The Prevailing Wisdom about EHR May Not Be So Wise

January 13, 2014

Like teenagers trying to imagine what sex will be like, the prevailing wisdom about EHRs reflects optimism more than experience and knowledge.

Continuing the thought from last week, what does that average physician (you, for example) really know about EHRs? For a few of us, the attention that we give to EHRs and technology in general borders on being an obsession. That means we have a lot of experience and, if we' re lucky, we' ve gained some knowledge in the process. Most physicians have yet to use an EHR or are in the midst of their first romance with one. It' s true that occasionally, a life-long marriage begins with "love at first sight" on a first-ever date, but not many. The divorce rate is a good indicator of how hard it is to choose a compatible partner.

What teenagers know about the opposite sex, and real sex, is based on what you might call "common knowledge" or the "prevailing wisdom" as taught by other, slightly older teenagers that have had one experience instead of zero?

Physicians tell me they like the fact that their EHR makes summary information about the patient's problems, meds, recent visits, labs, etc., all relatively accessible. That' s the prevailing wisdom part. They also tell me that they dislike the effort involved in charting, coding, and checking off the myriad items that have been made "required" because some guideline said they should be. The prevailing wisdom doesn't need to account for the problems because the benefits are so obvious. The problems must just be the idiosyncratic reaction of a few doubters. Data, after all, is innocent (accurate) until proved guilty. Technology will be our salvation, except for the fact that RAND hasn't been able to come up with convincing evidence to back up their predictions.

What got me thinking about this was an article in The New Yorker called "The Open-Office Trap" by Maria Konnikovais. According to the prevailing wisdom, "the open office was originally conceived ... to facilitate communication and idea flow. But a growing body of evidence suggests that the open office undermines the very things that it was designed to achieve."

Now that people have actually looked, evidence proves that the prevailing wisdom about the open office is wrong. That raises the probability that the prevailing wisdom about EHR is also wrong. To illustrate, I have selected several passages from the article that present this evidence and replaced the words "open office" with "EHR."

The altered material comes pretty close to comments that I have heard regarding EHR.

• When using EHR, "employees experienced more uncontrolled interactions, higher levels of stress, and lower levels of concentration and motivation."

• Interactions with the EHR "were detrimental to productivity, and that the more senior the employee, the worse she fared."

• "The employees suffered according to every measure: the new [EHR] was disruptive, stressful, and cumbersome, and, instead of feeling closer, coworkers felt distant, dissatisfied, and resentful. Productivity fell."

• EHRs "remove an element of control, which can lead to feelings of helplessness."

• "Researchers found that the ability to control the [EHR] had a significant effect on team cohesion and satisfaction."

• "The psychologist Nick Perham ... has found that ... commotion [created by EHR] impairs workers'  ability to recall information, and even to do basic arithmetic."

If these statements ring true, then the prevailing wisdom may not be wisdom after all. If you base your EHR decisions on what the prevailing wisdom says they are "supposed" to do, as opposed to an evidence-based assessment of what they actually do, and at what cost, you run the risk of misleading yourself. When it comes to choosing the EHR that will work best for you, prevailing wisdom doesn't provide heuristics or criteria to help you make an intelligent choice. We approach virtually every other medical modality by striving to base our decisions on sound theory and sound evidence. When will we dispel the aura that surrounds EHR and treat it like we would any other medical modality?