EHR: The Past is History, the Future Lies Ahead

February 24, 2014
Daniel Essin, MA, MD

Physicians' reactions to EHR are the same as they were 20 years ago and yet, there may be no going back. But here are some steps to help.

A couple of weeks ago, a reader commented, referring to EHR: "But there is no going back. These clumsy systems will and are getting better. In [two years to five years], probably pretty acceptable. The only interesting question, for the practitioner is, how to avoid error, maintain income, and sanity and survive, ['til] then." These are precisely the questions each physician must answer.

If EHRs were automobiles, there is no question that in two years to five years they would be better than they are today. The auto industry has re-imagined part or all of its designs many times. Today's cars resemble a Model T only in concept - a wheeled conveyance with motive power, steering, brakes and control systems. EHRs lack a similar, widely accepted, simple and well-articulated concept.

EHR is nothing more than a label attached to a group of products that bear a strong resemblance to that famous architectural hodge-podge, the Winchester House. "Mrs. Winchester was instructed [by a medium] to move west and appease the spirits by building a great house for them. As long as construction of the house never ceased, Mrs. Winchester could rest assured that her life was not in danger." Because so many of its 500-plus rooms were redone, only 160 remain. There are stairs that lead to the ceiling, doors that go nowhere and that open onto walls, and chimneys that stop just short of the roof.

Mrs. Winchester had unlimited funds and the primary purpose of the house was to remain under construction, not to be finished and occupied. Healthcare, on the other hand, has a job to do and an EHR is supposed to facilitate that job, not become the center of attention and be under constant modification.

Consider the following:

A recent Medical Economics survey found:
67 percent were dissatisfied with EHR functionality;

• 45 percent spent more than twice the incentive amount:

• Fewer than 20 percent found their costs reduced;

• 45 percent felt that patient care suffered;

• 70 percent said EHR interfered with care coordination;

• 73 percent said they would not choose the same system again;

• Only 38 percent thought their EHR would be viable in 5 years; and

•70 percent said that, overall, EHR was not worth the effort and expense.

These results should not surprise you. They are predictable. Physicians' reactions to EHR are the same as they were 20 years ago and yet, there may be no going back. There are several ways to respond.

1. Be "all in." "Damn the torpedoes, full speed ahead!" After all, everyone will share the experience, good or bad. The systems may very well be better in two years to five years. If they are not, and the scheme fails on a large scale, there may need to be a government bailout. Those who are all in should remember that they will be attempting something that has a poor track record. Einstein said that doing the same thing over and over again and expecting different results is a mark of insanity.

2. Wait for the dust to settle. "The best laid schemes o' Mice an' Men, Gang aft agley." (Robert Burns) Healthcare reform is one more attempt at a kind of "controlled economy." Administrations and administrators will change. Funding goes where the political wind blows. The sense of urgency about EHR is unjustified given the slow pace at which bureaucracy operates. Watchful waiting is a strategy to consider.

3. Prepare yourself to decide later. You can never have enough experience so get some. Try a few free/low cost web-based EHR offerings such as Practice Fusion and Kareo. These are not endorsements, just evidence that free EHRs are available. Immerse yourself in the process of configuring and using EHR. You will be surprised at the number of little things that you discover. Meanwhile, print every note and file it. That way, when you switch systems, your charts will be intact.

Remember:

• EHR is not an investment, it's an expense. Spend as little as possible.

• The encounter records are the only part of an EHR that have lasting value. Make sure yours can be kept accessible and intact as you migrate from EHR to EHR.

• Don't try to satisfy more than 80 percent of your "requirements." If you shoot for 100percent, you will discover that at least 20 percent and perhaps as many as 50 percent to 60 percent are irrelevant or worse - annoying.

• All-in-one products are popular but are less resilient than modular systems that allow unsatisfactory components to be improved or replaced without discarding the good parts.

• If you can't get home in time for dinner because you can't finish your EHR work, you have a problem. The system should work for you. You shouldn't work for it.

• Sanity first, financial stability second, technology last.