Jeremy Fischer, DO

The practice of medicine has relied on paper charts far longer than most other industries.  As banking and finance moved into the digital realm with records and improved user interfaces, the practice of medicine remained firmly in the analog.   With the HITECH act, the government created incentives for physicians to implement EHRs.  Love it or hate it, the effect has been a dramatic increase in adoption.  As practices rushed to adopt EHRs, a lot has been discussed about the effect on the physician’s charting and billing.   Perhaps not as much thought has been devoted to changes the EHR will have on the doctor-patient relationship. 

Right now many physicians have very strong feelings about the systems, and they are not all positive.  Many of the systems are cumbersome, expensive, and counter-intuitive.  They admittedly improve documentation legibility, but often at the expense of time.  Systems share information poorly, if at all.   They can frustrate patients and physicians and negatively impact the doctor-patient relationship.

I may be showing my age here, but there are some parallels to be drawn between EHRs and computing in the ‘80s.  At the time, there were multiple different platforms:  Apple, Commodore, PC, and more.  None of the systems were easily compatible and files could not be exchanged between systems.  The interfaces required typing in commands and were not intuitive.   Over the years, these problems were solved and became the state of computing that we have today.  EHRs have the potential to do so much more.    I believe that once EHR systems mature, they will improve patient care. 

One area of improvement is transparency.  A patient can see exactly what disease the physician diagnosed.   While this can be a source of tension, such as if the patient is put off by the code for morbid obesity, it can also be helpful.  The patient can see that heart failure or coronary artery disease was the diagnosis and take this other physicians.  Often times, patients will explain their diagnosis in general terms like “heart problem,” which does not give enough specificity to the treating doctor.  Valuable time gets spent on trying to contact the original physician. 

The next area that will be improved by EHR is physician communication.  EHRs should be able to seamlessly share data, but right now interoperability is limited.   This has become a focus to get different EHR systems to “talk.”  Once these problems are solved, physicians and patients alike are going to benefit tremendously.  As a doctor, your new patient can come in with their past history, medication list, and labs already available to you.  You will be able to spend your time with the patient instead of transcribing their information.  A patient will not have to explain the course of their illness over each time they meet a new physician, the new doctor will be able to start treating the patient and asking the right questions as they will already know what has been tried.    Once achieved, this could allow physicians to be more productive and use their skills in meaningful care of the patient rather than inputting redundant data. 

Another aspect of the EHR that will improve the doctor-patient relationship is the patient portal.   The portal allows patients to securely see their results, send a message to the physician, schedule appointments, and more.  At my office, there was great consternation before our portal went live.  Many physicians were concerned that patient messages would overwhelm the doctor.  For the most part, our experience has been positive and improved from the traditional phone call.   People tend not to answer their phone and this requires the doctor to leave a message.  It is easy to be overwhelmed as a patient and miss crucial information on the phone.  Physicians dread the “While I have you on the phone can I ask you something” conversations.  A strong patient portal can alleviate these concerns.  The communication is written so patients are able to look at the message as much as they need.   Patients can review it at a time and place they are able to focus on the message instead of answering the phone in the middle of a task.  

Likewise, patient messages are addressed by the physician when the doctor is able to focus on that task.  If the patient message requires a face-to-face visit, the physician should be able to reply to the patient with a link to the schedule. The portal should allow a virtual visit for patients with minor complaints.  As e-visits get reimbursed, physicians will be more willing to devote time to these type of visits.  Many doctors are reluctant to offer e-visits, because of the lack of physical exam, but these are often problems that we diagnose and treat over the phone without an exam or reimbursement.  Furthermore this can allow you to maintain your relationship with the patient so they don’t have to see an unknown provider at a retail clinic or urgent care.   Of course, there will be patients that will overuse the portal and patients that will call worried over minimally abnormal lab results, but those are a minority of people. 

EHRs are here to stay.  The current generation of systems is cumbersome, but the concept is still in its infancy.  I expect that as they develop there will be benefits that will greatly improve the doctor and patient relationship.  We just need to hold on until they get there. 

Jeremy Fischer, DO is the Program Director for Family Medicine at Henry Ford Macomb Hospital in SE Michigan

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