Data Fatigue

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Is that even the right phrase?

Because of how the systems are all set up at my office (by corporate mandate) we have a ton of moving parts. Healthcare is complicated anyway but our system makes it much, much more difficult:

The staff has to schedule in one program. But they also have to check the EHR (electronic health record) to make sure there is not something else of concern in there, like a pop up that says to schedule an appointment for that patient for 30 minutes instead of the typical 15 minutes. I have access to the EHR, I do not have access to the scheduling program.

Charges are posted manually in another separate billing system. 

Lab tests have to have the orders entered in the EHR but you have to log into a separate lab program to print out the orders and specimen labels. 

There is a separate patient “portal” system that has to be checked throughout the day where patients can send messages. It does not streamline into the EHR seamlessly. In fact, notifications that there is a waiting message do not come through until the next day so someone has to constantly be checking it to make sure we don’t miss something. If a patient makes a change in the portal system, like to their preferred pharmacy, I have to manually change that in the EHR.

Patients are allowed to cancel or confirm their appointments by phone or text but that means someone in my office has to comb through the info and manually cancel those appointments. 

There is an online mailbox that takes appointment requests and questions from the clinic website that has to be monitored twice daily. 

Toss in two answering machines that kick in when the phone volume is too high. 

We have three regular fax machines and an e-fax that have to be monitored.

Instant messenger on the computer that we have to use to communicate urgent things to each other.

Email.

All of the phone lines.

There is a physician “dashboard” on a website that we are supposed to log in to every month to check out our numbers and do various tasks like read corporate selected articles and answer questions.

I have my phone which also functions as my pager when I am on call.

The hospital system has their own separate EHR system that I have to access for patient records.

Data fatigue is real, folks. 

This is too, too much for a human being to keep track of. Finding staff that can handle this sort of mix is impossible from a 20 minute interview. It invites error and is getting dangerous. A new EHR will help to some degree by consolidating (hopefully) the scheduling, lab orders, portal system, and billing together into the EHR, but there is still all of the other stuff to keep track of and the change is a year away. 

Meanwhile, my brain does not like it. I cannot focus on the patient problems like I need to. While they are talking I am racing around the EHR trying to click all of the required buttons or trying to address the IM from the front desk saying a patient wants their forms completed RIGHT NOW. I have to force my brain to focus on the voice, to stay on what they are saying instead of multitasking or worrying if my staff checked the online mailbox this morning….

“I’m sorry. How long have you had that pain did you say?”

I don’t know if we can make it a year. 

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109 thoughts on “Data Fatigue

  1. Times are changing.
    Which country you are based in Victo?
    The image has wonderful sculptors. Do you know where they are from.
    Excuse me if questions were too many or too obtuse.
    Best Wishes,
    Anand πŸ™‚

    Liked by 1 person

  2. I’ve watched my own GPs with the new system they are using. I’ve heard them curse it.Yes, there are helpful warnings, seachable patient histories… but the amount of typing needs to be more than the time they have to spend with a patient… Either that or they concentrate on the patient then try and remember everything to write up in the couple of minutes while patients leave and enter. There is a fine line between being served by and enslaved by technology. I wonder if we have crossed it?

    Liked by 3 people

  3. AArgh! I can empathize Victo. When I was working as a transportation manager I had crew working 24/7 and 80 direct reports spread over 500,000 square miles. I had two cells phones (work and personal), a MIKE (press to talk), an office phone, two home phones [all phones had messaging systems], a pager, five computers (home desktop, work laptop, work desktop, personal laptop,school laptop [I was studying at the time]), 6 e-mail addresses (the work desktop had an internal A/S400 e-mail as well as a PC e-mail). My wife, watching me juggle devices when we went out, said I should get a bandoleer and string them across my chest. I told her that worried me as it would attract lightning and that my devices and I could be reduced to a small pile of ashes. It took me two hours just to check all messages and by the time I was done, many more messages had piled up and needed to be checked again. Shortly after I left that job I was diagnosed with colon cancer. I belong to a data collection group for colon cancer patients that tries to find commonness between cases. Their findings were that 75% of colon cancer patients reported high stress levels in their lives within a year prior to the diagnosis of cancer. It’s not hard to figure out. Physician beware.

    Liked by 1 person

    • The nonprofit agency I work for gets more and more paperwork every year to comply with government documentation requirements. The best, most compassionate therapist in the agency could not keep up with her paper work. She died from ovarian cancer a year and a half ago. She was in her 50s. It took her down fast.

      Liked by 2 people

      • Yes, there is a lot of anecdotal evidence linking stress and cancer – too much to ignore. That said, no one has yet come up with a mechanism that explains it. Mind you you can’t see air either but that doesn’t mean it isn’t there. πŸ˜€

        Liked by 2 people

      • Paul, I am going to delve into this further for a post. You gave me pause today. You have discussed this link to stress before. Dunno why it stuck so hard this time, but I really want to know more. The stress link makes intuitive sense particularly when you look at the ACE study. Anyway, future post coming up…. πŸ™‚

        Liked by 2 people

  4. IMO, Technology will be the death of us all if the Red Tape doesn’t hang us first. At least in the US you give your patients a 15 minute appointment. Here in the UK we only have ten, and for some of us, that’s not enough to get our clothes off for an examination!

    Liked by 1 person

      • Ten minutes per appointment, period. When I saw her about my knee and hip problems, I booked a double appointment, wore my loosest clothing, and kept to the point of my concerns and pain! Even then, she was checking the clock to make sure she didn’t overrun. Gone are the days when the doc would actually listen to you and ask questions rather than just nod.

        Liked by 1 person

      • No, our visits to GPs are free on the NHS, but if your symptoms are complicated or you wish to see a doctor with another member of the family, you’re encouraged to ask for a double, so that you get 20 minutes. I don’t go very often because I always feel rushed. The best GPs I had were in 1987-88 for my depression (he was terrific), and then 1996-2007 as she refused to have a clock in her office, and actually looked at me as I spoke. She helped me with my weight issues, I never felt I was wasting her time, and she actually treated me as an individual, not a number. The last surgery in Lincolnshire was abysmal, and apart from my diabetes checks with the nurse (from Oct 2011), I only went a couple of times, they were useless. Perfect example was wishing to discuss medication I wasn’t even on, and to prescribe medication I’d previously had bad reactions to (luckily the chemist told me what they were, so I didn’t get the prescription filled). Good GPs are like hens teeth.

        Liked by 1 person

  5. That is nuts!!! Where I work as an NP, we use EPIC (it is part of a hospital system) and EVERYTHING is in one system, lab requests, scheduling. The patient portal syncs with our EHR so their emails and our responses automatically populate in their EHR. Our secretaries take phone messages and in Epic there is an inbox where they can send those messages and you can see immediately when someone sends a message. You guys need a new system!!!

    Liked by 3 people

    • EPIC is what we are getting next year…. I used EPIC 11 years ago but have been existing in this hell ever since, made worse because I know how good it could be. At least there is a light at the end of the tunnel somewhat!

      Liked by 1 person

      • So they have a deadline then. (Epic in one year, or I’m outta here.) Maybe they’ll move faster if the current system is causing too many problems, ie, problems that don’t hurt patients, but gum up the corporate whatever. I’m NOT suggesting sabotage, but what I’m saying is, don’t kill yourself to make everybody happy. I think I’m saying this to myself too.

        Liked by 1 person

  6. I am 27 now. This year I decided to remove WhatsApp and delete it from my life. Only friends reach me through chat applications. The people that matter for me I call or I send a direct message and when convenient we meet.

    Dual entry systems have their use because you can double check and cross check everything but managing the flow of information and checks requires at least one full-time person to continually update the complete administration, even for a small team.

    To this day though, what is really important I write down and I prepare. I can effectively only do one thing at a time. Social media and big data cannot change that. Too much information and I slow down…

    Liked by 2 people

  7. The complexities of the new century. I work for a newspaper corporation (way down at the bottom of the food chain), and the layers of communication, forms, emails, multitudes of programs to interpret, schedules, priorities, texting, authorizations, meetings, corporate mandates, memos, misinformation, etc. is astonishing. It used to be, “Here’s an ad. Can you have it done in half an hour?” Now, if an ad is late or missing, it has to go through a corporate layer cake before we see it, and usually past the deadline. And I’m a humble graphic artist. I can’t imagine how frustrating it must be for you. Forgive me for my rant, it was a rough day. This certainly puts in perspective. πŸ™‚

    Liked by 1 person

  8. Computers aren’t the issue. Technology isn’t the issue. Developers are the issue.

    I’ve been on the inside of the computing business for almost 50 years and the change in capabilities, in the things we can do, is pretty astounding. The place where we have not made progress is in our everlasting search for simple (and profitable) solutions to complex problems.

    “Everything should be as simple as possible, and no simpler.” Most people do not understand that gluing complex applications together is often more difficult than writing the applications themselves. What you are using is the product of a company with a CEO that doesn’t understand that; who saw the vision and said “Build it” without asking for a plan, and next week said “Where is it?”

    While computers and technology change, clueless people do not. You can’t fix stupid.

    Liked by 3 people

    • Whenever something was going wrong the solution was to add another program. They had the opportunity to get a good program from the get go but they did not. Instead they kept patching a bad one and each new layer made it harder and harder use.

      Liked by 1 person

      • I’m sorry to say I’ve heard that story before. The other thing they always do, is patch over the cracks with hype. If the hype is good enough, you won’t notice the failures–or, at least, the people in charge of buying the product won’t notice.

        Liked by 2 people

      • I went to a family practice conference within a few months of them moving us into our current EHR and stopped by the booth of the EHR program. There were some serious issues with the program that we were told were “known problems” and that there was no solution available currently. Interestingly, the demo models were not showing these even though we were supposed to be using the latest update. So I ask the poor sales guy why this is, that what this boils down to is false advertising. He had nothing to say. So then I went back to the group I worked with and told them what I had seen. It slowly made its way up the chain of command until what was eventually sent down to me was that I must have not really paid attention to what they were demoing. Bull crap. I took the computer mouse from the guy’s hand and did the actions myself. They worked fine on the version he was showing. Then it was pretty clear were all hosed. It wasn’t about a good product or taking good care of patients, it was about lies and money on both ends.

        Liked by 3 people

  9. As we begin our transformation at work, one of the main things that has to be done is deciding what to use for our electronic record system. We were on McKesson and have morphed it so much that we cannot use it as it should be use now. We have work arounds on our work arounds. Its a mess.
    We were talking about how much easier doctors have it than home care……not so much, huh? We have one MD who has an RN follow him around all day to scribe his brilliance. I know some docs use Dragon or some form of voice recognition. I think we need one universal system that talks to everyone, hospital, doc offices, labs, home care and so on. One system. Can you imagine? Can you imagine having someone who knows what they are doing with something that powerful? lolol

    Liked by 1 person

    • I hate my shared system. I have other specialists mucking around in my chart changing medical histories and med lists and such. All of their HIPAA document to and copied of insurance cards and other detritus also gets scanned in for each physician. Soon the record is a barely recognizable pile of muck. Who can afford to have a scribe follow them around all day? Dragon is a pain in the butt in these point and click Meaningful use programs. You cannot dictate a family medical history. You are required to push the dang buttons! Must. Stop. Rant. Now. πŸ™‚

      Liked by 1 person

  10. What makes me crazy is the same form questions the system generates every time I have a appointment and the “medical assistant” stands there asking me the questions that are prompted by the computer. No individualizing the care offered. Just ask the same questions that may not really fit my situation.

    Liked by 1 person

  11. There must be a way out of this mess. I hope some day you find a better working environment, one that allows you to do what you do best -Help people be as healthy as they can be – and maintain your own sanity and health, too.

    Liked by 1 person

  12. This is interesting to me because from the patient side, it also seems as if things do not talk to each other (patient portals.) For example, I took my daughter to the pediatric orthopedist for a swollen knee. He ordered blood work, and even though I knew the results were in, they were conveyed to me by a receptionist who couldn’t explain what they meant or answer my questions beyond what the doctor told her. I checked the patient portal, hoping to see the actual results, but, no dice. Her x-ray was not even visible. I had to cal the office back several times, get them to fax the results to my pediatrician (they couldn’t give them to me over the phone because of HPAA) and then have him explain what they meant, with the disclaimer that the specialist might think differently. So, it is frustrating from the patient side as well.

    Fondly,
    Elizabeth

    Like

  13. Wow, sir… Linda from Task At Hand referred me to this post. Very interesting. I come from 2 perspectives, as a patient, and as someone who works at a company that ‘serves’ you guys in the hospitals – supposedly making it easier for the hospitals and the doctors. I say supposedly, because I see the whole system as one big mess with more and more players coming in making it more complicated. I hope your new EHR helps out, but then again, there is always the chase after the fancy new thing that is supposed to solve all the problems. Either way, all I can say, good luck and keep a sense of humor. . .

    Liked by 1 person

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