ND Physician June 2015

June 2015 June 2015 North Dakota Medical Association In this Issue The mission of the North Dakota Medical Association is to promote the health and well-being of the citizens of North Dakota and to provide leadership to the medical community. Submissions ND Physician welcomes submission of guest columns, articles, photography, and art. NDMA reserves the right to edit or reject submissions. All contributions will be returned upon request. Advertising NDMA accepts one-quarter, one-half and full- page ads. Contact our office for advertising rates. ND Physician is published by the North Dakota Medical Association, 1622 East Interstate Avenue P.O. Box 1198, Bismarck, ND 58502-1198, Phone: 701-223-9475 Fax: 701-223-9476 E-mail: [email protected] Katie Fitzsimmons, Editor Copyright 2015 North Dakota Medical Association. All rights reserved. North Dakota Medical Association Council Officers Steven P. Strinden, MD, President Debra A. Geier, MD, Vice President Fadel E. Nammour, MD, Secretary-Treasurer Misty K. Anderson, DO, Speaker of the House A. Michael Booth, MD, Immediate Past President 2015 Legislative Summary .............................................14 Robert W. Beattie, MD, AMA Delegate Shari L. Orser, MD, AMA Alternate Delegate Councilors Joseph E. Adducci, MD Neville M. Alberto, MD Physician Advocate .............. 3 NDMA Launches Misty K. Anderson, DO New Website .................. 22 Stephanie K. Dahl, MD Catherine E. Houle, MD NDMA in Action ................... 6 Timothy J. Luithle, MD NDMA Awards ................. 24 Steven R. Mattson, MD News from UND SMHS ........... 8 Fadel E. Nammour, MD Osama Naseer, MD The Fresh Air Report ........ 26 Sarah L. Schatz, MD Annual AMA Meeting ...........10 Shelly A. Seifert, MD Randolph E. Szlabick, MD UND SMHS Recognizes Rory D. Trottier, MD An AMA Viewpoint ...............13 Volunteer Faculty ............ 30 Dennis E. Wolf, MD Commission and PAC Chairs Parag Kumar, MD, Socio-Economics Sarah L.Schatz, MD, Legislation and Governmental Relations Shari L. Orser, MD, Medical Services and Public Relations Kristina A. Schlecht, MD, Ethics Kimberly T. Krohn, MD, Medical Education Thomas I. Strinden, MD, NDMA PAC Staff Courtney M. Koebele, Executive Director Leann K. Benson, Chief Operating Officer Katie Fitzsimmons, Communications Director Advertise Advertise in our next issue! Annette Goehring, Administrative Assistant NDMA accepts one-quarter, one-half and full-page ads. Contact NDMA at: 701-223-9475 • [email protected] 2 ND Physician Physician Advocate Physician Satisfaction We will continue our discussion about do not align with the cognitive or work physician satisfaction begun in the last flow requirements and/or preferences of issue of ND Physician. As the RAND physicians within and across specialties Corporation began to look at physician and settings. One clinical issue is satisfaction, the effect of electronic that EHRs were designed to support health records (EHRs) demonstrated transaction processing and billing and Steven P. Strinden, MD a stunning impact and the study was do not adequately provide cognitive rewritten to look more intently at the support for health care providers and impact of the electronic health record. for patients and for family caregivers. There are also lifestyle advantages noted with the ability to access When physicians perceive themselves patient information from home. as providing high quality care, they are The AMA sees three aims • Disease Control: Physicians more satisfied. Conversely, obstacles to in using EHR: improving describe the improvement in providing high-quality care are major ability to provide guideline sources of professional dissatisfaction. the patient experience of based care using EHRs. It makes Ergo- let’s talk EHRs. care (including quality and tracking patient markers of satisfaction), improving disease control over time easier ElectrOnic Health RecOrd the health of populations, and accurate. The EHR represents a unique and and reducing the per • Enhanced Communication: vexing challenge to professional EHRs enhance communication satisfaction. Few other industries are capita cost of health care. through the medical record exposed to universal and substantial itself, by facilitating access incentives to adopt such a specific and to other providers’ notes, highly regulated form of technology, a EHRs have important effects on eliminating illegible handwriting, technology that has not yet matured. physician professional satisfaction, both and utilization of messaging Nearly all physicians see the benefits positive and negative. In the RAND applications. This with the caveat of EHRs and believe in the “promise of study, satisfaction with EHRs was an that it works for physicians using EHRs”. On the other hand, physicians independent predictor of physicians’ the same system. cannot buy, install, and use a promise overall professional satisfaction and to help them deliver patient care. The having more EHR functions (reminders, But every rose has its thorn. Here are current state of EHR technology appears alerts, and messaging) was associated the negatives: to significantly worsen professional with lower professional satisfaction. No satisfaction for many physicians; correlation was found between overall For most physicians, the current state sometimes in ways that raise concerns satisfaction and the length of time since of EHR technology appears to worsen about effects on patient care. The RAND EHR installation. Here are some of the physician professional satisfaction study found that many EHR vendors positives to EHRs that physicians cited: significantly in a number of ways. are preoccupied with backlogged Poor usability, time consuming data implementation and selling current • Concept: Physicians approve of entry, interference with ‘face to face products and that this has resulted in EHRs in concept, describing better care,’ inefficient and less fulfilling a neglect of development priorities that ability to remotely access patient work content, inability to exchange could improve usability. information and improvements in information between providers, and quality of care. We also recognize degradation of clinical documentation The AMA sees three aims in using EHR: the potential for EHRs to further are prominent sources of physician improving the patient experience of improve both patient care and dissatisfaction. care (including quality and satisfaction), professional satisfaction in the improving the health of populations, future as the technology improves. • Cumbersome: Most physicians and reducing the per capita cost of • Data Access: Physicians find that who interact with EHRs directly health care. EHRs improve access to patient (without scribes or other data, both in health care settings assistants) describe cumbersome, How to effectively use EHRs is an and at home. This improved access time consuming data entry. For ongoing concern for physicians. The is seen as improving patient care many physicians voice recognition design and implementation of EHRs and professional satisfaction. systems were not accurate enough June 2015 3 EHRs were designed to support transaction processing and billing and do not adequately provide cognitive support for health care providers and for patients and for family caregivers. to improve on typing. Physicians satisfying meaningful use criteria facilitates the data capture and displays who use template-based notes or detracts from patient care. data tailored to the end-user. scribes were less likely to express • Cost: The investment in EHR concern. systems has exposed practices AMA recommends eight EHR • Interfering: Many physicians to considerable financial risk. In usability priorities to be addressed describe the EHR system as particular, the cost of switching and recognizes that many of the interfering with face-to-face patient EHRs-which is often necessary recommendations can only be care. There is a difficult trade due to factors out of a practice’s implemented in the long term due to off: divide attention between the control, is of high concern; and vendor product development cycles, patient and the keyboard or defer physicians in management the use of current legacy systems and data entry until after leaving the positions express concerns about existing contracts, regulations, and patient and lengthening overall the ongoing costs of maintaining institutional policies. work hours. I always complain EHR. to my patients that “I should be • Low-skill work: EHR requires Enhance PHYsicians’ ABilities poking my patient instead of a physicians to perform lower- TO PROvide HIGH QualitY Care keyboard.” skilled work. We talk about people Effective communication and • Lower Productivity: Most office working ‘at the top of their license’ engagement between patients and based physicians find themselves and I am doing data entry and physicians should be of central at lower productivity levels than transcription and billing. The importance in EHR design. EHRs before the implementation of derogatory term is ‘scutwork.’ should fit seamlessly into the practice their EHR. Physicians express • Low-quality documentation: and not distract physicians from frustration that information Template-based notes degrade the patients. EHR programs should be cannot be exchanged between quality of clinical documentation. designed and developed to meet the EHRs. Even when practices invest It is said that template notes cognitive work flow needs of physicians. in EHRs, fax is a common mode complicate the task of retrieving of

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