Pain Points - Clinicians in Hospitals, Outpatient Centers, Doctors offices.
Pain points and concerns of clinicians in settings such as hospitals, outpatient centers, and doctor's offices include electronic health record (EHR) usage, patient record-keeping and communication between the involved parties and care providers (a key factor in ensuring patient safety), MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and regulatory requirements in general, and general feelings of burnout.
The focus of our research is mainly on the post-acute, long-term, and ambulatory arenas, excluding general primary care physicians. Some results are related to physicians in general, though since the hospital or outpatient setting (included as the focus on this request) tends to encompass a large part of healthcare providers/clinicians, it seems reasonable that these are applicable.
1. Electronic Health Record (EHR) Usage
Challenges clinicians face with Electronic Health Record (EHR) usage include limited interoperability, difficulty in handling burdensome requirements, a lack of EHR usability, and reduced face-time with patients. Details of each of these are provided in an EHR Intelligence article from August 31, 2016.
EHR systems are used by "over 90%" of the healthcare industry, and the focus has shifted to exchange of health data between EHR and other systems, though with only minor progress. Exchanging health information from one clinician or hospital to another is limited, putting patient safety at risk, especially in emergency situations.
Difficulty in Handling Burdensome Requirements:
After EHR adoption, Medscape found that patients described a "48%" decrease in clinician workflow in a 2016 report. Reporting in EHR is often complex and burdensome for clinicians, with the "EHR Incentive Program out of the Centers for Medicare & Medicaid Services (CMS)" exemplifying a report measure with difficult guidelines. Strict standards in documenting records and engaging with patients often inhibit the clinicians from focusing on a patient's immediate health needs.
Lack of EHR Usability:
When completing tasks in EHR, clinicians find that the system is counter-intuitive and can slow down productivity. Lack of usability is a "primary pain point" for clinicians, as reported in a Frost & Sullivan study.
Reduced Face-Time with Patients:
EHR hinders engagement between the doctor and the patient, with system computers cutting into important face-to-face time and getting in the way of relationship-building. Medscape's 2016 EHR study reported that "57%" saw limited clinician-patient interaction time with the system in the way. Also, "50%" found EHR usage detracted from the total patients the clinicians could see each day.
2. Patient Record-Keeping and Communication Between the Involved Parties and Care Providers
Known as "telling the patient’s story," clinicians find that communication between involved parties and care providers is a key pain point. The exchange of patient healthcare information between responsible parties is a point of contention for physicians, because information can be difficult to sort through when looking for important data (known as "information foraging"), communication between healthcare providers must be "rapid-fire" quick, there is a medical jargon overload, and a lack of structure in communicating between parties.
Patient transfers are a concern for clinicians for the patient complexity, difficulty in identifying a best-scenario healthcare setting, increasing financial pressure, and obstacles to efficient communication between involved parties and care providers. A survey conducted by Philips and Regina Corso Consulting finds that healthcare data is becoming increasingly important in maintaining patient safety, with "74%" of clinicians and nurses saying that a lack of patient data during in-hospital transfers puts patients at risk.
3. MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and Regulatory Requirements
MACRA (Medicare Access and CHIP Reauthorization Act of 2015) governs how physicians are compensated based on patient healthcare outcomes and the quality of clinicians in treating patients. While it was initially widely accepted by physicians, it has been found to hinder smaller clinics with fewer resources and favor larger hospitals with a vast amount of staff and healthcare capabilities.
MACRA strains physicians financially and administratively, as it requires clinicians to track their quality of care. According to Ropes & Gray in 2017, "physicians must purchase and maintain costly information systems, including EHR" in order to reach performance goals. Clinicians find it to be costly and time-ineffective.
4. General Feelings of Burnout
A Physicians Foundation survey finds that "30.6%" Primary Care Physicians describe feeling burnt out. Of the PCPs surveyed, "29.0%" said they feel that they are overworked and overextended. PCPs who feel that they are at a full patient workload capacity account for "52.2%" of those physicians surveyed. A general feeling of burnout is a theme with clinicians regarding pain points.
In summary, the key pain points and concerns of physicians in settings such as hospitals, outpatient centers, and doctor's offices include electronic health record (EHR) usage, patient record-keeping and communication between the involved parties and care providers (a key factor in ensuring patient safety), MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and regulatory requirements in general, and general feelings of burnout. These are the major trends and key findings found during research.