Incoming AMA President Robert Wah Defends EHRs

Kenneth J. Terry, MA


June 05, 2014

In This Article

How EHRs Affect the Physician-Patient Relationship

Some physicians complain that EHRs have eroded their patient relationships by forcing them to focus on data entry and diverting their attention from patients in the exam room.[6] Various solutions have been proposed; these range from positioning computers to maintain eye contact with patients to documenting the visit after the patient has left the room. But instead of addressing those possibilities, Wah noted that EHRs provide new opportunities to improve patient interactions.

Unlike paper charts, which can only be used by one person at a time, he pointed out that "electronic systems allow us to have simultaneous access to the same information, so we can rework the workflow and make things different and more efficient in the process of seeing the patient." Similarly, it's much easier to find information in EHRs than in paper charts, he said.

"There are some concerns that by moving off of paper onto a digital platform, we've changed the character of the interaction with the patient," he continued. "But I'd submit that there are opportunities to make that a better interaction just as there are to make it more challenging. Everybody focuses on the negative [aspects of EHRs], and sometimes they forget some of the gains we've made in terms of the legibility, availability, and retrievability of the information."

Turning Medicine Into a Cookbook Recipe?

Another criticism of EHRs is that they cause physicians to change how they practice medicine. Some practitioners charge that EHRs produce "cookbook" medicine.[6]

Dr. Wah responded to this line of attack in two different areas: clinical decision support and the basic design of EHRs. Clinical decision support, which includes alerts and reminders, doesn't force the physician to do anything but merely provides better information to help the doctor make better decisions, he said.

For example, when he used an EHR in a military hospital, he'd get an alert if the prescription he'd just written conflicted with a patient's allergy to that medication. The EHR would also tell him whether the prescribed medication might react adversely with another drug the patient was taking or whether it was a duplicate of a drug the patient was on. "That alert didn't make the decision for me, but it told me right away so I could change what I wrote based on that new information."

EHRs are constructed so that physicians have to follow certain sequences of questions or actions to document easily in them. These "templates," as they're called, can usually be customized by physicians, sometimes with the help of IT professionals. Some groups have decided that they want physicians to use the same set of templates to minimize variations in work processes, facilitate quality reporting, and in some cases, obtain pay-for-performance incentives.

Dr. Wah noted that although variations in care are often associated with decreased quality, some variability is necessary to accommodate the differences among individual patients. As long as those differences can be taken into account, he said, he doesn't see a problem with physicians agreeing to follow certain clinical protocols and embedding those protocols in their EHR.

"One of the opportunities that digital platforms and electronic tools can give us is that if we can agree on what the right thing to do is, we can use these tools to make the right thing the easiest thing to do," he observed. "That will enhance our ability to do the right thing. The question is, how do you decide what the right thing to do is? Some people would disagree on what that is, and that can lead to problems. But if you agree on the right thing, and if you use these tools to make the right thing the easiest thing, I think that's a benefit for everybody."

Do EHRs improve quality? Most doctors don't believe so.[7] The evidence in the literature is mixed, and a recent study in JAMA found that Meaningful Users and non-Meaningful Users in the same organization delivered about the same quality of care.[8] Nevertheless, Dr. Wah insisted that if EHR interfaces are improved, and if EHRs make it easy to do the right thing, "it will lead to increased quality. There's quite a spectrum of variation today, both in the usability of the interface and in what we've all agreed is the right thing to do."

What is needed to persuade physicians to use EHRs in ways that improve quality, he said, is to give them something back in return for all their effort. "The giving back will include better information for quality. If we can give back information to doctors so they can make better decisions, they'll feed the system every day."


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