Doctors' 10 Biggest Mistakes When Using EHRs

Kenneth J. Terry, MA

Disclosures

May 01, 2013

In This Article

The Division of Labor

Mistake #6: Entering Too Much Data Into the EHR

Don't try to enter all patient data into the EHR yourself, Anderson says. Have a nurse put in the vital signs, update the problem list, and perhaps start the history of present illness, and then complete the rest of the note during or after the examination. "Doctors spend way too much time entering data into the record, even though they may not make any clinical sense out of that data," he points out.

In addition, Anderson says, EHR novices should start documenting gradually, perhaps starting with new patients. One reason for this is that when physicians start out with an EHR, they don't have any patient data in the system, and the initial data entry takes so much time that some doctors get frustrated and give up.

There's also nothing wrong with dictating progress notes, says Rosenberg. "For 99% of practices, structured data are worthless. In terms of doing searches for quality improvement, it's not worth what it takes to do it. If you're being required to get an EHR and you can dictate with voice recognition, that's a great way to go." Alternatively, he notes, some doctors successfully use scribes to enter data for them.

Mistake #7: Doing EHR-Related Work Your Staffers Should Do

Rosemarie Nelson agrees that doctors need not do much data entry. She points out that most of the structured data they need, such as problems, medications, allergies and laboratory results, can be entered by staffers, can come in through lab interfaces, or can be generated automatically. For example, the electronic prescribing module in an EHR automatically builds a medication list, although staff may have to enter other medications that patients bring in.

Many EHRs, however, are designed in a way that shifts some of the routine workflow in the practice to the physician. Those tasks include such items as maintaining problem lists and reviewing normal results. Instead of staff members doing these things, which are part of their job, doctors have to do them, which is "absolutely inefficient," she says.

"So you shouldn't allow that work to shift back to you. There has to be an effort in place to make sure everyone in the practice understands what their roles are. Part of the nurse's role is to help make the doctor's day more efficient, and that includes taking on tasks that some EHR vendor thought should be a doctor's, such as data entry."

Mistake #8: Using Shortcuts and Workarounds

Many physicians rely too much on shortcuts, such as EHR code checkers that help them verify that they have done everything required to justify a particular evaluation and management code, Ron Rosenberg says. This is a mistake because the code checkers often don't conform to Medicare's documentation and coding guidelines, he notes. Referring to an ophthalmology EHR, he says, "The way that system generates the note, it's blatantly fraudulent what they say about the review of systems."

It's also not uncommon for doctors to cut and paste sections of previous visit notes into current notes. That may simplify the process of creating the note, but it could land you in a world of trouble, Rosenberg points out. "The Office of Inspector General is really starting to look at that," he says. "Some doctors take the initial visit and keep carrying it forward. You're supposed to change what needs to be changed. But they're clearly documenting things that weren't done."

Moreover, Rosenberg says, this approach leads to suboptimal patient care and can create a "huge malpractice liability."

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