EHRs Still Have a Ways to Go

January 5, 2018

While progress has been made, we still have a very long way to go to achieve the dream of EHRs and other health IT.

A recent phone call from a provider friend of mine capsulized the frustration that I hear regularly from many physicians, PAs and other healthcare providers about the administrative demands of their position. She was literally buried under a mountain of charting with overbooking and a lack of administrative time contributing to her chart backlog.

The practice in which she works has a hybrid system of paper charts and electronic charts with dragon dictation. It is set up to gather information for the practice, not facilitate the documentation needs of the healthcare providers.

I have written a lot about the EHR and its transition in our health care system. In the past, I have analyzed the difficulties inherent in implementing the EHR among providers centered on training, computer experience, and the provider's age. I am at an age where I was brought up on an entirely paper system. However, I have always been an early adopter of technology and made it a habit to understand the EHR in attempt to use it to the fullest in both my private practice as well as my inpatient practice.

EHRs have a steep learning curve. However, most have a lot of tools and templates which can streamline the gathering and recording of patient data, if the provider has the time, and inclination to use them.

A recent article in an IT journal (Health IT Analytics) highlights advances in voice recognition technology. Not surprisingly, Google has been working and researching in this area. I personally have been simply amazed at the advancement of voice recognition dictation software. Voice recognition software is integrated in every aspect of our existence when you think about how our phones and other devices in our life respond to audible commands and dictation.

Medical dictation poses significant challenges in a number of areas. Not the least of which is obscure names of providers, medical terms, diagnostic terms, medication names, among other difficult and unique areas. Also consider the fact that dictation in the medical setting occurs many times in noisy areas, with distraction and cross conversation the norm.

I have criticized EHRs in the past on their focus mainly on gathering data for the system and not facilitating the work of the provider at the point of care. The article in Health IT Analytics talks about the significant amount of time each day that physicians and others spend in documentation both on-the-job and at home and how this harms personal satisfaction.

Google has been working on improvements to dictation systems that can not only capture after-care documentation of the patient encounter, but also systems that are able to capture conversations between providers, and between providers and patients in a natural setting.

Why is this so important? Computer skills are one of the major stumbling block to the implementation the EHR. If we don't find a way to make documenting the patient encounter easier and more streamlined for the provider, it will be very difficult to fully implement it among providers of all demographics.

I think about the experience of a friend. She is extremely frustrated and burned out. The majority of this comes from the growing administrative burden imposed on providing patient care in her practice. It never seems to get easier or better. I believe that many healthcare providers share this same experience and frustration as I listen to them every day at my community hospital.

I am heartened by the potential that improved and more accurate medical dictation systems represent. The technology has come a tremendous way in my lifetime and in the last 10 years. Yet, speech recognition and medical dictation technology has a long way to go. I am glad that organizations and researchers are working on this problem because I believe it is vital to better physician, physician assistant and other provider quality-of-life and satisfaction with their job.

And we can all agree that the ultimate goal of EHRs and speech recognition and medical dictation technology is improved patient care, patient safety, and the quality of the care that we deliver. We have come a long way in a short time. We still have a very long way to go to achieve the dream of technology facilitating and not hindering the patient care that providers on the front-line deliver.