Not everyone was surprised with the results of the recent report that found no connection between Meaningful Use and quality of care.
“There is so much frustration from a physician standpoint,” said Donald Voltz, MD, anesthesiologist at Aultman Children’s Hospital, in an exclusive interview with Clinical Innovation + Technology. That frustration is felt by all health IT users down the line, he said, and is due to vendors developing and selling products without understanding the real demands for front-line staff. And, he said, no one from the MU program ever observed clinicians using the systems to see whether they are practical solutions.
He cited the billing requirement for anesthesia to conduct a post-op visit before a patient is discharged from the PACU. He used to check a small box on the anesthesia record and sign off if the patient was stable. With the advent of health IT, his organization built a form into its EHR and it now takes Voltz more than 20 clicks of the mouse to get into that system.
With 50 to 70 of these discharges a day, he spends a lot of time at the computer clicking the right boxes. “How do I show that that’s really not good patient care? When workflows are competing with what the EHRs are requiring of us, that’s where lapses in care or potential errors become uncovered by these systems. To me, it’s not surprising that Meaningful Use is not impacting quality of care. We’re forcing physicians into workflows that are not useful for quality clinical care but at the same time they are required to be compliant with that.”
EMRs were developed on primitive database technologies, which resulted in a spare amount of complex data that physicians used to gather in a more visual paper-based framework. They knew where to go with the information. The EMR is developed on the same layout using just relational database architecture to develop and collect all this information, Voltz said. “The EMRs out there are not doing anything but collecting data—they’re not presenting the information back in a usable format, a format that allows for the management of patients and the communication of information to all the different players involved.”
In translating this manual flowsheet to the EMR, “it was a nightmare," said Howard Nearman, MD, anesthesiologist at UH Case Medical Center in Cleveland. They were set up by nonphysicians and the theory was that making everything digital would make everything all better. “It’s still very cumbersome and very inefficient.”
“Since I left residency in 2001 my patient load and complexity continues to go up,” said Voltz. That requires physicians to have the best tools available but the “way technology has been deployed is not commensurate with the way we work.” In fact, he said some physicians are cutting corners and not placing orders they need to because they can’t find them. Instead, they wait for a nurse to call questioning a missing order and then ask the nurse to place the order.
Also, most physicians have to interact with several EMR systems and the user interface is different for each, which is time-consuming. Voltz cited an obstetrician who said the most frustrating thing was that it took longer to enter notes from a C-section than it took to perform the C-section.
This is where software from Zoeticx comes into play. Zoeticx maps behind the scenes so clinicians can have a unified front-end which streamlines physician interaction. Zoeticz gets the relevant information to the clinicians in the same place regardless of the EMR.
Zoeticx offers software architecture that provides ambulatory and non-ambulatory care facilities with a single platform for universal EMR connectivity as well as an application programming interface open to third-party developers. The software eliminates the need for clinicians to search, said Thanh Tran, co-founder and CEO of Zoeticx. The basic idea is bringing the information to the clinicians rather than forcing them to chase after it.
The tools let developers and clinicians “focus on innovative solutions instead of solving the infrastructure challenge,” said Tran.
The software also helps clinicians close the loop, said Voltz, who consulted with the company. “Any patient situation can have multiple open loops.” The Zoeticx software communicates back to everyone involved. “If I have an issue in the OR, I can take a snapshot of the patient’s vital information and send out a need for a consultation and he’ll know exactly what I was looking at the time of my concern.”
Meanwhile, others can develop workflow tools that sit on top of the EHR. “Ultimately, it’s going to be a third party that’s going to solve the interoperability problem because there’s not a marketing pull or business strategy for vendors to do it outside of mandates and regulations.” He said forcing a solution on the healthcare system could make the interoperability problem even worse because it would probably be “cumbersome at best.”
Zoeticx also addresses the issue of lengthy upgrade times, said Tran. EMR systems are very large applications so it can take 12 to 18 months for the vendor to release an upgrade. And, most users require a substantial amount of customization on top of that. “A lot of the time, that means reimplementing those customized solutions. We’re talking about two to three years for any special requests.”
Time will tell if this new software can make a significant impact on the interoperability issues facing healthcare. “I love technology but I’m incredibly frustrated with the healthcare system,” said Voltz. “Docs don’t really care what goes on behind the scenes yet right now we’re being forced to realize it. When the system is not working, we get all the problems on the back end. We really want something on the front end to allow us to access information and someone else can deal with the back end.”
Everybody is afraid to talk about how bad EHR systems are, he added, and how bad they are for costs, workflow, and patient satisfaction and patient outcomes. No evidence is available yet but “a lot of the systems we rely on are pretty fragile on the back end. I’m afraid we’ll have a breakdown in the system that leads to the wrong data for the wrong patient. I think we can do it better. Other business sectors have done it better. If we start to apply some of those principles to healthcare, we will be able to have an impact.”