Is Your EHR Contributing to Physician Burnout? | Depression and Physician Suicide

Health and Wellness applies equally to patients and physicians.   Pamela Wible  focuses on physician suicide and the neglect of emotional illness in physicians points out the unusual stress placed upon medical students, trainees as well as practicing physicians.   She has presented at TedMed, and has published numerous books on the subject. The'Ideal Medical Practice" is taught at several prominent Schools of Medicine.

The concept of the Ideal Medical Practice was founded by Gordon Moore in 2001 well before the health information technology sea change.

Today there is an overemphasis on electronic medical records.  Unfortunately, as many adopters have learned the EHR may not contribute to improved medical care, but decreased efficiency and increased frustration to all health care providers.  Most of this has been inflicted by government and health insurance companies.

The work flow has been adapted to boiler plate electronic health record design, rather than EHR designed to the work flow.  At first glance this is the main reason for intense provider dissatisfaction with most current software design.  Another contribution is the rapid increase of requirements due to simultaneous demands of meaningful use, changing to the ICD 10 codes, new requirements for management of accountable care organizations and a finite limit to resources for the requirements.  The cost of these changes was partially offset by HITECH incentives, although they were inadequate for many providers. Ongoing maintenance requirements were totally ignored by HITECH.

All of these factors increase the likelihood of physician burnout.  Physicians are trained and inherently devoted to caring for  patients with complex problems.  EHRs create one more energy drain for doctors and nurses alike.  It has upset the balance of work-life, health and wellness.

The burden falls to providers facing diminished reimbursements.  Decreasing profitably and outright becoming insolvent in today's environment weight heavily upon physicians who are now locked in by obligations, ongoing professional responsibilities add to hopelessness, and despondency.  Physicians are trained to overcome difficult situations, and can manage problems.  EHRs and bureaucracy are often not manageable and greatly influence physician wellness.

Although physicians are proactive and outspoken, the administrators and regulators often do not listen. Congress does not listen.

Two weeks ago, the American Medical Association’s immediate past president, Dr. Steven Stack, chose what seemed like an odd venue to mention something called the “Quadruple Aim.”

He was giving remarks at the grand opening of the OSF Simulation Stage at healthcare startup incubator Matter in Chicago. The AMA supports Matter and has a lab of its own, the AMA Interaction Studio, in the same facility.  “We need to restore joy to the practice of medicine,” Stack said on the very day the Annals of Internal Medicine published an AMA-supported study showing that physician waste huge chunks of their day on administrative tasks. Notably, doctors in four ambulatory specialties were tied up on electronic health records and other desk work for 49 percent of the work day, the research found.   “We have got to get to the Quadruple Aim,” Stack said. That means the Triple Aim of safer patient care, better population health and lower costs, plus a fourth element, clinician satisfaction.

Is Your EHR Contributing to Physician Burnout? | EMR and HIPAA

Medical Practices of the Past QUIZ

Medicine in the 21st Century is based on scientific knowledge. Practices we use now have been reached by a wealth of knowledge gained over many years, tests and experiments and the study of data.


So, when you realize what practices were used as little as 50 or 60 years ago, it seems amazing that we’ve come so far ever since! It also makes you thank God you weren’t alive in those times, for the treatment may have been worse than the illness. Test your medical history I.Q. here.

Try our quiz and see if you can guess which practices are fact and which are fiction.



Medical Practices of the Past QUIZ Infographic

Trump Visa Changes Hit US Nursing Supply From Canada, Mexico

What !?

HENRY FORD HOSPITAL VS . NAFTA

vs.

Health care is now inextricably wound into the fabric of government. Even NAFTA's recision effects the availabllity of skilled health care professionals.  It goes something like this.

President Donald Trump's dislike of the North American Free Trade Agreement (NAFTA) is starting to affect the workforce in United States hospitals that rely on specialized nurses from Canada and Mexico to fill critical positions.

Under NAFTA, Canadian and Mexican registered nurses have for decades practiced in the United States on nonimmigrant professional TN visas, and each day many Canadian registered nurses (RNs) cross the border to work in US hospitals.

But under recent stricter interpretations by US Customs and Border Protection (CPB), advanced practice nurses and advanced clinical nurse practitioners are no longer eligible to work under the old RN category and must now apply for H-1B visas. The latter cover specialized positions for foreign workers from any country and can cost several thousand dollars per applicant for expedited processing.

Last week, a Canadian nurse practitioner working at Henry Ford Hospital in Detroit, Michigan, was denied renewal of her TN visa. "She was told by CBP that the reason for the denial was a change in interpretation of NAFTA and that advanced practice nurses, in their opinion, no longer qualified under the NAFTA registered nurse category," said immigration lawyer Marc Topoleski, who represents Henry Ford Hospital, at a March 16 new conference.  (Holy Moses, Batman !).  Nurse practitioners are no longer categorized as R.N.s.  Who makes that kind of decision ? Is it a fear of terror, or something else even more insidious and dark ? Did some negative factor for this particular person appear suspicious. In fact this policy has not been made official nor appear in any written policy documents. 

30 Canadian nurses at Detroit hospital pressured at border after policy change

The process could take as long as 3-4 weeks.

From left: Patti Kunkel, nurse practitioner, Henry Ford Health System; Marc Topoleski, principal attorney of business immigration services, Ellis Porter; Kathy Macki, vice president of human resources, Henry Ford Health System. (Dana Afana | MLive.com) (Dana Afana | MLive.com)

 HFH and others must file for a more complex and expensive H1B visa for those employees admitted on TN Visas.  Maybe an executive order from the Apprentice director would help

Trump Visa Changes Hit US Nursing Supply From Canada, Mexico

Primary Care: Some Good News Residency Match Day 2017 Sets More Records

In recent years several new medical schools have come on line.  Some of them are specifically designed to educate primary care physicians. (you know what we used to call GPs).  As a result that increase in medical school graduates along with the increasing emphasis on primary care by HHS, CMS reflected by better reimbursement rates gives hope that health care will become more accessible.





Residency Match Day 2017 Sets More Records

Common Blood Tests Can Help Predict Disease Risk :

By the time you finish reading today's Health Train Express you will be able to add one more metric to decreasing the liklihood of chronic disease.

It is not a guarrantee, nor an absolute predictor of your fate...all of these tests are readily available at you doctor's office.  Ask that they be done, when your physician asks you why....quote the following. Almost all plans now reimburse for preventive medicine.  If they deny you, appeal it to the health plan.  The squeaky wheel gets the ' oil '.

The research was presented Friday at a meeting of the American College of Cardiology and hasn't been published in a peer-reviewed journal.

"Our goal was to create a clinical tool that's useful, easily obtainable and doesn't slow the work-flow of our clinicians," said Heidi May, PhD, MSPH, principal investigator of the the study and a cardiovascular epidemiologist with the Intermountain Medical Center Heart Institute.

Dr. May and her team studied a primary care population consisting of both male and female patients who had no history of a chronic disease. ICHRON was developed among one set of primary care patients, then tested in a second, independent primary care population.

 The tests, done in Utah are not controlled and are biased heavily to the demographics of Utah, where the study was performed. ICHRON Score ( Intermountain Chronic Disease Score) is factored on several well known and routinely done lab tests.  Many of these are done annually, and are relatively inexpensive.

"It's a fascinating concept," says Wayne Dysinger, a preventive and family medicine physician and CEO of Lifestyle Medicine Solutions, a primary care practice in southern California, who wasn't involved in the study. "They may be on to something, but it's too early to say for sure." For one thing, the score would have to be shown to be accurate in a more general population outside Utah, which is largely white and has lower rates of smoking and obesity than other states.

Among women, those with a high ICHRON score were 11 times more likely to be diagnosed with a chronic disease than those with a low score. Women with a moderate score were three times more likely to be diagnosed. Men with a high score were 14 times more likely to be diagnosed than those with a low score, and those with a moderate score more than five times more likely to be diagnosed.

American Heart Association

Common Blood Tests Can Help Predict Disease Risk : Shots - Health News : NPR

Telehealth Outlook Under the Trump Administration | The National Law Review

 The Trump Administration is likely to drive telehealth advancement in a positive direction. use of telehealth technology.For example, President Trump’s plan to reform the Veteran’s Affairs Department includes improved patient care through the use of telehealth technology. There are also some indications that the newly confirmed Secretary of the Department of Health and Human There are also some indications that the newly confirmed Secretary of the Department of Health and Human Services (“HHS”), Tom Price, is “telehealth friendly.

Price also said he is interested in promoting telehealth because it “holds great promise, particularly for rural areas experiencing physician shortages and for patients with limited mobility.”

Despite the current focus in Congress on repealing and replacing the Affordable Care Act, telehealth legislation continues to gain traction and bipartisan support on the Hill. In February, a bipartisan group of 37 Senators sent a letter to Tom Price encouraging HHS to support telehealth and remote patient monitoring. Congress also has embraced telehealth advancement with a consistent stream of proposed legislation seeking to enhance the provision of telehealth services. Most recently, Rep. Joyce Beatty (OH-03) and Rep. Morgan Griffith (VA-09) reintroduced the Furthering Access to Stroke Telemedicine (“FAST”) Act that would expand access to stroke telemedicine (also called “telestroke”) treatment in Medicare. Congress also recently introduced HR 766 which would establish a pilot program to expand telehealth options under the Medicare program for individuals living in public housing. Additionally, Congress is poised to consider at least two bipartisan pieces of legislation focused on telehealth. The first is known as the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (“CHRONIC”) Care Act of 2016, which seeks to modernize Medicare payment policies focused on improving the management and treatment of chronic diseases using telehealth technologies. The second is known as the Creating Opportunities Now for Necessary and Effective Care Technologies (“CONNECT”) for Health Act, which seeks to mandate Medicare reimbursement for telehealth services (beyond the current, limited reimbursement framework). Finally, Senator Orrin Hatch (R-UT), the Chairperson of the Senate Finance Committee, recently released his “innovation agenda for the 115th Congress” which encourages the promotion of the “internet of things,” greater broadband investment, and increased device-to-device communication and cross-border data flows.

Telehealth will continue to increase in use despite proposed changes to the Affordable Care Act. Whether it will become a major player in health care will depend on studies to show if it cuts costs,improves care, or increases utilization as a redundant triage mechanism.  Telehealth does not . substitute for a visit to a physician, except for remote locations, where medical care would otherwise be lacking.

Telehealth Outlook Under the Trump Administration | The National Law Review

Seema Verma Confirmed by Senate as CMS Chief

Following a relatively benign debate about the new CMS Chief, Seema Verma is confirmed as the new head of CMS.

Seema Verma, nominee to head CMS, listens during a Senate Finance Committee confirmation hearing in Washington, DC.

Physicians seem to be  content that she is a governmental minimalist and favors voluntary participation in government programs rather than mandatory participation

Vice-President Pence was instrumental in recommending her to the position as he had worked closely with the Medicaid program in Ohio.

Verma has specialized in working with state Medicaid programs to improve care while lowering costs. The Trump administration will count on her to achieve those goals in a federal program that stands to shrink in a House Republican bill that repeals and replaces the 7-year-old Affordable Care Act (ACA). The measure would eliminate expanded Medicaid eligibility that 31 states chose under the ACA, and convert open-ended federal contributions to state programs to a fixed, per-capita amount, putting the program on a budget, as it were.

Verma's work with the Medicaid program in Indiana may be a preview of the program's future. She designed a "consumer-directed" version of Medicaid called Healthy Indiana Plan (HIP) that gives beneficiaries a Personal Wellness and Responsibility (POWER) account — similar to a health savings account — to apply toward a $2500 deductible. And while Vice President Mike Pence was governor of the Hoosier State, she helped created HIP 2.0, which expanded Medicaid coverage under the ACA. Beneficiaries who contribute a small percentage of their income to their POWER accounts are entitled to extra benefits such as dental and vision coverage.

Like the president that nominated her, the new CMS administrator espouses a small-government philosophy that many physicians may find refreshing. At her confirmation hearing, Verma said that physician participation in Medicare pilot projects for delivering and reimbursing medical care should be voluntary, not mandatory. She also decried federal regulations that might discourage physicians from participating in Medicaid and Medicare, and the burdens that electronic health records impose on clinicians in connection with the meaningful use incentive program.

Seema Verma Confirmed by Senate as CMS Chief