to use clinicians to collect their data for them.
  • The government sees EHR as a way to automate the collection of measurement data.
  • Healthcare organizations see EHR as a way to enforce compliance with policies and procedures.

None of these comply with the original, patient-centric purpose of the system.

While the goal of reducing administrative tasks is very clear, the process of doing so is not. In order to reduce or eliminate administrative tasks they must first be defined and that can about as easy as catching an oiled pig. Tasks differ from one payer to another. They appear overnight and without any advanced notice only to be changed or modified just as quickly. The question is, once “administrative task” is defined, who on earth can figure out how to reduce the tasks and burdens they impose? The ACP has some ideas and they boil down to one statement that should become the mantra of every healthcare system executive, governmental administrator, payer and vendor: “Stakeholders must work together to address the administrative burdens that fail to put patients first.”

The ACP developed a framework and taxonomy for evaluating the sources, intent, effect, and consequences of existing and new administrative tasks and includes recommendations on how to reduce them. You can read the details in the abstract. Some of the key recommendations include:

  • Push innovation from IT providers to improve data-entry technology that is stuck in the 1990s. Physicians and healthcare executives need to push information to the IT designers so they know what is failing. Health IT needs to streamline processes and reduce burden.
  • Payers, governmental and other oversight organizations, vendors and suppliers need to assess each administrative requirement, regulation or program to determine whether it should be challenged, revised or eliminated. Does it:
    • Impact delivery of timely and appropriate care?
    • Improve the quality of care delivered to each patient?
    • Impact the finances of the physician practice, provider, patient and family, and health care system?
    • Raise questions about physician expertise, training, education and experience and if so why are the questions being raised?

After these issues are addressed, the ACP says the path to remediation is clear.

  1. Any tasks that have a negative effect on quality and patient care, increase costs or unnecessarily question the judgment of physicians and other clinicians should be challenged, revised, or removed entirely.
  2. Administrative tasks that cannot be eliminated from the health care system must be regularly reviewed, revised, aligned, and/or streamlined in a transparent manner, with the goal of minimizing burden, by all stakeholders involved.
  3. The complexity of requirements or payment rules created by payers must be made more uniform and standard.
  4. All stakeholders must actively work to refocus the EHR system to ensure that its primary purpose is to support clinical care delivery.
  5. The use of EHR data collection capabilities for secondary or alternative purposes, such as for billing documentation, measure and public health reporting, regulatory compliance, etc. must be redesigned in a manner that does not distract or detract from patient care and that effectively and efficiently provides patients with access to their own information.

It all boils down to this; policymakers and other key stakeholders should collaborate with frontline clinicians and their patients to restructure the existing technology to help streamline information and processes. Like everything else in the healthcare system, it has to be about the patients. If it does not solve that question it simply gets in the way and creates another roadblock to the delivery of effective patient care that results in positive outcomes.  

*(Am J Emerg Med. 2013;31:1591-1594).

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