Physician workflow: barrier to consumer health engagement?

manage-workflow-with-emrThis week, I had a conversation with a physician whom I consider quite patient-engaged, who uses an EHR, and who works with one of the most wired health organizations in the United States. I complained to her that my user-generated data from my Bodymedia armband, Fitbit, Withings scale, among other #QuantifiedSelf devices, can’t find their way through the cloud to my doctors’ electronic health records or my patient portal. Her reaction was surprising to me. She was not so keen on the idea, saying, “It’s the physician workflow” that’s the problem.

The wordle on workflow comes from Dr. Chuck Webster (@EHRworkflow), one of the unique clinicians who blogs and is passionate about electronic health records and business process re-engineering. Learn more about Dr. Chuck via this great Perficient video from HIMSS 2012.

If you dig into the wordle and play a game of “magnetic poetry” with the words, you can cobble together various takes on workflow. I like the following mash-up: “the process or systems that clinicians use to ensure coordinated patient care.”

In this week’s Information Week, there’s a column that speaks to this issue: Doctors Push Back on Health IT’s Workflow Demands by Michelle McNickle (@m_mcnickle on Twitter). “The process for caring for patients is broken,” McNickle writes. Dr. Simeon Schwartz of Westmed Medical Group in Westchester County, NY, is quoted as saying that with respect to patient involvement, “”you can fix as many pieces as you want, but until you bring those pieces together into a new workflow, that won’t change the patient experience.” He confessed, “We’re [still] not creating the experience they [patients] want.”

Epocrates.v6iIn the meantime, Epocrates polled physicians in late 2012 to learn what’s keeping them up at night. The infographic summarizes the results of the study, with the topline finding that physicians’ lack of balance between work/home life, and uncertainty about government regulations, are most concerning.

Epocrates also learned that 90% of physicians access clinical content via a mobile app, and 40% use a mobile app once or twice a day.

Health Populi’s Hot Points:  Physicians have quickly adopted mobile platforms like iPhones and iPads because they realize, in real-time and quite immediately, real value from using them (see link to Manhattan Research’s survey). Epocrates captured aspects of physician value perceptions in their survey, shown in the graphic, that using clinical mobile apps bolsters patient safety and saves time: the most precious resource of the busy physician, who wants to recapture work/life balance per the survey.

Accessing my health/wellness activity data, for most physicians, isn’t so valuable to them…yet. Two of my PCPs (my OBGYN and internist) actually want to have my user-generated data populating my health record, but the vendor of their EHR (one of the big iron, closed systems that isn’t based on open-source standards) isn’t worried about that functionality right now.

The HITECH Act’s Meaningful Use, Stage 3, may foster this capability three or four years from now. But that’s one of those pesky government mandates — headache #2 for physicians — that’s a pain point, per the Epocrates study.

I will continue to be a shoemaker’s child with no shoes when it comes to marrying my self-generated health data to my medical information. So much for patient engagement. For now, bless Runkeeper, whose HealthGraph helps me track my activities, my food, and my sleep.

Now that’s what I call meaningful use.

 

 

 

One Response to Physician workflow: barrier to consumer health engagement?

  1. @Cascadia aka Sherry Reynolds February 16, 2013 at 9:29 pm #

    A couple of observations.

    1) Patient centered design encompass far more than simply importing patient generated data from apps (in fact nearly all information in your medical record is orignally generated by the patient – where else do they get the history from?). It includes things like online appts, email access to your doc, systems of care that take into account patient workflows, open and full access to your medical records (in real time as part of the care team not after some odd 4 day delay).

    2) The survey was by ePocrates – the largest drug checking mobile app and it would be interesting to see which mobile apps docs are using once or twice a day. I am guessing that if you back out the use of ePocrates it is very very low.

    3) Very very few docs complain about a lack of data..

    4) Meaningful use is simply seed capital meant to kick start some providers to explore adoption with little financial risk.. It is the floor not the ceiling and those providers who realize that their is a business case for patient centered practices will exceed it not find it a “mandate”.. Very few start-ups complain about the over-sight that VC’s and Angles have on their business so I would take full advantage of the funds.

    5) It is a false construct to think that a closed system (like Apple for example) is somehow preventing innovation. One of the larges ones (with 1 in 4 providers using it – Epic) in fact was one of the first to have a client created mobile app – Group Health.. that not only lets patients see their data but contribute to it.. http://www.ghc.org/mobile/ In fact when we went live at GHC patients could “write” to their charts via email before the docs even had write access (read only)

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