EHRs are ruining the physician-patient relationship

On February 17, 2009, President Obama, to stimulate the adoption of the electronic health record (EHRs) and supporting technology in the Unites States, signed the Health Information Technology for Economics and Clinical Health (HITECH) Act into law, as part of the American Recovery and Reinvestment Act of 2009.

Cheryl L. Branche, MD, MLSIn our culture, I believe that the public largely expects doctors to pay attention to patients and to care for and about their patients. The patient expects privacy, her dignity upheld; she does not expect the doctor to be multitasking, that is, performing data entry and focusing on the EHR,,the third person in the examination room…at least, I don’t.

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According to Micky Tripathi-founding president and chief executive officer of the Massachusetts eHealth Collaborative-ome years ago Clem McDonald, MD, from the Regenstrief Institute, captured the description of the early EHRs designers by saying:

“Our goal was to solve three problems: (1) to eliminate the logistical problems of paper records by making clinical data immediately available to authorized users wherever they are-no more unavailable or undecipherable clinical records; (2) to reduce the work of clinical bookkeeping required to manage patients-no more missed diagnoses when laboratory evidence shouts its existence, no more forgetting about required preventive care; (3) to make the informational “gold” in the medical record accessible to clinical, epidemiological, outcomes and management research.”

…and the goals are hauntingly similar today.

As a former practicing physician, I can see how the EHR can reduce errors related to poor handwriting (I had poor handwriting.); how it can improve the retrieval of consultation reports, lab and study results and how it can facilitate research. In fact, I remember rather vividly, prior to the EHR, tracking down medical records of patients who were being admitted, reviewing the records for medication lists, old problem lists, study reports, old histories and physicals and flipping quickly through clinical records for recent visit notes and lab results.

I remember writing numerous new prescriptions and preparing laboratory request forms. With the EHR, in many institutions, all that is passé.

Next: From physician to patient

From physician to patient

On a visit I had to the doctor, the EHR was not working.  I waited about an hour to see the doctor. When I was almost about to say something negative, I decided to discuss my thoughts about writing this article.

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Himani Janapana, MD, a Brooklyn, New York physician, added that many physicians did not like the EHR and suggested that I google “physicians’ attitudes toward the electronic record.” She was focusing on entering the data in the fields of the EHR. (This visit was the equivalent of a new visit when a history is taken.) I felt as though a third person in the room was getting more attention that I was and I was frustrated. Meanwhile the doctor was doing the best that she could in a difficult situation. What was worse was that I had nothing tangible to show for my visit:  No prescription. The prescriptions were electronically sent to the pharmacy. For all the technology, I left the office feeling at a loss.

The literature is filled with articles about physicians’ attitudes about the EHR, issues related to barriers and the needs of ambulatory and hospital-based doctors. Terms like privacy, physician specific workflow, record sharing, integrated billing and interoperability were frequently encountered.

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The EHR has changed the physician-patient encounter-it has become the physician-EHR-patient encounter (PEP). The EHR may seem to improve the business of medicine, but what is its role in the caring for the patient?

When I look to the future I wonder about the younger digital EHR native doctors and the future of patient care and compassion. How can we assure that care and compassion will be kept as important tools in the doctor’s black bag? Will there be a box to click once a given dose of attention and compassion is provided? Will care and compassion even be on the checklist of things to do during the physician-EHR-patient encounter? Will care and compassion be two words that will be carved out of the Oxford Junior Dictionary, like aspen and ash and ox?

Next: One thing is for certain...

I am slowly getting used to a bit more hurried visit and a little less attention from my doctor.  I wonder if my doctors will see the silent tears I cry…

…one thing is for certain: Today’s EHR won’t.

Reference

Tripathi, Micky.  “EHR Evolution: Policy and Legislation Forces Changing the EHR..”  Journal of AHIMA 83, no 10 (October 2012):24-29. Accessed on April 2, 2016 from http://bok.ahima.org/doc?oid=105689#.Vv_viL-K8nI.