If your provider experience is anything like mine, chances are you loathe the phrase “electronic health records.” Physicians are not always early adopters for new technology. But we are certainly open to new advancements that can streamline our workflows and make our workdays more manageable.
While electronic health records (EHRs) were presented to us as helpful tools to improve our physician workflows, many systems fall short. In fact, according to a 2014 Medical Economics survey, 67% of doctors are “dissatisfied with [EHR] functionality.” The problem is the federal government did not study EHRs in depth before mandating them. Yet still physicians must adopt EHRs or face cuts for reimbursement rates by 1% or more as the decade progresses.
Benefits of EHRs
Before harping on the deficiencies of EHRs, I do have to point out certain benefits. EHRs can be an enormous help when it comes to things like patient allergies to medications. In the past, I may have had to depend on a poorly handwritten note in a patient’s chart about his allergies to certain medications. Now, if I order a medication that patient is allergic to, the order will be flagged in the patient’s EHR.
Also, when I enter data into a patient’s record, that information is immediately available to other providers in the hospital. For example, if I’m treating a patient in the emergency room, that patient’s doctor upstairs can see the tests and medications I’ve ordered and knows everything that is going on in real-time. In this way, the EHR is live and dynamic — which is really valuable.
Why EHRs Fail Doctors
That being said, EHRs, in my experience, are not the helpful tools they were marketed to be. Several factors come into play here.
Waste Time, Lose Money. The most common complaint is that EHRs waste time—a criticism shared by three out of four physicians according to a recent Deloitte survey. Another study from the American Journal of Emergency Medicine found emergency room physicians spend only 28% of time with their patients because they have to spend another 43% of their time inputting information into EHRs—I can attest to that.
Physicians can’t see as many patients as they used to, and now have to charge patients more to keep their practices afloat. Also, implementing and maintaining EHRs can be costly. Providers who have tighter profit margins end up passing some of these costs along to patients to pay the bills.
Not Designed by Doctors. One of the major problems is that most EHRs are designed by people who don’t know physicians and don’t understand our workflows. You can tell they’re made by technology experts and not by healthcare providers. Instead of simplifying a physicians’ workflow, EHRs can add more steps, especially if the user interface is as clunky as some that I’ve seen.
Too Much Irrelevant Information. In the past, handwritten or typed charts were only a few pages long. Physicians could make quick, informed decisions. Now, we face EHRs that are 50-plus pages long and filled with useless information to filter through, such as details nurses need to process billing. This type of information does not belong in a patient’s chart, and it makes it more difficult for doctors like me to take decisive action.
No Connection With Other Providers. EHRs were marketed to us as a way to access a complete, up-to-date picture of a patient’s medical history, regardless of which providers or clinic she went to last – in one word, interoperability. However, EHRs today generally do not connect with other hospitals and clinics. It just hasn’t happened. Other doctors within the same facility may be able to access the same records (which is valuable), but that’s a far cry from widespread interoperability. If a patient goes to another facility, that information may be difficult or time-consuming to obtain.
What We Can Do With EHRs
Like it or not, physicians must find ways to deal with EHRs in our practices [link to optimizing EHRs article]. While we may complain about EHRs to each other, a better use of our time is asking the question, “How do we make them better?”
Physicians should be more proactive about giving feedback to our in-house IT experts or the companies themselves, such as Epic Systems Corporation or Cerner Corporation. Maybe then we can see the features we want in a simpler, more intuitive user interface that will make our lives easier.
Another instrumental tool in the world of EHRs is the scribe. My scribe is a pre-med student who follows me around and puts all of my documentation into the EHRs per my instructions. Pre-med students are often very comfortable using these types of technology, and they are worth their weight in gold. What you pay for a scribe in salary, you will increase in productivity.
Maybe most importantly, having a scribe can increase your job satisfaction — and help prevent burnout [link to burnout article].
While current EHRs have problems, we need to find a way to live with them. If we capitalize on the benefits of EHRs and continue to push for change, we’ll eventually get to the EHR end-goal: technology that helps us practice better medicine.
