Wednesday, March 01, 2017

A Reminder That One Of The Things That Is Necessary For Success With Health IT Is Workflow Support.

This appeared last week:

AMA CMIO: EHRs are falling short of meeting the needs of doctors

Michael Hodgkins warns that innovation needs to consider integration with clinician’s workflow.
February 21, 2017 12:38 PM
ORLANDO — Health IT vendors are still missing the mark when it comes to answering the needs of America’s burnt-out physicians.
“This is not about putting our hands up and saying stop innovation,” said Michael Hodgkins, MD, vice president and chief medical information officer at the American Medical Association. “It is simply about the need to focus on evidence, accuracy, how it’s integrated with our EHRs and how it’s integrated within our practice.”
It’s not necessarily news that broad dissatisfaction is darkening the mood in the physician community. According to Hodgkins, who delivered his remarks at HIMSS17 on Tuesday, physicians are spending twice the amount of time on deskwork and EHR maintenance, including 38 hours a month spent on EHRs after work hours, than they are treating patients.
The AMA probed that dissatisfaction in a recent survey and found with issues, there are really only a handful that plagues them. Physicians want to provide high-quality care, but EHR work seems to get in the way of that, he said. At the same time, practice sustainability and changing reimbursement models that favor scale and shift risk to the providers is leading many practices to merge or sell out altogether.
Throw in the more than 200,000 healthcare platforms and apps that are competing for not only physician buy-in, but consumer use as well, and that can further overwhelm physicians.
“What I tell physicians is just wait,” he said. “If you think the impact of the electronic health record has been significant, what do we expect from the impact of the proliferation of mobile apps, many which are unproven?”
Hodgkins said physician input is often not being sought before these platforms are built, and the result can be dangerous.
Lots more here:
The point here is that, in countries where most billing is based on fee for service (Aus, US), that time is genuinely money and that the use of any system by clinicians is going to be seen through the prism of how much time use costs vs. how much is saved through efficiencies delivered vs. the positive clinical impact of use.
While this trade off will be an individual thing the better the integration of functionality with clinical workflow, and the better support the system offers, the more likely success will be achieved.
It would be good to see analysis of just how well we are managing in this area both with and without the myHR. Does anyone know of any research into the matter?
I wonder is this position being advertised by the ADHA going to address this issue?

Director Community Partnerships and Insights - Australian Digital Health Agency

  • Clinical background
  • Brisbane or Sydney based with a national remit
  • Understanding of the full spectrum of health consumers
The Clinical and Consumer Engagement and Clinical Governance Division provides clinical input to the strategy and design of the national digital health systems, driving system usability and clinical outcomes, based on extensive engagement with health providers and health consumers. As such this Division is the prime external face of the Agency.
Reporting to the General Manager Community, Clinical Partnerships and Insights, the Director Community Partnerships and Insights supports the development and delivery of the Agency's consumer engagement and consultation strategy, enabling a flow of critical data reflecting stakeholder needs to shape the Agency's strategy, design and delivery initiatives.
Translating stakeholder feedback and insights into work plan deliverables will require analytical and knowledge management skills within a systems thinking framework, through which you will identify patterns, translate qualitative into quantitative data, identify likely outcomes, and produce quality written reports. Project management skills, including a strong grasp of project governance structures, are essential. 
You will be familiar with the processes of government (either from within or from working with), will understand and be comfortable operating in a political environment, and will have the capacity to listen, assuage concerns, provide clear guidance, and sensitively manage corporate reputational risks.
Here is the link:
An initial read certainly seems pretty replete with a lot of ‘manager speak’!
David.

13 comments:

Anonymous said...

It does not sound like a fun place to work hardy an innovative and leading picture being painted. Still not sure why the PCEHR cares about clinical workflow, improvements or costs.

Anonymous said...

"Still not sure why the PCEHR cares about clinical workflow, improvements or costs."
Why does the PCEHR/MyHR exist then? Some bureaucrat's wet dream? An expensive waste of the public's money if it is.

Anonymous said...

No it is not a nice place to work, you dare not voice an opinion that is not Tim's, he has ears well placed in every corner

Anonymous said...

7:04 pm. I am not sure how the Canberra document library could fit into a clinical workflow of any reliance. It is just a digital scrapbook of fragments of information. Probably to polluted now to be of much use. If Government stopped doing these sorts of things the savings might actually surpass the expected cashable benefits these over priced under thoughtout ideas try to achieve. By all means work with the community to agree the problems, fund standards where they are needed, implement policies that encourge working together, create a national body that attracts good management and leaders in clinical and computer sciences that can help the market develop solutions and new business models based on standards and policy, foster interworkung cultures, but don't build, operate and compete its is embarrassing to watch and expensive to fund.

Anonymous said...

"I am not sure how the Canberra document library could fit into a clinical workflow of any reliance. It is just a digital scrapbook of fragments of information." That's the point. the PCEHR/MyHR should care about clinical workflow, but doesn't. And a better word than fragment is figment. Look it up, it's very appropriate.

Anonymous said...

You want to see what the Aust Strategy will look like - https://www.gov.uk/government/publications/uk-digital-strategy

Anonymous said...

9:45am not a chance, nice but dim is on a mission to prove care.data will work, he will continue to come up with weak scenarios as evident in press releases of late, do a talking fest at our expense round the country and through association with others claim he is right. The key will be if international trips are to U.K. and Europe are top agenda items rather the prioritising Asia pacific neighbours with whom we share far more in common.

Anonymous said...

5:25pm I have to agree to some extent, the conversations have been a bit same same as the rhetoric has become tiresome and completely devoid of insight, almost insulting. You get the feeling the government has invested in a lemon leadership punt and is now easy pickings by the vendor and consultancy houses.

Anonymous said...

I would be happy if the CEO and Executive running Government and Industry coaxed the Jurisdictions into implementing the HPI- O fully rather than this exemption they were given so so many years ago. Without that in place we might as well close shop, it is all very nice picking on GP's but what about the states and terratories? Did we buy a Churchill or a Chamberlain? Or are neither upto the task?

Anonymous said...

Anonymous 8:30 PM that raises a very good point. The nation invested a lot into the HI service. David do you or any readers know if this has been fully implemented as intended? And if not is it still needed?

Might become something Turnbal and be merry band might be able to demonstrate strength in resolving if it is still a problem.

Anonymous said...

Based on past successes I cannot see either being successful in fixing a stamp to an envelope l, they might stand next to some who can and claim they were instrumental in selecting the envelope though. Anon 8:30 PM Puts forward a very important point and something NeHTA could never do as it had no teeth, this is not the case for ADHA. Complete and fully operating HI service is esentail and it is more than just IHI's. I hope with past experience this is why the Executive for Gov and Industry was appointed.

Anonymous said...

We may never really know, reading the news this morning on Cancer Regstries, private health and checking the ADHA website. I observed a clear path back to secrecy, alternatives facts and blatant misleading. The department progress report was found to be less than truthful, discovered they knew the project was going to be late as far back as last year and told no one, the private health system is a sham and seems to be falling apart. The Agency Board is no longer open and transparent with no information releases since December 2016. Makes you wonder just what is going on.

Anonymous said...

Cannot comment with any true insight into Jursidictions adopting the HI structure and intent in full, but it is more important than Secure Messaging to the My Health Record especially to ensure citizens have as much control as possible. This maybe why the changed the name and no the narrative around the thing, the current government would get a big tick from me if the solved it once and for all. It also seems distant from the conversation with Tim and co-conspirators.