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Doctors aren't the problem, unusable systems are the problem, says this doctor. She airs her EHR grievances.
Doctors are the problem with wide-spread implementation of EHRs.
This is something we have been told for years. We are blamed for being averse to new technology and likened to the dinosaurs of the healthcare industry. But how many of these so-called health IT experts pause to truly think why doctors hate EHRs and how these issues can be resolved?
I have been using EHRs for more than a decade, long before it was the thing to do. This was back when there were only a handful of vendors peddling their products. I am a very tech-minded person and the use of EHR spoke to me as something easy to incorporate into my practice. I created my own templates to ease the process and my notes were readily accessible and readable, most often in the one-page SOAP format that we have all been trained on.
The EHR worked out very well until the field of vendors exploded and suddenly, "everyone had the best product." And then, the government stepped in and tried to define how these software companies could design their products and what doctors must record in that note. Suddenly, my EHR was no longer approved to record compliant progress notes. I started over with a certified product.
With the advent of Meaningful Use, the reporting requirements grew stricter. While most of the data we were required to report was already being done in our clinical practice, it was considered insufficient. It needed to be captured in a format that could create reports that the government could use to evaluate "quality."
Hence, the point and click technology was born into EHRs. While it may sound easy, it represents a time drain clicking through multiple screens to report these metrics and wastes hours of times creating the reports we must submit. I'd rather spend the time determining why my patient's blood sugar is too high than determining their race, which is a required reporting element and in my area, it is often mixed and not so easy to define.
Technology advances much quicker in medicine than any other sector. Doctors are using robotics and genetics for precise treatments that were not available just a few years ago. We are not averse to trying new technology. This technology improves outcomes and saves lives. However, we do not race to incorporate technology not what it is purported to be and actually takes time from activities that can improve our patients' health. Any time the government changes the reporting requirements, the vendors rush to implement updates, which often just create another step in the data collection process.
Why do doctors hate their EHRs?
The technology fails to do what it is advertised to do, e.g. interoperability. Most systems do not connect with other systems and the vendors are unwilling to work together to create bridges to make it happen. We are left with fragmented systems where we need to log-in into many different sites, download results, and then re-upload them into our EHR. Many times this does not even work and we are left to print out these reports and then scan them into the system. This is an unimaginable amount of time which could be better spent educating patients.
EHRS are not work-flow congruent. Rather than easing our charting while in front of patients, it creates distractions and disruptions clicking between pages to locate what is needed. And when a progress note is needed on paper, it often prints out pages and pages that are not clinically useful.
They are costly, not just in terms of the product, but in training the staff and implementation.
They were forced upon us without giving us any voice in how they should be implemented. The reporting requirements are not necessarily the best ones to track quality of care yet, we must comply or be penalized.
A decade ago, I actually liked my EHR. It did what it said and I could use it how I liked. It was a record that was medically relevant and I could use it to treat my patients. And it was formatted in the standard SOAP note layout known to healthcare practitioners the world over.
I no longer like my EHR. Checking boxes that have little meaning to the patient sitting in front of me is a task I was not trained for. Perhaps, it is time to let doctors return their focus to practicing medicine and find someone to be the data entry clerks. Better yet, perhaps politicians just leave the exam room to those with the medical training.