The original article can be found here, and was written by John Russell for the Chicago Tribune on December 12, 2015.
When Dr. Niva Lubin-Johnson sees her last patient of the day, she knows it’s not quitting time. Not even close.
She’ll often stay in her Chatham medical office on the South Side another two hours, updating patient records with their relevant medical histories, allergies, laboratory results, medications, X-ray images, immunizations, vital signs and billing information.
There are so many boxes to click through, she wonders whether she spends more time with her patients or with her computer. She’s had to cut back from seeing four patients an hour to three so she doesn’t feel overwhelmed. When she does examine patients, she also spends much of her time on her laptop, filling out dozens of electronic forms mandated by law.
“Is this really helping us with patient care? The answer is no. We’re just checking off boxes, sending in a report,” said Lubin-Johnson, 58.
It’s getting to the point where she is looking forward to retiring. It’s a thought she rarely entertained before the federal government began requiring physicians to use an elaborate — or maddening and onerous — system of electronic health records four years ago or face penalties worth tens of thousands of dollars in lower Medicare reimbursements.
She’s not the only one. Around the country, medical associations attribute increasing doctor burnout to the demands of clicking through page after page of records, whether the patient shows up for a physical, a quick follow-up visit or treatment for chronic disease.
Family physicians, who normally worked into their late 60s if not 70s, are closing up their practices, several medical societies say. Others are just refusing to participate in the program, and are watching their practice revenues drop. A recent study by Mayo Clinicresearchers, working with the American Medical Association, found that more than half of physicians felt emotionally exhausted. Among the reasons: heavier workloads and “increased clerical responsibilities.”
Electronic health records were supposed to be a game-changer, giving doctors and patients a wealth of medical information at the click of a mouse. The goal was to reduce medical errors, help diagnose illnesses, increase transparency and accountability, engage patients in their care and improve public health. Doctors signed up, lured by financial incentives and the promise of better patient care.
There is evidence that electronic health records are helping patients to get more access to their medical information. Nearly four in 10 people surveyed by the Office of the National Coordinator for Health Information Technology said they were offered access to their records in 2014 — a significant increase from a year earlier, when only 28 percent said they were offered access.
More than half of the patients offered access in 2014 actually checked them, and 87 percent of those who did found the information useful.
And some doctors say that electronic records are valuable, even if the government mandates are cumbersome.
“A patient calls me at home, and I can look up the record,” said Dr. Stanley Friedell, a Chicago obstetrician. “With a click of a button, I can see everything. … But things can be improved.”
More and more, doctors are grumbling that federal mandates are clogging up their days with busy work, turning them into data-entry clerks and taking time away from patient care.
Even more upsetting, they say, is that after spending hours entering data, software crashes or refuses to upload to national databases. Computer systems among hospitals and laboratories often can’t talk to each other.
“So when we are trying to get records from other institutions, other hospitals, private offices, it is very difficult,” said Dr. Javette Orgain, a family practice physician in Chicago and chair of the Illinois State Board of Health.
Now, as the federal government is preparing to ramp up the requirements, medical groups around the country are protesting. Last month, more than 100 medical societies, led by the Chicago-based AMA, called on Congress to delay new requirements.
Since 2011, the Department of Health and Human Services has rolled out requirements in stages, from the basic (recording medications and allergies) and getting progressively harder (submitting electronic data to immunization registries and collecting information for use in research). The next set of requirements comes due in 2018.
To receive federal incentive money, doctors have to attest that during a 90-day reporting period, they used a certified record system and met the criteria for “meaningful use objectives.”
The AMA has gathered dozens of written and videotaped testimonials from doctors around the country, sharing horror stories and frustrations through its website as part of its “Break the Red Tape” campaign against “meaningful use.”
“I feel that I am typing my way into burnout,” wrote Dr. Laura Knudson, a family physician from Bloomington, Ind. “Instead of spending my days listening to patients and solving their problems, I feel that I spend most of my time struggling to make unique stories and needs fit into an arcane system of clicks and drop-down menus.”
Dr. Katherine J. Atkinson, a family physician from Amherst, Mass., said she had to hire an information technology consultant for 19 months to help train her staff. “It’s been so exhausting,” she said on the video. “It’s interfered with patient care. It’s left us financially bereft.”
The AMA said that 58,000 physicians were certified for the “meaningful use” program during the first three years, but that number has steadily dropped. Last year, about 22,000 fewer physicians attested that they had met the requirements. This year, more than 250,000 physicians will be penalized financially, the AMA said.
The AMA said it is not shying away from technology. It points out that most doctors use computers, tablets and smartphones throughout the day. But it complains the medical record technology is new and unreliable and crashes too often. Just last week, a hardware storage glitch at Hospital Corporation of America, which runs 165 hospitals and 115 surgery centers in 20 states, shut down parts of its electronic health records.
Similar problems have bedeviled other health systems in recent months, including outages at hospitals in Missouri and California, affecting their ability to dispense medications, according to trade publication MedCity News.
“It’s just chaos, countrywide,” said Dr. Wanda Filer, a family physician in York, Pa., and president of the American Academy of Family Physicians. She said she received an email two weeks ago from a physician in Louisiana who spent 40 hours of his own time in the evenings trying to prove he had met Meaningful Use Stage 2 requirements to qualify for incentives. He got a receipt that his information went through.
“But it turns out, it did not,” Dr. Filer said. “And he’s going to take a significant dollar penalty for something totally out of his control. What is happening is onerous.”
Doctors say they expect a certain amount of glitches, but they are tired spending hours troubleshooting computer problems. Even when they are in the exam rooms, they are often typing, potentially missing visual clues for their diagnoses. Worse, some patients may think their physician is checking email rather than listening.
“Patients complain about that all the time,” said Dr. Jeannine R. Turner, a cardiologist at Northwestern Memorial Hospital. “The computer now sits between us.”