Facebook Twitter LinkedIn YouTube RSS

Do you have EHR Burnout?

A recent study by the American Medical Association (AMA) shows that physicians spend twice as much time with their EHR as they spend in “direct clinical face-time” with their patients.* Even more troubling: “For every hour physicians provide direct clinical face time to patients, nearly 2 additional hours is spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another 1 to 2 hours of personal time each night doing additional computer and other clerical work..”

The study also found widespread career dissatisfaction among physicians with over 50% reporting “EHR burnout”.  It’s no secret that physicians waste valuable time each day due to their EHR; 92% describe their EHR as “clunky” and “difficult to use” and 96% report that their practice will never return to pre-EHR productivity levels if they continue with their current EHR.**

According to author, speaker, and consultant on the subject of physician burnout, Dike Drummond, MD, physician burnout affects an estimated one in three physicians at any given time* “Improving the work life of physicians to help them avoid burnout is such an important goal that researchers are now calling it the “fourth aim” of health care, next to improving population health, enhancing the patient experience, and reducing costs.”  Drummond says, “To avoid burnout, you have to address the stressors in your practice.”  EHRs are a major source of practice stress.

*Study by the Annals of Internal Medicine and funded by the AMA, 2016. Available at: http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties

***Physician Burnout: Its Origin, Symptoms, and Five Main Causes, Dike Drummond, MD, Fam Pract Manag. 2015 Sep-Oct;22(5):42-47. Eight Ways to Lower Practice Stress and Get Home Sooner. Dike Drummond, MD, Fam Pract Manag. 2015 Nov-Dec;22(6):13-18.


Physician EHR Dissatisfaction Linked to Template Technology

With the majority of US doctors now having used an Electronic Medical Record (EMR/EHR), physician dissatisfaction with EHRs has reached alarming levels.  Major surveys point to a national crisis in EHR usability.  Physicians complain EHRs are difficult in practice and waste valuable time that could be better spent with patients.  Most EHRs, say doctors, have poor user interfaces based on template technology that slow charting down and hurt overall medical quality.  American physicians are angry.

According to surveys conducted by the AMA and Medical Economics, doctor’s dissatisfaction is linked to poor usability stemming from template based EHRs.  87% of physicians who use EHR systems claim usability issues as their primary complaint, and 92% of practices describe their current EHR as “clunky” and/or “difficult to use.”  A full 96% agree that their practice will never again achieve pre-EHR productivity levels if they continue with their current EHR.  A survey by American College of Physicians (ACP) found that every respondent reported losing some time each day because of EHR use.  Physicians blame template EHRs for losses in productivity, bedside manner, and medical quality.

The 2009 High-tech Act earmarked 3.9 billing dollars for Healthcare IT modernization.  Rewards in the form of financial incentives from Medicare have been the driving force behind the Meaningful Use (MU) certification, intended to encourage nationwide Electronic Medical Records adoption.  “Enhanced oversight, combined with potential cost efficiencies and quality-of-care improvements, have led to the federal government’s carrot-and-stick approach to EHR adoption,” says Medical Economics.

Over the past 5 years alone, hundreds of vendors have entered the market in a massive rush to sell EHR systems to physicians.  The majority of these companies are actually medical billing companies with no experience in clinical charting.  However, adding a template EMR along with billing services puts these companies in-line for the federal incentive payments designed for EMR adoption.  Medical billing and insurance companies alike have moved rapidly to market template EHRs.  In general, template technology is easy to develop from a technical standpoint yet difficult to utilize in practice.

Also contributing to the poor usability of template systems has been the rush to design and certify such systems for Meaningful Use.  The Centers for Medicare and Medicaid (CMS) set stringent deadlines for EMR vendors certify for MU Stage 2 by January 1st of this year.  This led most vendors to hurry EHR development opting for expediency over quality.  Product certification was seen as more important than product functionality.  As a result, Meaningful Use Stage 2 has been an unmitigated failure.  The attestation numbers speak for themselves.  With 147 certified EMR vendors certified, only 50 physicians in the entire United States were able to successfully attest for Stage 2 by May, 2014.  Finally, when only 2,700 had attested by August, 2014, CMS relented and allowed the attestation timeframe to be pushed back.

The dismal MU Stage 2 attestation figures reveal important lessons for the EHR industry:

First, it may be easy for an template EMR to pass Meaningful Use certification.  However, developing an EHR that helps physicians practice better medicine while achieving MU attestation is a different matter.  EHR systems that were rushed to meet arbitrary Meaningful Use timelines have proved unusable.  Unrealistic deadlines have led to awkward, difficult-to-use technology that slows down the work of practicing physicians.  Healthcare technology is too important to be rushed.  Likewise, the practice of medicine is too serious to be manipulated with carrots and sticks.  Certifying an EHR that helps (and not hurts) doctors cannot be accomplished under arbitrary Meaningful Use guidelines.  Physicians are now bearing the burden of a poorly planned federal certification program.

Second, template technology itself, although easy and inexpensive to develop, has proven problematic in clinical settings.  Most physicians site systemic issues in the rigid template user-interface.  “Template-based notes degrade the quality of clinical documentation”, reports the Huffington Post.   Doctors “described template-based notes as a significant threat to both clinical quality and professional satisfaction.  Such notes were described as complicating the task of retrieving useful clinical information. This problem was reported by physicians in all specialties and practice models included in the study.”

Physicians also argue that the fundamental premise of the Meaningful Use program is flawed.  Like any technology, the best way to push implementation is to create a user-friendly product that helps speed efficiency. Template EHRs take physician attention away from patients, thereby reducing productivity,” reports, Medical Economics.  What’s worse is that templates force the user to follow a preset format as they see patients.   The problem is that no two patients are the same and no two physicians are alike.  As a result, template EHRs slow physicians down, degrade medical quality and in general do not perform well in real life clinical settings.

As losses in physician productivity and medical quality mount, serious legal implications of extended template EHR usage are surfacing as well.  Template EHRs open physicians up to increased malpractice threats while their use in clinical settings is being labeled a “patient safety-risk”.  In a recent medical malpractice lawsuit in New York, the court succinctly placed the liability issue in the case on the use of templates in the physician’s EHR.  The doctor indicated that she had no option regarding the use of a template: ‘you have to choose a template,’ and by that choice, a screen pops up and provides the doctor with other options or choices to make’.  The template limited the entry of information and differential diagnosis choices and the results were catastrophic.

As 2017 is underway, most US physicians are either struggling to adapt their rigid template EHR systems to function in real-world clinical settings or 2) replacing their template EHRs with systems not based on inflexible template technology such as more flexible and adaptable “template-free” EHRs.

Systems free of structured templates are proving to be a solution to slow and poor quality charting.  Praxis EMR, an award winning system with artificial intelligence (AI), is a popular example of one such template-free EHR.  Instead of forcing a physician to follow preset templates, Praxis EMR learn from its user.  This allows a physician to practice faster and higher quality medicine than is possible with template technology.   Physician’s report time savings of 2-3 hours a day, improved documentation and medical quality, and lower workplace stress levels after using Praxis EMR.  To see how Praxis EMR works, please visit: www.praxisemr.com/demo


EMR versus EHR

Published on August 26, 2016, by in EMR/EHR.

What a difference a single letter makes

Over the past few years medicine has witnessed Healthcare IT companies re-label their Electronic Medical Records (EMR) as Electronic Health Records (EHR), and then market them to practicing physicians as ‘new and improved’.

Countless EMR companies have followed suit, and now it seems just about everyone is calling their EMR product an EHR, with the ‘H’ for Health implying something bigger and better than the original Electronic Medical Record.

At first glance the letter change makes sense. The argument follows that ‘Electronic Health Record’ is more inclusive than ‘Electronic Medical Record’, benefiting not only the doctor, but also patients, insurance companies, not to mention the government. The word ‘medical’ is more limited, implying that EMR is only a tool for doctors and nurses. Indeed, proponents of EHR argue that the tool should be for all stakeholders: patients, insurance companies, government, and all other interested parties. From this perspective, the physician becomes just one more ‘player’ in the ‘ecosystem’ of stakeholders.

But, what about the physicians?

Our profession has dramatically changed in the last 30 years

Not too long ago, doctors were strictly forbidden from advertising, and any connection with an insurance company was seen as a gross ethical violation. Today, insurance companies and third party payers often advertise on the physician’s behalf and take the dividends to the bank while hiring the very physicians who created the restrictions. “Our insurance keeps you healthier”, is the mantra. Of course, as physicians we know how silly these claims often are. When all is said and done, society still looks to physicians for its healthcare needs. Nobody honestly believes that one insurance company makes people healthier than another, or that insurance companies, rather than physicians, keep people healthy.

EHR, Pay for Performance and outside interests

Underneath the name change from EMR to EHR there is a subtle implication that this new tool will also serve to “keep doctors in line”, pressuring them to practice ‘better’ and more cost-effective medicine, as dictated by the other EHR stakeholders. Just ask yourself why insurance companies have invested so heavily in Pay For Performance (P4P) schemes. Could it be because they are looking out for the physician’s best interests and they want to help “good doctors” make a few extra bucks? We think not. Most of those behind the rhetoric are not physicians, and of the few that are doctors, the majority have never practiced medicine full time and therefore don’t fully appreciate the issues at hand. Their rhetoric continues however, and unfortunately most of us do not have the time to expose their misguided propaganda.

Here lies our great predicament. By not having enough time to get involved in these ‘side issues’, doctors first permitted a huge bureaucracy to grow around them, eating up precious healthcare dollars while limiting their ability to provide the best care possible. The bureaucracy has amassed an enormous amount of power, and now seeks to exert control. The Third Party Payer bureaucracy has now turned its attention to EHR as a means to do its bidding by remote control. They want to control not only how much money a physician earns, but also how he or she will work.

There is something very serious indeed behind this single letter change.

Computers are far from objective

Folks often make the false assumption that the computer is an objective, neutral, thinking-machine. Indeed, it is this point of view that has helped persuade most of our colleagues to buy into the idea of EHR, as opposed to the more focused Electronic Medical Record. One might ask, ‘what difference might it make whether it is an EMR or an EHR? The machine will still make the right decisions for us all, if we program it to do so’. This viewpoint is very naïve as it misses the whole concept of what software is about.

Actually, the computer is incredibly biased – biased by the programmers that developed it

The computer is NOT a traditional machine, and yet it is not ‘human’ either. The computer stands on a fascinating and fuzzy boundary between the mind and the machine. And it will make a huge difference to a practitioner whether he or she uses an Electronic Medical Record or an Electronic Health Record.

What if a computer is not neutral, but rather behaves according to how it is programmed? Should the program function for the doctor (Electronic Medical Record), or for “society” whatever that means (Electronic Healthcare Record). This depends on who will use it, and who it is that needs the information generated. It is here where the subtle change in terminology is crucial.

All computer programs take sides, and a good program should take the side of its user. If your position is that of the controller of healthcare in a financial institution, then it is markedly different than if your side is that of a practicing physician in a small practice, or a hired physician in a larger healthcare institution, or even a patient.

Have you thought of why many insurance companies want to allow you to use their EHR for free that most likely would have cost thousands of dollars? What kind of a ‘Trojan Horse’ will doctors be getting?

INTERFACE: A wonderful word for the new times

In reality, we are constantly “interfacing”. Doctors interface with patients, with the hospital administrators, with office managers, with the insurance companies and other third-party payers, with the Medical Board. The good news is that this is what computers are meant to do, on your behalf, and in some ways faster and more effectively. Instant communication to the right people at the right time.

Thus, it seems to us that there is a gigantic difference between an Electronic Medical Record and an Electronic Health Record, just as there is a big difference between an Electronic Medical Record and a Personal Health Record (PHR- managed by patients themselves). Insurance companies have powerful software, including Pay for Performance systems that are developed by experts for the insurance companies to lower their medical care costs as much as possible. They SHOULD have this software. We are not against that.

This is all well and good, but as a practitioner of medicine, you deserve to have your software tailored to make sure you benefit as much as possible. Of course, because the vast majority of doctors put patients first, then their patients would also benefit, as a result.

We believe the answer lies in the development of excellent interfaces between Electronic Medical Records (biased toward providers), Medical Billing applications (biased towards providers’ finances), Patient Health Records (biased toward patients), Insurance and government software (biased toward business institutions and government) and medical research software (biased toward investigators who also need your data). Interfaces are not only possible but also very positive. Indeed, our entire open society is based on interfacing and compromise.

Software cannot be all things to all people

All software should interface with other interested parties’ software in real time, each benefiting its respective client base. You cannot be all things to all people, and neither can software. This is what the voices behind EHR fail to understand.

We strongly believe that far from killing it off, the advent of EHR, when fully understood, will make the Electronic Medical Record stronger than ever. The EMR should be biased on the side of its purchaser, which ought to be the medical practitioner. The EMR is meant to be a liberator to free the physician’s time, make his chores easier, and improve the income and the quality of service a physician renders. Moreover, the EMR should protect a physician not only from making mistakes but also from not practicing the best possible medicine. In the P4P arena, this should should be a no-brainer; everyone should score 100%, since the P4P should be there by the doctors side at the point of care, and not simply examining cases after the fact. A good EMR would insure this. An EHR may not care as much, since this may imply higher medical expense and less of a bottom line to the third party payers and the patients and employers. However, each one of those patients wants the best possible care when it is their own health is on the line, even the stingiest insurance company CEO…

These are tall orders to be sure, but the alternative is unacceptable; imagine if your software also served insurance companies and the government at your expense and that of your patient. There is always room for compromise in order to benefit the medical community as a whole, but these compromises ought to take place at the negotiating table between doctors, medical society and the other interested parties – and NEVER in the programming of a software application.

Each software developer should listen closely to its client base, and interface with other products representing other interests wherever possible. EHRs, made by folks that listen to everyone, will not work in best interests of the medical providers, or for the ultimate best interests of their patients. Trying to be everything to everyone, as the EHR proposes, is a sure recipe for disaster.

Please ask yourself the following question: Am I a Medical Doctor or a Healthcare Worker?

The answer to this question should make your preference for the term EMR or EHR obvious.


Praxis EMR is the Number One Rated EHR in Major User Satisfaction Surveys for 2015

AAFP Physicians Give Praxis EMR Highest Rating when Switching EHRs; Black Book Ranks Praxis Number One Overall in Solo and 2-5 Physician Practices

Praxis EMR, an award-winning developer of electronic medical records (EMR/EHR) software received the highest satisfaction ratings in two major physician-user surveys released independently by the AmericanAcademy of Family Physicians (AAFP) and Black BookMarket Research in 2015.

The AmericanAcademy of Family Physicians ranked Praxis EMR the #1 EHR by physicians in its survey “Physicians Who have Switched EHRs.”  Praxis EMR ranked first place in physician satisfaction when doctors were asked to rate their new system after having switched EHRs.  Praxis EMR outranked 73 other systems, with the largest percentage of physicians who strongly agreed, “I am happy with our new EHR system.”

The EHR Switch Survey studied physicians who have changed EHR systems since 2010 and evaluated their overall satisfaction after changing.  The survey by Robert L. Edsall and Kenneth G. Adler, MD, of Family Practice Management (FPM) sought to understand the key factors driving practices to change EHRs.  The report outlines key challenges physicians encounter when changing EHRs, and examines whether changing EHRs leads to improved EHR performance and satisfaction.

“While our sample is too small to suggest winners and losers in the EHR marketplace, we do see some suggestive numbers,” explain Edsall and Adler. ”EpicCare Ambulatory and Praxis had the most net gains in customers among our respondents.” However, when user satisfaction was compared between the two EHRs, the difference in satisfaction was compelling.  Praxis eclipsed Epic and outranked all other EHR systems.

Black Book Market Research also named Praxis EMR the #1 EHR in overall user satisfaction for 2015.  Black Book is recognized as an unbiased source for polling, market research and client experience. Praxis earned the highest ratings of the year in overall user satisfaction among Solo Physicians and in 2-5 Physician Practices across all specialties of medicine, as well ranking #1 for the entire Internal Medicine specialty.

“Praxis is the only EMR not based on templates, and this is why physicians prefer it to other EMRs” said Doctor Richard Low, CEO of Praxis EMR. “Most EHRs turn doctors into data-entry clerks, forcing them to use rigid templates in order to document complex medical situations.  Medicine is an art and no two doctors practice the same way.  This is why templates do not work in medicine,” said Dr. Low.

The difference between Praxis EMR and template-based EHRs is its ability to adapt to each physician user’s unique methodology.  Rather than using pre-loaded templates, Praxis uses artificial intelligence technology that learns from each user to chart progressively faster and more effectively.

“As medical students, physicians studied medicine, not data-entry,” said John Davis, M.D., owner of Grayson Valley Family Medicine, P.C., and Praxis EMR client.  “Template EHRs force us to check boxes and fill in the blanks, and that’s demeaning.” added Dr. Davis.  “With Praxis, I’ve found an EMR that helps me provide better care to my patients, meeting my own standard of care.”

“An EHR should be about helping physicians practice better medicine their own way” emphasizes Doctor Low.  “At Praxis, we believe that maintaining usability and freedom while charting is essential to improving medical quality, lowering costs, and improving physicians’ income.”

About Praxis EMR

Award-winning Praxis EMR is the leading innovator of Electronic Medical Records, serving thousands of physician-users.  Instead of relying on templates, Praxis utilizes intelligent technology that self-learns while users documents in free text.   Praxis’ focus on clinical usability consistently earns it top ratings in physician user satisfaction surveys.  View the Praxis demo: www.praxisemr.com.


New EHR Survey shows users want more than just the basics

Published on June 10, 2014, by in Uncategorized.

A recent survey by Software Advice, in collaboration with Research Now Healthcare, found that many of the most common concerns for prospective EHR buyers are no longer such overwhelming problems for current users. The ongoing survey has collected responses from over five hundred EHR users to date.

The results show that 58% of users had little or no problem with the costs of supporting the system. 49% believed that learning to use the EHR posed little, if any, challenge. In addition, achieving government Meaningful Use standards was little or no problem for 61% of users. These numbers suggest that several of prospective buyers’ most pressing concerns are not echoed by current users– in other words, EHRs tend to work better in these areas than many non-users expect.

The survey also found that 50% of users thought that reduced productivity was a moderate or major challenge. Another 55% felt the same about integration with other systems. Customization was a major problem for 20% of users and a moderate problem for another 29%.

Interestingly, many of the major challenges presented by the study are Praxis EMR’s major strengths. Among its users Praxis has allowed for a major increase in productivity by decreasing the time needed to document cases. One of the key features of Praxis is its ability to smoothly connect to all users in the Praxis network to one another, as well as to pharmacies, labs, and other administrative services. Praxis was founded on the basis that each doctor practices uniquely and deserves a system they can personalize without the use of a template.

The overall results of the survey suggest that EHR users are more satisfied than they have been in the past with basic EHR functions. They are now beginning to seek more advanced features, such as personalization and better interoperability with other tools. Overall, it is clear that physicians are becoming more comfortable with the EHR basics and beginning to demand more of their technology.

See the survey here.


Survey: The era of the EHR switch is far from over

Published on May 15, 2014, by in Uncategorized.
Source: The EHR Software BuyerView 2014 Report, Software Advice

Source: The EHR Software BuyerView 2014 Report, Software Advice

According to a recent study on 385 randomly selected medical practices by Software Advice, Inc., 40% of EHR buyers are looking to replace their EHR. The desire for better technical support and more integration between applications ranked among the top reasons for replacement.

From the first quarter of 2013 to the first quarter of 2014, the number of buyers seeking EHR replacements grew by a third. Of the 2014 buyers, more than 50% cited cumbersome software, the desire for integration, or inefficiency of prior EHR systems as the reason for seeking new technology.

In the assessment of concerns for new software, it was found that about 40% of buyers were most concerned with strong mobile support. 89% of buyers wanted software that would integrate with other applications, including billing and patient scheduling.

Of those surveyed, 47% were medical practitioners, while 36% were owners or directors. All expressed a desire for a system with government compliance that could be implemented quickly and efficiently. The trend in growth of EHR buyers is expected to continue in coming years.


The EHR dissatisfaction crisis: looking beneath the surface

The rise in provider dissatisfaction with EHRs and the second-time buyer boom have been well-documented and much-discussed. However, when analysts look to understand the cause of this dissatisfaction, they identify only superficial reasons: lack of training, workflow issues, price, or poor customer support, to name just a few. They fail to look deeper and miss the underlying structural cause of physician frustration.

When they break down the reasons for the poor reception of today’s EHRs, analysts are missing a crucial point: doctors are dissatisfied with major EHRs because they are all built in the same flawed manner. Templates are the reason for the plummeting survey results and the rapidly increasing second-time buyer contingent. Templates overwhelmingly slow doctors down, create unnecessary and uncomfortable new workflows, expose doctors to the risks of sub-par documentation, and more – yet nearly ever major EHR uses them.

If the EHR industry is to address usability problems, it must look beyond the symptoms and find the underlying cause: the structure and nature of templates.


Template-free Charting At HIMSS13!

Published on March 11, 2013, by in Uncategorized.

For the first time in our 20-year history, Praxis EMR was a first-time exhibitor at the HIMSS Conference & Exhibition in New Orleans March 3 – 7, 2013.

The Exhibition was an amazing opportunity to share our unique technology with attendees.  We had fascinating conversations about what EHR usability really means, and how to use our template-free system to help doctors practice better medicine.  In addition, we were honored to see Praxis user Dr. Jeremy Bradley receive the HIMSS Davies Award for excellence in the use of electronic medical records.

Overall, an exciting and informative week. Check out these photos of our booth!


Interfacing and Interoperability: not an EHR selling point

It may sound counterintuitive, but it’s true: interoperability should no longer be a major selling point when looking for an EHR.  Why?  Because every good EHR should be fully interoperable.  And soon, every EHR will have to be interoperable.

Interoperability is one of the most exciting areas of health IT: it holds incredible potential to change the practice of medicine, and can dramatically increase the quality of treatment patients receive.  As we all know, the federal government has provided increasing support for interoperability initiatives in recent years.

Many of the major EHRs attempt to impress physicians with their size, then boast that their systems can “talk to,” or are compatible with, a range of billing software, other hospitals, and other EHRs.  Uninformed EHR buyers are overly impressed, and move to purchase one of these systems.  It’s true that interoperability is a crucial part of any EHR: so crucial, in fact, that you should never purchase an EHR that is not fully interoperable. For that very reason, though, interoperability is not a special benefit or selling point.

The federal government has stepped in and mandated interoperability.  When these requirements are fully implemented, any certified EHR  will be able to exchange information with any hospital, laboratory, medical equipment, or billing software, as well as with any other EHR.  Software that can not achieve full interoperability is simply not certified.

In other words, don’t let the issues of size and compatibility distract you in the EHR search: purchase your favorite EMR, large or small, as long as it is ONC-certified.  All EHRs and health centers will be required to interface with yours.

Never let any EHR company sell you interoperability as a special or unique feature.  It’s time to go beyond interoperability and talk about what really differentiates today’s EHRs: usability.


Choosing the Right EHR is a blog series about the many factors to consider when purchasing an EHR.  It offers important perspectives for doctors looking to purchase their first EHR, as well as those who are switching to a new system.


Is your EHR an automobile or a tricycle? The quick-start myth

Many doctors say, “I want a no-brainer of an EMR that is easy to learn and is very cheap, free if possible. In fact, I want to try it out without any reading or training whatsoever.”  Be careful what you wish for: you are bound to get it!

No one would argue that it is easier to learn to ride a tricycle than to drive an automobile.  Few, however, would claim that a tricycle is more usable - at least, we don’t see many adults driving tricycles to work these days.  Indeed, tricycles are so simple that three year-olds can use them without training, while many of us spent a semester in high school learning how to drive a car.  Completely free of context, therefore, a tricycle is more “intuitive,” even more “usable,” than a car. However, a tricycle’s quick learning curve is easily overshadowed by the automobile’s superior power and functionality.

For these reasons, when an EHR promises that you can “learn in minutes” or “be up and running instantly,” take a second look.

All of the best EHRs require training – in fact, studies show that the level of EHR satisfaction is directly correlated to the amount of training users have undergone.  The better you know your EHR, the more it will do for you, the more satisfied you will be.  On the other hand, EHR users with the least amount of training are generally the least satisfied. Many of the best EHRs cannot be learned in just five minutes, but they are superior tools that will do more for your practice.  Take time to learn your EHR, and you will be rewarded.

Don’t be distracted by the appeal of the quick (or “instant”) start-up.  Instead, take a look at what the EHR can do for you on a day-to-day basis after suitable training.  If a program were to save you two hours a day for the rest of your professional life, how much time would be reasonable to learn how to use it right? This is the real question to ask yourself and your EHR vendor.