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    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.”

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    • [email protected]
      "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 survey." I find that very hard to believe. Every day I hear patients complaining that the "last doctor put their head in the computer and never even looked up at me when I was speaking". It is not our job nor expertise to make the lousy EMRs work. I agree that they work very well for data mining. However they are next to useless in the exam room. Have you not read the data stating that "for every hour a doctor spend with patients that we spend 2 hours documenting" I don't know what EMR you use, but it must be better that what the rest of us are using. Perhaps you could teach us how to "improve" our EMR.
    • [email protected]
      But something that doesn't work IS useless. EHR impedes PATIENT care. It takes the focus off the patient and onto the computer. As a repository for information (what the chart historically is meant to be) a computer can be extremely helpful. As a mandated collector of useless information and clicking it is amongst the top reasons for physician disenchantment with the practice of medicine. As a billing modality, it is useful. My disgusting gripe with EHR is I am forced to use it in a manner which helps neither my patients nor myself. Let me use the computer as I see it being useful; you, Dr. Millstein, use the computer as you find it useful. We are not the same, but the powers that be are trying to make us that way. As far as "value as a tool for tracking our adherence to clinical best practice..." seriously? I would rather my being able to take care of my patient, follow clinical best practice and not have attorneys/insurance/government looking into my computer for reasons to deny care, not pay for care, or find a technicality for suing me. Wouldn't you? Can you not do your best for your patient without such a monstronsity of useless information that is inserted into your every note?

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