Doctors burn out, MyHR flares up

Pulse+IT had hoped to keep our weekend edition a My Health Record-free zone this week considering all of the recent palaver, but it just keeps popping up saying “look at me, look at me” and we find we just can't seem to drag our eyes away.

We hold firm to the belief that the heat over the opt-out debate is dying down somewhat – Google Trends agrees with us, although as you'll see from the poll below, two-thirds of Pulse+IT readers don't – but we did expect an eruption to flare up now and then and it did so this week.

First was a rather curious story on Monday in which it was claimed that your entire genome was going to be uploaded to the My Health Record – quite what hackers will make of all those megabytes of ATCGs, we don't know – but we did like how the story was thoroughly squashed by the RACGP's Nathan Pinskier with a bit of old-fashioned common sense.

Then just today there was a story about some unions planning to call on members to boycott the system over fears that employers will get hold of employee health information. Those who've been around the traps a bit will remember discussions over this issue back in the PCEHR days of 2011 and the opt-out legislation year of 2015. This is an area of employment and medical indemnity law that is endlessly debated and will continue to be so, My Health Record or no My Health Record.

Health Minister Greg Hunt and the Australian Digital Health Agency popped up to say the law unequivocally states that healthcare providers can't access the My Health Record for employment or insurance purposes, and if they do, they go to jail and lose their registration, or at best receive a fine. Unfortunately for Mr Hunt and his government at the moment, half the country doesn't believe a word he says so whether anyone will pay attention remains unclear.

Elsewhere on the planet, there was some interesting new information about Apple and its Health Record app. There are now 80 US healthcare providers participating in the project, which uses a FHIR interface to let patients access their medical records through their iPhones. Some of these organisations are huge – Intermountain, Johns Hopkins, Kaiser Permanente, the University of California system – and its not just access to hospital EMRs, but to those used by specialist clinics and family physicians too.

The technical capability for this will be available in Australia in the next year or so as Cerner plans to release a FHIR API for the local market, although when exactly Apple will release the capability to other countries is not certain. We liked this story from the US Health Data Management magazine, which provides a simple overview of how Apple is viewing progress with FHIR.

In other news this week, the most popular story on Pulse+IT was about a presentation by University of California San Diego CIO Chris Longhurst and Royal Children's Hospital CMIO Mike South on the problem of EMR-related physician burnout. Most in the health IT industry would have heard of this serious issue in the US, where hours spent on deskwork is being blamed for all manner of ills. We particularly liked this article from author and doctor Abraham Varghese in the New York Times recently, saying that while EMRs aren't the sole reason for physician burnout, they have certainly become the symbol.

At his presentation at HIC 2018 last week, Professor South showed examples of clinical notes from the US that did indeed seem like the doctor was being paid by the word. He joked about one example written by a surgeon that appeared to be copied from a template on how to extract the most money out of one consultation, in which the clinician insisted they had examined nine different body systems on the one patient. Aspersions were cast on this claim, with Prof South doubting there was a surgeon alive who could even name nine different body systems let alone examine them.

At UC San Diego, Dr Longhurst has introduced a “home for dinner” program so doctors can get home and actually have dinner with their family, rather than spend all evening finishing their documentation. Like RCH, UC San Diego uses an Epic system, which Dr Longhurst has in past called “the cream of the crap”. Only 15 per cent of users are satisfied with it, while another 20 per cent are indifferent.

Dr South said it's not as bad at that in Australia. where we're more likely to have a “home to shop for groceries, walk the dog and cook the dinner” program. Satisfaction scores with the EMR are much higher here too.

However, Dr South did fear that we'd follow the US lead and begin to use clinical notes for more than their actual purpose, such as billing and reporting. He wants to keep them for clinicians and for patients alone, and to keep them short and sweet. He believes it's not the tool that's the problem but what we expect doctors to do with it that is.

We'd be interested to know your views on this, not just from a hospital doctor perspective but from GPs and nurses too. Anyone who has seen the copious amounts of documentation that aged care nurses have to fill out knows what a burden it is. Does an electronic system make it worse? What can be done to alleviate it? Let us know in the comments below, or you can have a more informal conversation in the Pulse+IT Chat discussion group, which has attracted over 1000 members from the eHealth community this month alone.

That brings us to our poll question for the week: do you think EMR-related clinician burnout is a problem in Australia and NZ?

Sign up to our weekend edition to vote or leave your thoughts below.

Our poll last week asked: Do you think changing the MyHR act will take the heat out of the debate? 33 per cent said yes, while 67 per cent said no.

Comments  

# Terry Hannan 2018-08-11 09:50
The comment about EMR burnout is only partially accurate. Most clinicians are already burnt out because of poor health (information) systems to which has now been added a system they have little or no idea about and worsens their clinical loads but are being ‘obligated’ to use it. A system ‘failing’ as per Prof Lawrence Weed in Medicine In Denial.
# Mike South 2018-08-11 10:14
Thanks for covering our presentation Kate. The topic of clinician burnout is important. There have been increasing reports of this in Australia and a number of doctors and nurses have suicided. The excessive demands of their work often being seen as a driver for this. In the USA it is a huge topic at the moment - clinicians report being stressed and "burnt out". They are leaving the profession and some are suiciding. In the US the EMRs/EHRs are copping a lot of the blame for this and there is much written on the topic. So far EMRs are not being mentioned much in Australian publications on burnout but I feat it is only a matter of time. That said for some Australian EMR implementations (both at individual hospitals and in private practices) clinicians seem to like the systems more and are more satisfied. I think much of the problem in the US lies with the bureaucratic "meaningful use program" and the drive for revenue. The compliance, revenue, and medicolegal brigade have more control of the content of the clinical notes than the doctors. Hence doctors are writing notes that are 4 or more times longer than ours and it is mostly non-clinical gobbledygook. It can be very hard to find the patient story in these notes and differentiate the clinical signal from the administrative noise.

As I see it, EMR systems are just a tool. Sure they need further enhancement of the user experience but the big problem, in the US at least, is what doctors are being asked to do with the tool. Understandably the EMR has become the symbol of clinician burnout for many.

I am worried that there may be drivers to change our note-keeping to for such purposes and we need to resist that. Notes should be concise, with easy to assimilate information, and about the care of the patient.

Many of us have been working on EMR systems for the last decades on the assumption they can help improve quality and save patient lives. I am confident they can do this but it should not be at the cost of burnt-out doctors and nurses losing their own lives to suicide.

PS no offense intended to my wonderful surgical colleagues
# Terry Hannan 2018-08-11 11:02
Mike, nIce comments. Your comments re meaningful use are very relevant but we must note that many of the original and still current systems that have shown benefits are/have been directed at better patient care. We in Oz may have different names for meaningful care but the process of implementing ‘maladaptable’ systems exaggerates the issues you document.
Koppel reviewed these problems in 2017

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