Monthly Archives: January 2022

Research shows that gender, specialty, geography are among the top factors contributing to EHR overtime work for clinicians

The amount of time spent on after-hours EHR documentation is one of the main factors driving clinicians’ burnout. Clinicians’ specialty, gender, region and organizational structure are the four main factors determining how much time they spend on this after-hours work, according to study results released Jan. 25 by EHR company Athenahealth.

This new research from athenahealth on the time clinicians spend documenting in the EHR finds that the ongoing stressors of the pandemic and a critical staffing shortage make now a more important time than ever to address the related factors that are likely to impact clinicians’ satisfaction and wellbeing.

The research team analyzed 8.1 million hours of active EHR work completed by 14,520 clinicians using Athenahealth software over a five-month period in the first half of 2021.

Four major issues were highlighted by the research team:

1. Healthcare organizations requiring more complex documentation have clinicians who spend more time in the EHR, both during and outside patient hours. These organizations tend to be larger and have more detailed policies on charting, as well as a more varied mix of payer contracts and fee structures, according to the study.

2. The weekly number of hours a clinician spends in the EHR varies by specialty. The study found adult primary care clinicians spend the most time in the EHR per week, followed by neurologists. Mental Health clinicians are not far behind in the number of hours.

3. Female and male clinicians spend the same amount of time cumulatively on EHR documentation per week. However, female clinicians spend more time on documentation on a per-patient basis, scheduling an average of 60 visits per week, compared with their male counterparts, who schedule an average of 73. Gender differences in documentation minutes per visit is at least 20 percent across most clinician specialties, according to the study.

4. Given female clinicians’ likelihood to spend more time in the EHR and the more equal clinician gender ratio in New England and the Middle Atlantic, clinicians in the Northeast spend more time on EHR documentation than other regions in the U.S.

One major difference between specialties is in the number of patient visits they schedule each week. Despite data showing that orthopedic surgeons schedule the most patients weekly, they spend the least amount of time in the EHR as compared to other top specialties. Mental health clinicians see the fewest patients, as they tend to have longer, more conversational encounters that are one-on-one.

Determining the reasons why burnout is correlated with specialty may ultimately lead to how to solve – or at least better address – some of healthcare’s most pressing challenges. The volume of quality measures that clinicians must meet if their organizations are involved in risk-based contracts can vary widely. Primary care physicians, for instance, typically have more quality measures to account for versus orthopedists. Other factors contributing both to EHR time and burnout include regional market competition and gender, for instance.

This new research from Athenahealth on the time clinicians spend documenting in the EHR finds that the ongoing stressors of the pandemic and a critical staffing shortage make now a more important time than ever to address the related factors that are likely to impact clinicians’ satisfaction and wellbeing.

Source: Athenahealth Survey of how much time clinicians spend in the EHR. Publ: Jan 26, 2022

A Virtual Reality Shopping Environment Could Help Evaluate Cognitive Deficits or Decline in Adults

New research published in the Journal of Medical Internet Research, uses a novel virtual reality shopping task called “VStore” to measure cognition, which asks participants to take part in tests designed to mirror the real world. Researchers hope that it will be able to test for age-related cognitive deficits and future cognitive decline.

In the ‘VStore’, participants “go to the shops” to navigate a shopping scenario as a way of assessing functional cognition, as well as the thinking and processing skills needed to accomplish complex everyday activities. The immersive environment (a virtual shop) mirrored actiities encountered in everyday life and meant that participants were better able to engage brain structures that are associated with spatial navigation, such as the hippocampus and entorhinal cortex, both of which can be affected in the early stages of Alzheimer disease.

The trial recruited 142 healthy individuals aged 20-79 years. Each participant was asked to “go to the shops,” first verbally recalling a list of 12 items, before being assessed for the amount of time it took to collect the items, as well as select the corresponding items on a virtual self-checkout machine, pay, and order coffee.

Cognition tests, such as those used to measure the deficits present in several neuropsychiatric disorders including Alzheimer’s disease, schizophrenia, and depression, are traditionally time-consuming and onerous. Vstore—the technology that the researchers used in this study—is designed to overcome these limitations to provide a more accurate, engaging, and cost-effective process to explore a person’s cognitive health.

Researchers were able to establish that Vstore effectively engages a range of key neuropsychological functions simultaneously, suggesting that the functional tasks embedded in virtual reality may engage a greater range of cognitive domains than standard assessments.

Reference:
Lilla Alexandra Porffy, Mitul A. Mehta, Joel Patchitt, Celia Boussebaa, Jack Brett, Teresa D’Oliveira, Elias Mouchlianitis, Sukhi S. Shergill. A Novel Virtual Reality Assessment of Functional Cognition (VStore): Validation Study (Preprint)Journal of Medical Internet Research, 2021; DOI: 10.2196/27641

Non-Invasive Vagus Nerve Stimulation for Treatment of Posttraumatic Stress Disorder

A Vagus Nerve Stimulation(nVNS) device called gammaCore™, this week has received a Breakthrough Designation from the U.S. Food and Drug Administration (FDA) for the treatment of posttraumatic stress disorder (PTSD) after showing a reduction of symptoms of PTSD by 31% when compared to sham treatment.

The Breakthrough Device Designation was supported, in part, by research from an Emory-Georgia Tech team led by J. Douglas Bremner, M.D., in the Departments of Psychiatry and Radiology at the Emory University School of Medicine, and Omer T. Inan, Ph.D., from the School of Electrical and Computer Engineering and the Coulter Department of Biomedical Engineering at the Georgia Institute of Technology in Atlanta, Georgia. Their research, built upon a strong mechanistic rationale and animal studies, shows nVNS blocks sympathetic and inflammatory responses to memories of traumatic events in patients with PTSD, modulates brain responses to traumatic memory, and reduces symptoms of PTSD by 31% when compared to a sham stimulation.

The Breakthrough Devices Program is a voluntary program for certain medical devices and device-led combination products for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions.

The goal of the Breakthrough Devices Program is to provide patients and health care providers with timely access to critical medical devices by speeding up their development, assessment, and review, while preserving the statutory standards for premarket approval, 510(k) clearance, and De Novo marketing authorization, consistent with the FDA’s mission to protect and promote public health.

Why PTSD?

PTSD is a highly prevalent and disabling disorder with limited approved treatment options. According to the U.S. Department of Veterans Affairs National Center for PTSD, approximately 15 million adults in the U.S. experience PTSD each year. In the Military and Veterans Administration alone, PTSD is reported to affect between 10-20% of veterans who served in each Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF), the Gulf War (Desert Storm), and the Vietnam War. More than half of all patients with PTSD report severely impaired quality of life in areas including mood, social and family relationships, leisure activities, sense of well-being and life satisfaction.

According to one of the investigators, Dr. Douglas Bremner commented, “Current treatments for PTSD involving medication and psychotherapy have limitations due to limited efficacy, possible side effects, and the unwillingness of many PTSD patients to engage in therapies that involve reliving traumatic memories. gammaCore represents a new class of treatment separate from medication or psychotherapy that is safe, relatively free of side effects, and does not involve costly and invasive procedures for implantation, like previous VNS devices approved by the FDA for treatment of refractory depression.”

Gammacore device has been previously approved by the FDA for: (Source: https://www.gammacore.com/)

Migraine – Clinically proven to treat and prevent migraines in users ages 12 and up. Help reduce migraines days without additional drugs.

Cluster Headache – The only clinically proven device to treat and prevent cluster headache attacks, while providing fast, reliable relief for those suffering with cluster headache.

Hemicrania Continua (HC) & Paroxysmal Hemicrania (PH) – 1st and ONLY device for HC and PH treatment, proven to reduce pain severity or headache frequency.

COVID-19 – Emergency Use Authorization to treat users with known or suspected COVID-19 and experiencing reduced airflow.

Sources:

FDA
Fact sheet for healthcare workers

Instructions for use of gammaCore

gammaCore™ Press release