What Doctors Really Want -- and Aren't Getting -- From EHRs

David Lee Scher, MD

Disclosures

June 10, 2015

Remember What EHRs Were Supposed to Do?

Even before most physicians adopted electronic health records (EHRs), we understood how both we and our patients could benefit from this technology—at least as it was originally envisioned. No more wading through paper charts. No more hunting for referral letters or test results. No more wondering whether our dictations found their way into the correct charts in time for follow-up visits.

In addition, the prospect of accessing patient records from any location and seamlessly being able to exchange records electronically with consultants, hospitals, and other care team providers is naturally appealing.

A study by the Rand Corporation, "Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy," found that physicians overwhelmingly approve of the concept of EHRs, primarily for their potential to improve data access and care.[1]

Unfortunately, the concept and the reality have turned out to be quite different. Decreasing face-to-face time with patients, the demands of data entry, the inability of diverse EHRs to communicate with each other, and poor usability have not only failed to accomplish promised goals and meet physician expectations but have also contributed to job dissatisfaction.

Because EHRs are not going away and there are no quick fixes for the most common drawbacks of the technology, changes to practice workflow have been suggested and adopted. For example, one criticism is that the EHR comes between the physician and patient by being a distraction during the office encounter.

One solution is to demonstrate the utility of the EHR to the patient. Readily accessing a lab result or showing a heart rhythm strip or radiographic image to the patient on a computer monitor can be seen as a positive experience and might encourage the patient to use a practice's patient portal—which can often afford the patient access to this same information—in the future, satisfying a meaningful use goal.

On the other hand, the time it takes to enter data into the patient record is extraordinary and significantly affects our time management. Some physicians have adopted workarounds. One is to copy and paste documentation from one patient record to another rather than writing a new note from scratch, which saves time. This copied and pasted information might be a patient's history, problem list, review of systems, medications, or physical exam results from another provider or encounter.

However, this can create more problems than it solves. That's why the American Health Information Management Association (AHIMA) issued guidance in a document titled "Appropriate Use of the Copy and Paste Functionality of Electronic Health Records."[2] It states that "misuse of this functionality has the potential to result in or contribute to several overarching challenges, with implications for the quality and safety of patient care, medico-legal integrity of the health record, and fraud and abuse allegations." AHIMA goes on to recommend that "users of the copy/paste functionality should weigh the efficiency and time-savings benefits it provides against the potential for creating inaccurate, fraudulent, or unwieldy documentation."

Another, often more beneficial workaround has been the use of medical scribes. The job of the scribe is to enter notes during patient encounters and might include other clerical tasks.[3] The use of medical scribes has become so widespread that it has been the subject of a guidance document by the Joint Commission.[4]

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