Don't implode EHR use, improve it

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform.

I am dismayed to see a number of recent blog posts questioning the value of the EHR, and even going so far as to suggest that it is counterproductive and a deleterious wrong turn for healthcare. While we can commiserate about the inefficiencies, alert fatigue, time strain, cost, and distraction in the exam room, questioning the essential value of electronic healthcare data is counterproductive. Rather, we should focus our innovative energy on improving it.

Imagining medical practice today without an electronic record is inconceivable to the point of absurdity. I shudder when I think of going back to paper bills and referrals, phone lines flooded with matters handled with dramatically improved efficiency in our online portal, fat charts overflowing with illegible notes and reports, and a sizeable portion of our real estate taken up by the medical records room, just to scratch the surface. Then of course there is the EHR’s incomparable value as a tool for tracking our adherence to clinical best practices, and viewing data on patients’ compliance with screening and prevention recommendations. Digital records have allowed the office practice transparency and accountability that patients now demand and deserve.

Questioning whether we should have invested in EHRs in the first place is energy unwisely spent. Scrapping them and starting over may be a good plot for a dark comedy, but is not our current or near-future reality. On the other hand, physicians can leverage our experience and insight and contribute to making EHRs better. We can also help engineer workflows in which non-physician personnel are doing a share of documentation that does not require a physician, helping to keep everyone in the office working at the top of their license.

As an employed physician working in a large health system, I am somewhat shielded from the expense of owning and maintaining an EHR, and I empathize with other practitioners who have to shoulder this more directly. I’m not sure it makes sense to look at detailed cost accounting in order to evaluate the EHR as an investment though, if one is planning to be in practice for a number of years. The EHR is less likely to go away than are certain unsustainable practice models. It makes more sense to evaluate which system to use, and what type of vendor relationship works best for the practice needs.

Next: “Just because something doesn’t do what you planned it to do doesn’t mean it’s useless.”

The EHR as an obstacle to patient-doctor interaction in the exam room is another common physician complaint. Interestingly, it rarely comes up as a negative comment in our patient satisfaction surveys. The EHR only need be an impediment to connecting with patients if we allow it to be, and the way we deploy it during a visit can make all the difference.

First, we can introduce it and briefly explain to patients that we will periodically need to enter some information into the record. When reviewing test results, it can be helpful to share the screen with the patient to help clarify details and engage them in the discussion. We can document during a visit without appearing glued to the console-it requires “reading the room,” and knowing when the patient most needs our full attention, such as during a detailed description or sensitive emotional expression. Making good use of shortcuts such as smart phrases (commonly used sentences that populate the record with only a few keystrokes) can free us from excessive typing. Scribes are also an option, and gaining popularity.

Thomas Edison said, “Just because something doesn’t do what you planned it to do doesn’t mean it’s useless.”

I prefer to look at the EHR as a work in progress that requires the wisdom and creativity of physician leaders to gradually craft it into something that is an ideal tool to support our craft and improve patient care.