The hype these days in health information technology is all about electronic medical records. They are being toted as the way to improve patient care and create interoperability through the entire healthcare system. While these goals are truly incredible, the reality of them have yet to surface. Doctors are being nearly forced, by government regulations, to adapt this technology that most find wanting. Doctors feel that the EMR greatly slows down their work flow and cause inefficiencies in the system. And interoperability seems to be far in the future as many simple interfaces between systems fail to be easily accomplished.
EHRs have been the topic of improving patient care and clinical outcomes. While some studies have established this, most doctors are again not seeing this on the frontlines in their clinical practices. In fact, many feel that the EHRs are directly interfering in their ability to adequately take care of their patients.
How Are EHRs Disrupting the Doctor-Patient Relationship?
1. When doctors take their tablets, notebooks or other handhelds into the exam room, they are now concentrating on the patient as well as the EHR. I have heard many patients complain that the doctor no longer pays attention to them but rather spends time just looking into his/her computer.
2. Most doctors feel that data entry into the EHR has proven to be a time drain. Many doctors take this work home with them or do it after hours. This is adding to the stress that most doctors are already feeling. Similarly, the doctors that attempt to do it while seeing the patient or in between patients, often get behind in their schedules. Patients do not like to wait.
3. Every EHR has their own standard of formatting records. There are 100’s of EHRs out there and everyone is different. It becomes extremely difficult sometimes, to find the data in the record that is needed to take care of the patient.
4. Systems occasionally go down. When this happens, so does our ability to access the patient chart or even schedule appointments. The whole workflow of everyone working in the office gets disrupted.
5. With the rise of EHR use, regulations such as Meaningful Use have come into play. While now it is an incentive program, in the future, doctors who do not comply with these regulations will be penalized. Meaningful Use, especially for a small practice, is very time-consuming. And in order to qualify, many more metrics than are needed become required to be reported in the patient chart. The minutia added takes time away from the patient and makes searches of the chart for needed information more difficult to happen.
6. Along with EHR came the electronic prescribing program. While sending e-prescriptions is a great aid, they sometimes don’t go through. Patients are sometimes led to believe that the doctor never sent the prescription because it never arrived at the pharmacy. Call backs from the patient and pharmacist further act to disrupt the doctor-patient relationship.
While electronic records have a great potential for improving outcomes and making us more efficient, the reality has not been achieved yet. The technology needs to be improved and evolved to match what those on the frontlines (ie physicians) need. Systems need to be able to be customized to our workflow rather than trying to get us to adapt to technology we believe is sub-standard.
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