I don't think AI can solve these issues in healthcare: pop-up flag for concern of topical ophthalmic erythromycin prescription. The recommendation is to monitor the patient.
Solution: involve physician in the design of an EHR because every flag that pops up is attention that is taken away from other critical aspects of care.
I have a script for this [Annual wellness visits]: "Welcome to your Medicare Annual Wellness Visit. This is a little different from just a physical. The US government and Medicare are very worried that as people get older we start to cover so many health issues that we never get to talk about the big picture important stuff like fall risks, dementia, and living wills. So they set aside this appointment for that. Now be aware they won't let me address ANYTHING else this visit. I code for anything else and it won't count. It's checky boxes all the way but it helps us address some really important stuff." When in doubt, blame The Man.
Providers and physicians don’t like them because they are not meant for notetaking or putting orders in. These are tertiary functions for an EHR after billing and medicolegal compliance. More time is spent clicking boxes to get compliant billing levels than actually putting readable notes in.
In fact, you can make a perfectly acceptable billable note without an ounce of free text, or any idea of what happened during a visit.
Schneider recalled one episode when his colleagues couldn’t understand why chunks of their notes would inexplicably disappear. They figured out the problem weeks later after intense study: Physicians had been inputting squiggly brackets — {} — the use of which, unbeknownst to even vendor representatives, deleted the text between them. (The EHR maker initially blamed the doctors, said Schneider.)
I commonly advise residents to actually slow down, think before you click, and pretend as if you are being charged per click, so each is more intentional and you won’t be distracted and overwhelmed.
Some doctors write their notes using speech-to-text dictation, others use templates and/or point-and-click tools, and a minority work with (human) scribes.
Similarly, some doctors fastidiously remove completed Inbox messages whereas others do not, either because they’d rather not click “done” or to save them for later reference.
These practice variations reflect differences in training, tech savviness, personal preferences, practice environment, available resources, roles, and responsibilities.
So this weekend I spent over an hour on the phone with a Hospital’s help desk because the stupid EHR software wouldn’t work on my dad’s laptop.
Once in med school they paid some of us to help rollout epic to these old school ophthalmologists. When one who was close to retirement and hated computers tried to exit the program he got this “are you sure” confirmation box but just tried to click the X more and more aggressively and before I could tell him what to do he ripped the power cords out of the wall and told me “that’s what we think of computers around here.”
“You’re sitting in front of a patient, and there are so many things you have to do, and you only have so much time to do it in — seven to 11 minutes, probably — so when do you really listen?” asked John-Henry Pfifferling, a medical anthropologist who counsels physicians suffering from burnout.
“If you go into medicine because you care about interacting, and then you’re just a tool, it’s dehumanizing,” said Pfifferling, who has seen many physicians leave medicine over the shift to electronic records. “It’s a disaster,” he said.
While I like mychart for sending result notes, the amount of mychart messages I get regarding things I can’t help with like billing, prior auths, and questions that could be visits are becoming increasingly frustrating as I don’t have time to address this stuff.
And I do have a system in place for most things, but the volume of mychart messages per day quickly becomes insane and there’s only so much I can do for many of them. I’m already seeing patients all day and doing paperwork and interpreting results. I don’t have time to do all this.
My EHR can't figure out that "rhuemat arthritis" is the misspelling for RA but somehow we are on the verge of major healthcare disruption with AI.
I don't doubt that the technology exists. I just question if the status quo can be disrupted when the profits are so immense.
“Let me put it to you this way. I operated next to someone’s spinal cord yesterday and I was more nervous about my post op orders.”
[On taking notes before EMRs] Notes were really notes you were taking for yourself, not a detailed billing document. I was always finished with the note when the patient walked out of the room, and I am NEVER finished now that I’m using an EMR. I was in a shoulder generation so always had labs in the computer to review. Reading other doctors’ handwriting was always an issue.
“The nursing flowsheets? You do not want to open that Pandora’s box.” As a nurse using epic (or any EMR)…. Thank you. 😂 The amount of time I waste charting is astronomical.
Portals are the cause of so much health anxiety. People often look at their labs before the doc has had a chance to review them: and then lose their minds when they see any lab value that is even a tiny bit off.
This is nothing new to anyone here but... Why the FUCK are some EHRs the way they are?
I'm not even talking core functionality or design or large scale items that EPIC dweebs can come out of the shadows and at least try to justify. I'm talking STUPID, common sense bullshit that any SANE person would have accounted for. Ex:
The list goes on.
End Rant.
If one more admin tells us to work smarter not harder, I am going to scream inside my heart. But not outside because I want my paycheck. Arrrgh.
They assign the easy patients to the NPs but still give me 20 minutes per patient no matter how complex. I know some of you get less than that-- I left a job that gave me 10.
“Physicians have to cognitively switch between focusing on the record and focusing on the patient,” he said. He points out how unusual — and potentially dangerous — this is: “Texting while you’re driving is not a good idea. And I have yet to see the CEO who, while running a board meeting, takes minutes, and certainly I’ve never heard of a judge who, during the trial, would also be the court stenographer. But in medicine … we’ve asked the physician to move from writing in pen to entering a computer record, and it’s a pretty complicated interface.”
At 2:30am in the morning as I was emergently operating on a ruptured brain aneurysm trying to save the patient’s life, something dawned on me. I spend 10 times more time typing and dictating than operating on the brain 🧠 with my hands.
Just think about it! It took me 12 years of hard training to master the skill of brain surgery and I spend 10 times more time on typing and dictating. Over my career this ratio has increased and is accelerating. Talk about inefficiency and burnout! No wonder EHR is a big concern for physicians. Wonder how many of us end up with carpal tunnel syndrome which threatens our jobs as physicians.
We need to be very careful on how to implement AI in healthcare and learn from the EHR mistakes which continue to haunt us to date.
Lawyers want to sue doctors for malpractice if AI algorithms lead to bad outcomes….but also sue if doctors don’t follow AI rec’s & there’s a bad outcome.
And Tech companies, hospitals, & insurers want AI implemented but no liability for AI malpractice or mistakes.
Sounds about right—do what we tell you but if it leads to a mistake it’s your fault & you are liable
I've been an attending for about 1.5 years. As many others I have struggled with trying to keep on top of the work. As many of you, the inbox load is probably the biggest burden. I have 36 clinic hours and 4 admin hours per week. Our patient load is relatively low per day (15 patients) though we have fairly poor staff support so 15 patients per day is the max we can handle (udip would add 5-10 min to visit, ekg 15+ min to visit). I get on average about 20 messages per day from patients which doesn't include hidden messages in refill requests and messages from other staff. We had 3 providers leave so the remainder of us have been stuck covering their messages/labs and forms.
I genuinely don't know how I'm supposed to see a full panel of patients per day, answer 20 patient messages, try and fix issues my staff isn't able to figure out, close my charts and handle a stack of forms within a reasonable time frame. I'm sitting here with forms from 2 weeks ago and i still know i won't get to it until i somehow make time. i probably put in about 2 hours of admin each day. i generally skip lunch most days.
I get about 5-6 new patients per day so i spend ~40min each morning before i go in pre-charting and populating my notes so I can quickly close the notes soon after each visit. I think I'm in the minority in those who do this, but I find it super helpful and was a habit i developed in residency. My hope is that once i close my panel and have more continuity i can use this as extra admin time.
I've made my notes pretty basic. I punt as many questions as i can into a visit. For lengthy forms I ask patients schedule a visit. due to the relatively low volume per day I try and address a decent amount per visit to optimize billing to achieve my RVU goals which hasn't been an issue. My patients generally like me and i get good "reviews".
I've thought about leaving my place for someplace better with more support but I'm afraid the issue is me rather than where I am. Leadership tells me its not better elsewhere but i find this hard to believe. I genuinely love primary care and my job but sometimes I don't know if its cut out for me.