A New Medical Specialty?

Compensating for the technology effect

January 22, 2014

What is the Technology Effect?

• Patient Viewpoint– My exam is too short and impersonal– The doctor looks at the computer, not me– I am not satisfied with the quality of care

• Provider Viewpoint– I don’t have enough time with the patient– I spend too much time charting– I am not satisfied with my job, I feel burnt

out.

So, how important IS physician job satisfaction to patient quality of care?

Rand Study• Sponsored by the AMA• January – August 2013• 30 practices in 6 states achieving

diversity in:– Sizes– Specialty– Ownership

• 447 responses to a survey on job satisfaction– 656 physicians surveyed– 68% response rate

Main Findings• Quality of care issues:

– Obstacles to providing high-quality care are a major sources of professional dissatisfaction• practice leadership unsupportive of quality improvement ideas• payers that refused to cover necessary medical services

– Need interventions that address these quality concerns, simultaneously improving both the quality of care patients receive and physician professional satisfaction

• Electronic health records:– physicians approved of EHRs in concept– potential of EHRs to further improve both patient care and professional

satisfaction – for many physicians, the current state of EHR technology significantly

worsened professional satisfaction in multiple ways. • Poor EHR usability• time-consuming data entry• interference with face-to-face patient care• inefficient and less fulfilling work content • inability to exchange health information between EHR products• degradation of clinical documentation• EHRs have been more expensive than anticipated

Additional Factors• Autonomy and work control• Practice leadership• Collegiality, fairness, and respect• Work quantity and pace• Work content, allied health professionals, and

support staff• Payment, income, and practice finances• Regulatory and professional liability concerns

– “meaningful-use” rules stood out as having the greatest influence on professional satisfaction

– physicians agreed generally with the intent, but expressed frustration with the time and documentation burdens these rules imposed

• Health reform not a major issue

Conclusions“EHR usability represents a unique and vexing challenge to physician professional satisfaction.” • Findings suggest the technology has not yet matured. • Only one in five physicians we surveyed would prefer to return to

paper-based medical records. • The current state of EHR technology appears to significantly

worsen professional satisfaction for many physicians—sometimes in ways that raise concerns about effects on patient care.

• Future EHRs must solve current problems– data entry,– difficult user interfaces, – information overload

• Meaningful-use rules may not provide physicians with sufficient flexibility to match the needs of their practices—especially for those who do not provide primary care.

Producing a greater number of “satisfied” physicians is not the only goal. Even physicians who report high overall professional satisfaction will have sources of stress, frustration, and burn-out in their clinical practices that interfere with patient care.

Implications• Physician practices need a knowledge base and

resources for internal improvement, especially with managing change

• As physician practices affiliate with large hospitals and health systems, paying attention to professional satisfaction may improve patient care and health system sustainability.

• When implementing new and different payment methodologies, the predictability and perceived fairness of physician incomes will affect professional satisfaction

• Better EHR usability should be an industrywide priority and a precondition for EHR certification

• Reducing the cumulative burden of rules and regulations may improve professional satisfaction and enhance physicians’ ability to focus on patient care

• Make entries in thepatient’s chart in real time

• Allow the physician to focus on the patient, not the computer

• Free doctors from after-hours charting• Increase physician job satisfaction

Enter the Scribe

“With a scribe, I can think medically instead of clerically.”“Having the scribe has been life-changing.”

The Upside

The Downside• Patient privacy concerns• Cost• Training

ReferencesFriedberg, MW. Chen, PG. Van Busum, KR. Aunon, F. Pham, C.

Caloyeras, J. Mattke, S. Pitchforth, E. Quigley, DD. Brook, RH. Crosson, FJ. Tutty, M. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. Santa Monica, CA: RAND Corporation, 2013. http://www.rand.org/pubs/research_reports/RR439.

Hafner, K. A Busy Doctor’s Right Hand, Ever Ready to Type. New York Times. 12 Jan 2014. http://www.nytimes.com/2014/01/14/health/a-busy-doctors-right-hand-ever-ready-to-type.html.

Shipman, SA. Sinsky, CA. Expanding Primary Care Capacity By Reducing Waste And Improving The Efficiency Of Care. HealthAffairs. doi:10.1377/hlthaff.2013.0539Health Aff November 2013 vol. 32 no. 11 1990-1997. http://content.healthaffairs.org/content/32/11/1990.abstract?sid=d376c99a-0479-450c-b0e9-713a3e476985.