A Day in the Life of “Death by a Thousand Clicks”

On WBUR, three prominent Boston physicians just decried the impact of poorly-designed or poorly-implemented electronic medical records on patient care. Our research into click-level data supports their experiences.

A Day in the Life - Gantt

Three prominent Boston-area physicians just contributed an opinion piece to WBUR, “Death By A Thousand Clicks”.  When doctors and nurses turn their backs to patients in order to pay attention to computer screen, they argue, it pulls their focus from the “time and undivided attention” required to provide the right care.  Multiple prompts and clicks in an electronic health record system (EHR) impact patients – and contribute to physician burnout.

As a healthcare professional uses an EHR, HIPAA requires that EHR to capture click-level detail about records accessed and actions performed.  This click-level detail is intended for auditing, but can also be used to identify situations where a provider’s performance – and quality of life – are impacted by an EHR implementation.

A Day in the Life of Dr. Jones

“Dr. Jones” is a pseudonym for a physician whose work day is probably all too familiar to the three authors of the WBUR piece.  Over the course of a single day, she has 24 scheduled appointments – which require 16 hours and 2,541 clicks.

This click-level data is embedded deep within the EHR data that Arcadia mines for its customers, and it represents a highly-detailed set of interactions between the provider, support staff, patients and the EHR software itself. Compiling each “click” within the system into a Gantt chart provides an intuitive visual summary of Dr. Jones’ work day.  By compiling and analyzing those thousands of clicks, we can see critical operational data like patient wait times, provider efficiency, and documentation distribution.

A Day in the Life - Gantt

Dr. Jones starts her workday at 6:30 AM, preparing for a morning huddle with her staff.   By comparing the patient’s scheduled visit start time with the first “click” by Dr. Jones, we can see that over the course of the day she gets behind.  Patient wait time (and patient dissatisfaction) increase, and Dr. Jones works through lunch to make up for having seen a drop-in patient with stomach pain.

By the end of the business day, Dr. Jones’ patients are waiting 90 minutes to be seen after check-in.  Unfortunately, Dr. Jones’ work has not yet ended.  She drives home, eats dinner, and then spends hours accessing dozens of EHR modules to close out notes for each visit so that charges can be billed.

How does Dr. Jones compare to her peers?

A Day In the Life - All Providers

Each provider is represented by a bubble, with Dr. Jones in orange.  The vertical axis represents documentation quality, an area in which Dr. Jones is strong compared to her peers.  The horizontal axis represents efficiency (a composite measure of duration and clicks in the EHR per patient).  Providers on the left are highly efficient. Here, Dr. Jones struggles relative to her peers.  Unsurprisingly, the upper-left quadrant is vacant – capturing high quality documentation is very hard to do in an efficient and timely matter.

Learning from Dr. Jones

Our considerable experience with click-level EHR data corroborates the story that Drs. John Levinson, Bruce Price, and Vikas Saini tell in their WBUR piece.  When systems are poorly designed or poorly implemented, it’s not just the patient-provider relationship that suffers – it’s also the provider’s quality of life.

Provider burnout is a significant issue, and one that puts patient access to care and safety at risk.  We strongly support Drs. Levinson, Price, and Saini when they say, “The sound of medicine is not the click of a mouse. It is the human voice. Let’s bring it back.”

More about the data visualization “A Day in the Life”

You can explore the full version of our data visualization “A Day in the Life of Dr. Jones” in our Data Gallery.  If you would like to download a high-resolution version suitable for printing, please complete the short form below.

A Day in the Life

 


Michael Meucci

Michael Meucci is Arcadia’s Vice President of Market Development in the East.  Michael’s primary focus is on supporting Arcadia’s clients and prospects in identifying how the Arcadia Analytics platform and Arcadia’s Managed Care services can be best matched to client needs to accelerate success in risk and value based payment models.

Michael combines a depth of experience in product management, marketing and technical leadership with a focus on data integration in distributed ambulatory healthcare settings.  Specifically, he has a deliberate focus in supporting the deployment of data-driven clinical transformation programs at scale.  Michael was the primary lead on the development of Arcadia’s Accelerator platform, a web-based transformation planning and management toolkit designed to provide transforming practices with task level planning and tracking of the activities required for successful transformation.  Working at Arcadia, Michael has provided strategic oversight and guidance on the development of scalable, state wide patient centered transformation programs in California, Louisiana and Florida focused on the integration of trusted, real-time analytics into team based care models to enable improved care planning and coordination and more effective decision support.  Michael also serves as a subject matter expert supporting data aggregation and analytics initiatives in Maine, Illinois, Massachusetts, Rhode Island, New York, Virginia and Connecticut, ensuring that knowledge and innovation in each project is captured and shared appropriately with current and future clients.

A two-time Arcadian, Michael’s previous experience includes serving as the Product Manager at Linkwell Health, a venture backed disease management and patient engagement company, where he supported the build, marketing and launch of Linkwell’s online engagement platform and an internship at Monitor Group, an international strategy consulting firm now owned by Deloitte, building industry expertise with leading organizations in the pharmaceutical, medical device, and high-tech fields.

Outside of the office, Michael enjoys reading World War II fiction, hunting for mid-century modern furniture and is an avid traveler known for building his travel itineraries around culinary adventures.

Michael holds a Bachelor of Arts in Economics and Entrepreneurial Leadership from Tufts University.

Explore the 2017 Arcadia Data Gallery

At Arcadia, we believe data is more useful when it is beautiful. We unveiled our 2017 Data Gallery at HIMSS earlier this year – and now you can explore it online in our new interactive website.

Explore the Data Gallery