The burden of EHRs, implicit bias in patient care, and a Right Care Action Week Listening Booth

September 8, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Physicians spend twice as much time wrestling with electronic health records than they do providing care to patients during the office day, according to a study published this week in Annals of Internal Medicine. Authors Christine Sinsky, MD, et al, also find that outside of office hours, physicians spend up to two hours of personal time each night doing more computer and clerical work. Researchers examined the work and patient care of physicians in cardiology, orthopedics and family and internal medicine and noted that 27 percent of their time was spent on direct clinical face time caring for patients and 49.2 percent spent on electronic records or other desk work. Susan Hingle, MD, at Southern Illinois University School of Medicine, in a companion editorial for AIM, concludes “Many studies have documented lower patient satisfaction when physicians spend more time looking at the computer and performing clerical tasks. Patient satisfaction can affect health outcomes via adherence to the care plan and can also affect physician and hospital reimbursement so the stakes are high.” And physicians who use EHRs are found to be at higher risk of burnout, as a recent report in Mayo Clinic Proceedings determines. Bruce Japsen, in Forbes, writes that IT vendors have gained a windfall from the Health Information Technology for Economic and Clinical Health Act, the legislation which provided more than $20 billion in 2009 to help providers implement EHR. “[The study] shows electronic health record systems designed to speed patient referrals and improve treatment are contributing to doctor burnout and taking away from patient care,” Japsen asserts.

Researchers have identified implicit bias (unconscious bias) as a key factor in the fight to eliminate racial and class disparities in health outcomes, forming a critical mass of research over the last decade. Implicit bias from clinicians has been found to affect referrals for thrombolysis patients, prescriptions for pain medication after surgery, and communication in end-of-life care. This week, a study highlighted in the American Journal of Managed Care found that non-Hispanic black patients experiencing back or abdominal pain were less likely to receive an opioid prescription upon discharge from the emergency room compared to non-Hispanic white patients. Because emergency medicine physicians must make quick judgments to determine whether a patient is potentially a drug abuser, the authors conclude that these decisions “may reflect inherent biases that health care providers hold unknowingly.” Not only does implicit bias affect patient treatment, but patients’ perceptions of bias can also impact health outcomes. As reported by Kaiser Health News, early findings from an Altarum Institute survey indicate that patients who perceived bias or disrespect from their clinicians were less likely to follow medical advice or seek additional care. Uninsured or Medicaid patients, low-income patients, and non-white patients felt they were treated worse by their clinician, compared to insured, high-income, and white patients. When clinicians had a cold bedside manner, did not make eye contact, or did not ask them questions, patients in the survey noticed and took it to heart. “There’s a huge need for provider training in communication and warmth,” said Chris Duke, director of Altarum’s Center for Consumer Choice in Health Care.

Right Care Action Week (October 16-22) is an opportunity for clinicians, patients, and community members around the country to come together and plan events that demonstrate the right care. Murray Levin, MD, former professor of Medicine at Northwestern University, plans to set up a Listening Booth table at his local recreation center in Deerfield, IL. As a longtime teacher and physician, Levin has seen the evolution of doctor-patient communication over many decades. The good news is that doctors today are more accepting of feedback from patients and families; the bad news is that they have less and less time to talk to patients (maybe in part because of electronic medical records). At the tabling event, Levin hopes to encourage more dialogue between doctors and patients by listening to the health care concerns of his community members and offering patients advice for relating to their doctors about tests and procedures. One of his primary goals is to shift doctor-patient relationships from “stiff and formal” to open and personal. “If you don’t establish a personal relationship, both you and the patient are losing out,” said Levin. Read our blog about Levin’s event, stay tuned for more RCAW profiles, and don’t forget to join us. Sign up now!


The 2016 Preventing Overdiagnosis Conference, Winding Back the Harms of Too Much Medicine, will take place September 20-22 in Barcelona. More information here.




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RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.