By Karen Pearsall
In 2013, doctors at a community hospital emergency department in Allentown, Pennsylvania, decided to measure physician productivity using electronic medical records.
They found that emergency physicians were spending more time on data entry than on any other activity, including patient care. Total mouse clicks approached 4,000 during a busy, 10-hour shift. (Hill RG, Sears LM, Melanson SW. American Journal of Emergency Medicine. 2013; 31:1591-4).
This study was mentioned in a lecture I recently attended in California. It was delivered by Abraham Verghese, MD, an eminent Stanford University physician and a New York Times best-selling author.
“The current computer system we work with in the hospital is a disaster of epic proportions,” Dr. Verghese said. “[Excessive data entry] is not designed for patient comfort. It is designed for billing. It has turned us into highly paid clerical workers.”
Plus, it is contributing to physician burnout.
No sooner were the words out of his mouth than his audience of more than 1,000 physicians burst into applause. I don’t know if the response would have been the same from a Canadian audience.
I do know that in the long-term care sector, and in the home-care sector, excessive data collection is a huge concern. In the long-term care sector, for example, massive amounts of data are regularly collected on each of our 78,000 Ontario residents to determine how much money the long-term care facilities will receive from government. The higher the residents’ needs, the more money they get. Staff call it “charting for dollars.”
The data also allow the long-term care facilities a way to track their quality performance with respect to established benchmarks and against each other. Long-term care is a highly competitive business. Data are uploaded to the Health Quality Ontario website, and from there to a national database where analysts can do what they wish with it.
The current Liberal government is obsessed with data collection in the long-term care setting. It wants to put tablet computers into the hands of every personal support worker working in long-term care within the next three years. Where does this end?
I wrote to John Hirdes, PhD, a professor in the School of Public Health and Health Systems, University of Waterloo. He is the lead representative for the interRAI (Resident Assessment Instrument) tool in Canada. Versions of this electronic data collection system exist in long-term care, home care, and hospitals. It has roots in the 1987 U.S. Nursing Home Reform Act that mandated the development of a standardized minimum data set and it has since become a global phenomenon.
I asked Dr. Hirdes to point me to a study showing that interRAI leads to better patient care in the long-term care setting. (The interRAI has been mandatory in Ontario long-term care facilities since 2010.) He referred me to a small study done in The Netherlands a decade ago. The study found that 40 residents living in residential homes who received multidisciplinary, integrated care received better care than those who did not. The multidisciplinary team was informed by interRAI data that were collected and reviewed every three months.
When I wrote back to Dr. Hirdes saying that I was unconvinced, he wrote back saying that I did not understand what I had read.
After I calmed down I contacted Albert Banerjee, PhD, a research fellow at Stockholm University, who had done his own small study. Staff in long-term care facilities in Ontario told him that while they feel data collection is important, it is very hard to get workers to read the care plans that follow from this. “There seems to be a big gap between the rhetoric of the RAI and the realities of care,” Dr. Banerjee told me.
I fear that the humanity of healthcare is being lost in a sea of data. So does Dr. Verghese, who once wrote in the New England Journal of Medicine that the U.S. hospital patient in the bed has become merely an icon of the real patient, who is in the computer.
There is an economic angle, too. The collection of interRAI data in Ontario long-term care facilities alone has cost approximately half a billion dollars since 2010. I base my estimation on the salaries of the data collectors and on the cost of licensing the software in 630 facilities.
I have asked Ontario’s auditor general to do a value for money audit to see if data collection in the long-term care sector is worthwhile, considering the time taken away from providing direct care, pervasive staffing shortages, and the staff burnout we are witnessing across the province.
Kathy Pearsall, originally from Sudbury, is a freelance writer and a member of the Toronto-based, non-profit Concerned Friends of Ontario Citizens in Care Facilities.
