Time Begets Quality, DPC is the Key to Utilizing FitBit Data.

Venture Beat recently released an article expounding on all the reasons doctors don’t want data from health wearables like Fitbit. Among those reasons? Not enough time to analyze, and no proven system to analyze it in.

One higher-up explains: “Doctors would love to be excited about wearables — they’re gadget guys at heart — but their day-to-day is spent battling 30 year old fax machines to get your last lab report.” says Jeff Tangney, CEO of Doximity, which makes a social communication platform for clinicians. “For a busy doctor, the ability to use email would save more lives than a Fitbit.”

Atlas MD’s Dr. Josh told his side of the story in an interview with The Daily Beast. His view looks completely different from that of docs who shudder at the thought of more data. He not only cares about his patient’s FitBit data, but welcomes it. He finds this information so useful, he’s integrated fitness app tracking into his EMR software (that also handles emails, in case you were wondering) to better communicate with his patients about the one thing that matters most – their health.  Read more

Women’s Health Works Better When Doctors Are Motivated To Inquire

Women are often considered drivers for healthcare in their families.

Unfortunately, Kaiser Family Foundation performed a study and found that many women face cost and logistical barriers to obtaining healthcare for themselves.

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45% Of Physicians Say EMRs Make Care Worse And Cost Practices Money

It’s another case of hate to say we told you so. Looks like for too many doctors, their worst EMR fears have come true, proving to be expensive, a drain on staff and technically inadequate. A total of 45% of respondents to a study said that in fact, patient care is worse since implementing EMR.

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Healthcare Is Broken. But Throwing Pills At It Won’t Solve The Problem.

Kevin Pho knows how to craft a headline. He says on Kevin MD, that patient satisfaction is all the rage, and that it might actually kill.

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Posted by: AtlasMD

January 9, 2014

1 Comment

CDC Study Finds Lung Cancer On The Decline

Finally, some good news in healthcare! The CDC writes on their weekly Morbidity and Mortality Weekly Report, “Lung cancer incidence decreased to a statistically significant extent from 2005 to 2009 among men in all U.S. Census regions and 23 states, and among women in the South and West U.S. Census regions and seven states. By state and age group, lung cancer incidence rates decreased or were stable in most states.”

But bittersweet already seems to be the theme of 2014. Two statements to look at:

“CDC has declared reducing tobacco use a ‘winnable battle’ and supports comprehensive efforts to prevent the initiation of tobacco use, promote quitting, and ensure smoke–free environments.”

“Although many factors might have contributed to this decline, a study of 44 states showed that strong tobacco control indicators were correlated with lower lung cancer incidence rates among adults age 20–44 years.”

From a doctor’s perspective, and a health perspective, this news is worth celebrating. However, the cause of the celebration is debatable. How much of this reduction in smoking was the result of strong patient-doctor relationships, versus decades of anti-tobacco PSAs? Again, we don’t have a problem with public service announcements or even people freely electing to smoke (although we’d never advise it). It’s just worth pointing out that there’s still room for family physicians to make an impact on our nation’s health — by getting to know our patients, earning their trust, and helping them make their own healthy lifestyle choices.

READ THE COMPLETE CDC REPORT HERE

Study Suggests More Insurance, More ER Visits

Sabrina Tavernise writes in The New York Times about a new study that flips a steadfast assumption on its head. At first glance, you’d think that giving people more access to Medicaid would lower the frequency of ER visits. However, a study conducted in Oregon has proven the exact opposite.

The study was published in the journal Science. It compared two groups of people — a 2008 lottery randomly selected thousands of low-income people in the Portland area and provided them Medicaid coverage; a second group entered the lottery but received no insurance. Here’s the shocker. “Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts,” writes The Times. The pattern was strong, holding true across most demographics, times of day, and types of visits. These even included conditions that we could have treated here in our Atlas MD office.

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Research Shows Top 10 States And Top 25 Cities To Practice Insurance-Free Medicine

Are you curious if your state or city made one of the lists? Keep in mind, we’re having a great time practicing direct care here in Wichita, KS, and get this–we didn’t make either one! On top of that, not all of these states are eligible to dispense prescriptions (New York, Montana, Texas, and Utah prohibit it). In our experience, the real value in running a direct practice comes from offering wholesale prescription discounts. Over time the savings add up, especially for patients with chronic conditions (diabetes, thyroid disease, asthma, migraines, etc.) where it becomes cheaper to subscribe to your clinic and stop using insurance to pay for prescriptions.

Given these facts, we’re not treating this as the ultimatum for who or where one should or shouldn’t open a direct care clinic. However, the research brings up some good reminders. According to Dr. Chris Ewin, Founder and physician at 121MD in Fort Worth, TX:

“Direct practices should be successful in most cities and states where there is an inadequate supply of primary care physicians.” He adds, “… Most important, a physician needs to have social skills to sell him/herself and their new practice model to their patients and their community.”

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EMRs Now Omnipresent, Along With Affiliated Stress…

Electronic medical records are being adopted at an all-time high. Now 409,839 eligible professionals and providers are getting “federal incentive payments” (i.e. kickbacks from Uncle Sam) for adopting or using an EMR system.

A recent study was published in the Journal of the American Medical Informatics Association that examines the effect of EMR omnipresence. Specifically they were curious what the machines do to working conditions and how they affect stress, satisfaction and burnout among primary care physicians.

How was the study conducted?

The survey results came from 379 physicians dealing with various EMRs in 92 clinics spanning New York, Chicago, Milwaukee, Madison, Wis., and even some rural areas in Wisconsin. The docs took a survey and reported on four aspects:

  1. Time pressure felt during patient encounters
  2. Perceived control over workplace issues
  3. Job satisfaction
  4. Job burnout

Afterwards, the clinic managers also marked which of 15 common features or functionalities were present in their EMR. From there, the clinics were grouped into three categories:

  1. Those having the majority of the 15 most common features (50% of the sample clinics)
  2. Those with a moderate amount (24%)
  3. Those with a low number of common features (26%)

What were the results?

Researchers compared the physicians’ responses to the clinic’s functionality classification (high, medium or low). Physicians at clinics with moderate-function EMRs experienced significantly more stress than physicians at clinics with low-function EMRs. The medium functioning EMR group had a higher rate of burnout. And here was a weird result: the physicians who operated the high- and medium-functioning EMRs felt less satisfied with their current position overall.

Okay, but what does this mean?

According to lead researcher Stewart Babbott, MD, of the University of Kansas Medical Center in Kansas City, the mid-functioning group having high stress might suggest that these clinics were transitioning. He went on to say, “Our finding that physician-reported stress was highest in the moderate-use group ‘made sense’ for those practices in which some of the functions were on paper and some in the electronic record or for those without a fully functioning EMR.” Fair enough, we’ve said it, too:

“A shoddy EMR is no doctor’s friend; it’s like having a friend you have to explain everything twice to.” – @AtlasMD (Click to Tweet)

And here’s our favorite part. Remember how we’ve been talking about all those boxes that need clicking? The ones that generally don’t do anything? The results showed a significant relationship between time pressure and physician stress in the group with high-functioning EMRs. It was only in this group, too. This suggests that physicians may be particularly pressured for time during patient encounters in the face of a large number of EMR functions. “This ‘made sense’ to us in thinking about the possibility that those in the high-use group had more to do in the EMR,” says Dr. Babbott.

Please, keep in mind that this study suggests CORRELATION and NOT CAUSATION. Dr. Babbott stressed this after the study, saying that further studies are needed to determine the precise relationships.

“Further study is needed to focus on those efforts which can be most specifically related to EMR use,” he says. “If the moderate-use group’s higher stress is due to that practice being in transition between a paper-based system and an EMR, then this work supports stress being an issue to address during that transition. Similarly, if the high-use group’s stress is related to more functions and requirements for each patient’s care, then addressing processes of care and care team support could be of benefit.” (We included this last quote if only to showcase how political this researcher is. We’d recommend better EMRs, too, but that’s just us.)

Unfortunately, there was no mention of Meaningful Use in the study. Strange, right? This is the same legislation demanding more features in the EMR, and incentivizing doctors to implement them. Of course, our perspective outside of the red tape is different than docs still operating within it. But if you ask us, a machine that stresses us out at work, is a machine we’d be happy to get rid of.

Posted by: AtlasMD

September 30, 2013

1 Comment

EHR Study Finds Emergency Docs Click 4,000 Times In A 10-Hour Shift

The American Journal of Emergency Medicine conducted research and found that emergency doctors “spend significantly more time entering data into electronic health records than they do with patients.” The study concluded that “improved efficiency in data entry would allow emergency physicians to devote more time to patient care…”

According to the published paper, emergency physicians spent 43 percent of their time entering data on a given day. Only 28 percent of their time was spent directly interacting with patients. And, during a busy, 10-hour shift, total mouse clicks neared 4,000.

Here’s what the paper’s author, Robert Hill, M.D. from St. Luke’s University Health Network in Allentown, Pa., had to say:

“Emergency department physicians spend significantly more time entering data into electronic medical records than on any other activity, including direct patient care.”

He lists out factors that get in the way of efficient EHR usage, including operating system speed, server/mainframe responsiveness, typing skills, user-friendliness of system, interruptions, extent of training, opportunity to delegate tasks, and various environmental attributes. However, in his opinion, “Efficient use of the EMR system will increase physician productivity and hospital revenue.” We couldn’t agree more. If you agree with his thinking, too, you can tweet it right now.

READ FIERCE EMR’S COVERAGE OF THE STUDY HERE

Hands Up — Who’s Bringing Their iPad into the Examination Room?

The Direct Primary Care Journal shared findings recently about the prevalence of iPad usage by physicians. According to the report, the most common activity of physicians who use an electronic health record (EHR) and use a smartphone or tablet is “sending and receiving emails.” The second most frequent activity among tablet users is “accessing EHRs (51% daily).” Compare that with just 7% of physicians using their smartphone to access EHRs.

VIEW THE COMPLETE BREAKDOWN OF RESEARCH FINDINGS ON THE DPCJ’S WEBSITE

We’ve highlighted some of the results here:

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