Trapped in an EHR

Nearly 70 percent of physicians find themselves stuck with EHRs they can’t quit for reasons ranging from cost to lack of better options, according to the Medical Economics 2018 EHR Report. About 57 percent said they wouldn’t recommend these systems to their peers due to administrative frustrations, lack of interoperability and how they distract from patient care. We spoke to five of the physicians who answered the survey about the EHRs they say they are stuck with. Limited by the options A common reason physicians remain stuck in an EHR they don’t like is a sense of limited options. Keith Aldinger, MD, an internist with a large group practice, Living Well Health Center, in Houston, Texas, says, “It’s pick your poison.” He’s particularly frustrated with the lack of interoperability, which he says was supposed to be the whole point of the original RAND Corporation study that suggested EHRs would improve health benefits and reduce costs.  “They’re not interoperable and the government hasn’t brought pressure to bear on IT vendors to do that, yet they levy penalties against physicians if they haven’t demonstrated meaningful use of the tool,” he says. While acknowledging that he and his fellow physicians could put pressure on the medical group to change to a different EHR, he says, “I don’t see anything out there worth putting pressure on to change to.” Aldinger, who was in independent practice before he joined Living Well in January, 2018, has used two different EHRs and says, “I don’t find any of them helpful when you’re entering the room clinically.”  “You spend a heck of a lot more time with the computer than with the patient,” he says. “I don’t think a computer possesses any of the characteristics that help you interview or interact with people better.”  He doesn’t want to bring in a scribe, as some physicians have done, because he feels that having another person in the room can interfere with the patient’s sense of safety or confidence. “It would just be another presence that made the patient uncomfortable in fully discussing what they want to say,” Aldinger says. Not only does entering data into the EHR distract from communicating with his patients, he dislikes having to sort through what he calls “digital debris”-far more information than he needs-to get to what he’s looking for, particularly when the emergency department sends records. The records are very lengthy, even for simple clinical encounters. “Someone comes in just for a cold and it’s three to five pages due to these pre-populated things they want you to do,” he says. The only improvement he is hopeful about is a possible shift to voice dictation. An affiliated hospital uses a system called Nuance, which Aldinger has tested with success. He envisions this technology replacing manual template box clicking with simple voice commands. ‘Corporate medicine’ calls the shots Edwin Schmidt, MD, a primary care doctor with SSM Medical Group in St. Louis, Mo., feels constrained by his EHR.“We don’t have any choice in it. It’s corporate medicine. Whoever is on top picks our medical record,” he says. 

He dislikes that his EHR adds complexity to once-simple tasks. He says that he and the five other physicians in his office have all adopted different ways of doing the exact same process in their EHR because it’s just not straightforward. 

“Even if [IT] corrects the problem later, it’s not worth the time to learn how to do it when you’ve already jury-rigged your own system,” he says.

Despite his frustration, and the extra hour of work it adds to his schedule at the end of each day, he won’t be changing EHRs before his planned retirement in 2020.

Nor is he hopeful that there’s a better option. “The big [vendors] say they have physician input, but those are physician administrators who are more interested in the administrative component than practicing medicine,” he says.
If he had his way, Schmidt says he’d go back to paper “in an instant.”

A necessary evil

Scott McLeod, MD, an independent primary care physician in Woodstock, Va., looks longingly back to the time two years ago, when he was using an EHR that he found pretty user-friendly.

But in order to keep up with the shift to quality reporting measures as an independent practice, he joined Privia Health, a practice management and population health company that required him to switch to a different EHR.

“It was a downgrade in terms of ease of use,” McLeod says. Before, he had unlimited templates, which allowed him freedom to customize them as needed. Now he has only  173, and can’t change them easily, he says.

The transition between EHRs was so intensive that he acquired tennis elbow and carpel tunnel syndrome from what he describes as “endless clicking” and felt burned  out to the point that he had to take two weeks off during which he did not look at a computer.

But he feels that this EHR is the price of staying independent. As a result, he’s had to reduce his patient load by 20 percent to keep up with all of the administrative work, and his income has decreased.

Having now used the system for two years, he is as comfortable with it as he can get. “I know its ins and outs. I can make it do whatever it can do, but I’m also very aware of its limitations,” he says.

Starting from scratch

Steven Ames, MD, a primary care doctor with Thurston Medical Clinic, in Springfield, Ore., left independent practice to join a medical group to stay in business.

His previous EHR did not interface easily with the new one, and he couldn’t find anyone to help him adapt to the new system because none of the data was standardized. “It was sort of like going from VHS to DVD, so there really wasn’t a way to input data,” he says. As a result, he had to manually transfer data for every patient.

What’s more, information from other sources has to be entered separately. “I call it a bunch of islands instead of anything being integrated,” he says.

He uses a scribe because “It keeps my head out of the computer” but it doesn’t solve all of his problems.

He’s frustrated by how EHRs areprimarily “based on how to get reimbursement, how to create a database that then proves to the government what we did and what our value is.”

Ames would like to see a healthcare system where patient information is centralized, not siloed. Patients would have a data card containing everything pertinent: address, birth date, health insurance information as well as doctor visits.

“You’d have one repository of past medical history,” he says.

Of course, he’s aware that this is something of a pipe dream at present. At best, he says, “They just need to develop some interoperability standards so that each system can talk to one another. Right now, it’s like some [EHRs] are on a railroad track, some are on a highway and some are on a dirt road.”

Mired by a merger

A hospital merger between Scarsdale Medical Group and White Plains Hospital in Harrison, N.Y., brought with it a forced change of EHR for internist and gastroenterologist Malcolm Schoen, MD. Schoen thought his previous EHR was less than perfect, but he calls the new one “a horror show.”

He’s frustrated by how it complicates simple processes. “You can’t just get a spreadsheet of vital signs. You have to go to each individual visit and look it up,” he says.

Additionally, the only way he can enter medications into the patient’s record is if he knows the name of the pharmacy the patient uses. And there are medications missing from the database that he has to call in to the pharmacy himself.

Following the merger, patient information did not transfer to his new EHR and he’s had to come in as much as twohours early to do pre-charting. The added burdens are taking a toll on him. “I’m losing sleep and extremely stressed, but all the doctors in my fifty-doctor group are,” he says.

Still, he hangs a small amount of hope on the possibility that the medical group will consider a better product. “I’m anxious to see what else is out there. They can’t all be like this,” he says.