Computers create work...PO Day 153

We knew it, didn't we? We never did buy the idea that computerization saved time. We sit down at the machine for just five minutes and don't get up for an hour! It's turning out that is true with the Electronic Health Record system too.

In an October 2014 article in the International Journal of Health Services Drs Woolhandler and Himmelstein, New York Internists, analyzed and compared time spent by the average US doctor on bureaucratic tasks and job satisfaction. The following information is excerpted from their report.

The average doctor spent 16.6 percent of their work time on paperwork unrelated to patient care, in 2008, the last year that data was available. The data came from the 2008 Health Tracking Physician Survey of 4,720 physicians. The paperwork involved billing, getting insurance approvals for treatment, financial and employee management and contract negotiations. Paperwork that directly concerned patients such as writing notes in charts, ordering lab tests and writing to other doctors was not included in the paperwork estimation. "Paperwork" is used here euphemistically for computer work. So any time one sees "paperwork" you should read data entry on the computer.

The greater the amount of time a doctor spent in "administrative" paperwork the less satisfied he was with his chosen profession. Solo practitioners spent more time on administrative duties than did members of a group. Psychiatrists had the greatest burden of paperwork, followed by internists and General practitioners. Pediatricians spent the least time on non-patient tasks and were the most satisfied of doctors.

Now here is the come-away information: those using electronic health records, either solely or a mix of paper records and electronic records, spent more time on these administrative chores than did the doctors who used solely paper records. Proponents of EHR have maintained that computerization would reduce doctors' paperwork but it appears the opposite is true. Over the last two decades the

bureaucratic burden has grown for physicians. Fewer doctors are solo practitioners and many have moved into small group practices where bureaucracy rules.

Dr. Himmelstein commented: “Our crazy health financing system is demoralizing doctors and wasting vast resources.“Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction,” Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. International Journal of Health Services, Vol. 44, No. 4.

The only rebut to these remarks is that they are based on a study from 2008. However, I have not had the sense that my doctors nor their staff are any happier with the amount of paperwork the EHR has created for them now.

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October - getting back to normal, November - almost there!

Hospital compare site...P O Day 130

CMS, the government administrative arm of Medicare, has created "the Hospital Compare" data base. This allows the Medicare patient to compare the rate of unplanned readmissions or deaths within 30 days of being in the hospital of their choice with the rate of those unfortunate events at other hospitals locally or nationwide. The purpose is to improve the quality of care with a measurement  that is easy for the consumer to understand. The goal for the hospital is to anticipate and prevent problems that lead to readmission or even death following hospitalization for certain conditions.

"Hospital Compare" records and reports instances when the patient is readmitted to the hospital within 30 days of discharge if they were initially treated for 1. heart attack, 2. heart failure, 3. pneumonia, 4. hip/knee replacement surgery, or 5. hospital-wide readmission to include internal medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology services.

Also reported is the 30 day death rate from heart attack, heart failure or pneumonia.

They keep track of surgical complications such as: pneumothorax, blood clots, postoperative wound dehiscense, accidental puncture or laceration, pressure sores, venous catheter related infections, postoperative hip fracture due to a fall, and postoperative sepsis.

Ultimately this data serves two purposes: First, the patient can go to the Hospital Compare Home Page and compare the record of three hospitals of their choosing. This rate is also compared to national averages. Second, Hospital Compare is part of the Hospital Quality Initiative whose intent is to help improve hospitals' quality of care by distributing objective, easy to understand data on hospital performance. both for the benefit of the patient and the hospital.

This is a great way to be able to compare your local hospital with other nearby facilities and even nationwide statistics. To go to the Home Page of Hospital Compare by clicking on this link
http://www.medicare.gov/hospitalcompare/search.html:

I briefly mentioned this medicare site on P O Day 83 so if you have already checked it out thoroughly, forgive the repetition.

Archive timeline: 2014: May and June - preparing for surgery, July - surgery and post op problems, August - recovery and physical therapy, September - thinking medically, October--