EHR

The increased use of health IT among providers could reduce the number of patients physicians are able to see, according to a study published in the American Journal of Managed Care, FierceHealthIT reports.

Study Details

The study was based on survey responses from primary care physicians in Michigan (Hall, FierceHealthIT, 11/19). The survey -- by the Center for Healthcare Research & Transformation and the University of Michigan Child Health Evaluation and Research Unit -- was conducted between October 2012 and December 2012 and included a total of 739 respondents.

Responses from physicians who were not practicing at the time were not included.

Study Findings

The study found that physicians used a mean of 5.1 health IT services. The most commonly used health IT service was electronic prescribing, while a Web portal for patients to schedule appointments was the least common.

Overall, 83% of respondents said they anticipated having the capacity to accept new patients in the future.

However, the study showed that the odds of physicians who reported having the capacity to accept new patients decreased by 14% with each additional health IT system used.

Further, the study showed that the number of patients seen was more likely to be negatively affected by health IT at smaller physician practices than larger practices (Tipirneni et al., AJMC, 11/17).

According to the study, EHRs and electronic access to admitting hospital records were most closely associated with an expected lower capacity. Meanwhile, technologies that were less likely to negatively affect capacity included:

• Electronic prescribing;
• Reminder systems;
• State immunization registries; and
• Web portals for scheduling appointments or requesting medication refills (FierceHealthIT, 11/19).

The study also found that physicians with higher health IT use were less likely to accept privately insured patients than those with Medicaid or Medicare. The researchers said this was surprising because providers generally receive higher reimbursement rates from private coverage.

The researchers concluded that the findings "call into question" whether health IT expansion "translates into improved efficiency and capacity in primary care practices" (AJMC, 11/17). They added, "In an era of concurrent [health] IT and insurance coverage expansions, policymakers must weigh the unintended consequences of each in order to optimize capacity to care for the newly insured" (Rizzo, "Becker's Health IT & CIO Review," Becker's Hospital Review, 11/18).

Four groups of health IT vendors and technology companies have submitted bids to compete for the Department of Defense's $11 billion Defense Healthcare Management Systems Modernization contract, FierceEMR reports (Dvorak, FierceEMR, 10/31).

Background

In February 2013, DOD and Department of Veterans Affairs officials announced plans to halt a joint integrated electronic health record, or iEHR system, and instead focus on making their current EHR systems more interoperable.

In August, DOD issued a final solicitation for bids for the DHMSM contract.

As part of the project, DOD will replace the:

• Armed Forces Health Longitudinal Technology Application, or AHLTA;
• Composite Health Care System; and
• Various EHR components, including AHLTA-Theater (iHealthBeat, 8/27).

The final day to submit proposals was Oct. 31 (Request for Proposals, 10/24).

A team of DOD civilians, military personnel and subject matter and procurement experts will evaluate the proposals (iHealthBeat, 8/27).

In March, then-VA Secretary Eric Shinseki told lawmakers that VA planned to submit an advanced version of its EHR system as part of the competitive bidding process to replace DOD's current system (iHealthBeat, 4/29).

However, VA spokesperson Genevieve Billia last week said, "VA never planned to formally bid in DOD's acquisition" (Brewin, "Health IT Update," NextGov, 10/30).

Latest DOD EHR Contract Bids

The groups that submitted bids for the contract include:

• A partnership between IBM and EHR vendor Epic;
• A team that includes Computer Sciences Corp., a defense contractor and systems integrator, Hewlett Packard, a computer services firm, and EHR developer Allscripts;
• A team that includes EHR vendor Cerner, Leidos -- a government systems integrator -- and Accenture Federal; and
• A group that includes PricewaterhouseCoopers, General Dynamics Information Technology, DSS and MedSphere (Carr, InformationWeek, 10/31).

According to NextGov's "Health IT Update," DSS and Medsphere both offer EHRs based on VA's VistA software ("Health IT Update," NextGov, 10/30). However, the VistA software under the PwC team would be a commercial version that follows standards developed by the Open Source Electronic Health Record Alliance and incorporates best practices from other commercial versions.

Dan Garrett of PwC, said the commercial VistA software is "a better fit than anything else that's commercially available," as it is designed for the DOD market.

DOD officials say they plan to make a decision on the contract by July 2015 (InformationWeek, 10/31).

Physicians who use electronic health record systems experience more administrative burdens than their peers who use paper records, according to a study published in the International Journal of Health Services, FierceEMR reports (Durben Hirsch, FierceEMR, 10/28).

Study Details

For the study, researchers from the City University of New York analyzed data from the 2008 Health Tracking Physician Survey -- the most recent available -- to gauge how much time physicians spend on administrative tasks. The data included a nationally representative sample of 4,720 physicians who practiced 20 or more hours per weeks (Physicians for a National Health Program release, 10/23).

Study Findings

The study found that physicians who used EHRs reported spending about 17% of their working hours on administrative tasks, compared with 15.5% of those who used paper records.

Doctors using both EHR and paper records faced the greatest administrative burden of all groups, spending about 18% of their workweek on administrative tasks, according to the study.

Overall, the study showed the average physician spent 16.6% of the workweek, or 8.7 hours, on administrative tasks.

In addition, the study found that more time spent on administrative tasks contributed to lower morale. For example, physicians who said they were "very satisfied" spent an average of 16.1% of their time doing administrative tasks, while doctors who reported being "very dissatisfied" spent 20.6% doing such work (Physicians for a National Health Program release, 10/23).

The researchers attributed the increased administrative burden among EHR users to:

• EHR documentation being more time-consuming than paper documentation; and
• Providers considering some EHR data entry that relates to patient care, such as billing, administrative (FierceEMR, 10/28).

The initial misdiagnosis of the first Ebola-infected patient in the U.S. resulted from a combination of human and computer error, according to a new study published in the journal Diagnosis, Modern Healthcare reports (Conn, Modern Healthcare, 10/23).

Background on Ebola Case

Thomas Eric Duncan arrived in the U.S. on Sept. 20 and was sent home from Texas Health Presbyterian Hospital after seeking help for a fever, stomach pain and sharp headache on Sept. 25. Duncan returned to the hospital on Sept. 28 where he was diagnosed with Ebola and placed in isolation. He died less than two weeks later.

According to the hospital, Duncan told a nurse during his initial hospital visit about his recent travels to Liberia, and the nurse correctly entered his travel history information into the hospital's electronic health record system.

On Oct. 2, Texas Health Resources released a statement saying that although the nurse had included the information about Duncan's travel history in the EHR, a flaw in the system had prevented physicians from seeing the note.

However, on Oct. 3, officials effectively retracted the statement, explaining that "the patient's travel history was documented and available to the full care team in the [EHR], including within the physician's workflow." The hospital noted that "there was no flaw in the way the physician and nursing portions interacted related to this event."

The hospital uses EHR software developed by Epic Systems (iHealthBeat, 10/20).

Details of Study

According to InformationWeek, some of the study findings are speculative, as the researchers did not have access to a comprehensive collection of nurse and physician notes and could not examine the EHR system's configuration in great detail (Carr, InformationWeek, 10/23).

After analyzing an Associated Press review, the researchers found that the use of a "series of predefined symptom options" could have led to the confusion over Duncan's diagnosis. The researchers were able to determine that hospital workers used "predefined patient instructions" because of the "generic nature" of the phrases used in their notes (Modern Healthcare, 10/23).

According to the study, such templates are used to capture data, but they also can sacrifice "utility for appropriate triage and diagnosis." The researchers added that EHR systems and the meaningful use incentive program emphasize recordkeeping over care and detection of uncommon conditions (InformationWeek, 10/23).

Implications

The researchers said that the case illustrates that "EHR-based clinical workflows often fail to optimize information sharing amongst various team members, leading to lapses in recognizing specific clinical findings that could aid in rapid and accurate diagnoses" (Modern Healthcare, 10/23).

As they stand, EHRs "lack the innovations needed to prevent misdiagnosis," according to the report. Therefore, the researchers recommended that regulators focus on enhancing EHRs' decision-support tools, sorting methods and alerts (InformationWeek, 10/23).

Epic Defends EHR System

In related news, Epic President Carl Dvorak said the EHR system should not be blamed for the misdiagnosis, Health Data Management reports.

Dvorak said that the system properly displayed information, such as travel history and symptoms, but it was overlooked by various health workers. He said the information "got missed by the nurse who actually documented that the patient came from Liberia -- that's a knowledge gap," adding, "And, it got missed by a physician" (Slabodkin, Health Data Management, 10/21).