EHRs on the Mind
Physicians’ hatred for electronic health records (EHRs) seems to be everywhere. Nearly every physician blog, listserv or social commentary on the state of medicine seems to include their dislike for electronic recording and reporting over traditional paper-based methods for documenting subjective (patient) complaints, objective details (physician findings), assessments and plans into the EHR. If you watch this video, I think the feelings summarize what many in addition to ZDoggMD perceive as a major problem in patient care with the hashtag LetDoctorsBeDoctors. Anyone with a helicopter in their video is doing something right.
Physicians claim they spend more time with the keyboard then they do with the patient. Pop-ups, warnings, recommendations, boxes to check and a series of cut-and-pastes it seems takes more time and provide less value in terms of medical documentation.
I recall one patient record that stated for weeks “bilateral pedal pulses present and intact”. The only problem was the patient had bilateral below the knee amputations and the click box or cut-and-paste lasted for weeks before someone apparently read this and knew something was wrong. Quick anatomy lesson – these are the dorsalis pedis and posterior tibial arteries which would be absent with someone with a below the knee amputation.
I also understand the software may not be as functional or laid out exactly as every practioner would like given different workflows and items to document. In some settings I understand this works extremely, however, what may work in outpatient pediatrics may not work in the PACU or for inpatient oncology.
There is no shortage of EHR implementations that have gone awry and there will be many more. Interoperability will continue to be a problem as will billing interfaces and more.
But why are we still having this discussion?
Since I was a medical student I have used an EHR in some capacity. It was a stylus you had to touch to the screen to order labs and radiology studies but it was electronic. No paper requisitions. As an intern we had a crude MUMPS-based system that contained some data and required some data entry that allowed for documentation of patient stays and treatment records. Discharge medication prescriptions and discharge instructions were still hand written. As a resident the systems we used progressed a little more incorporating more functions and data into a paper-less workflow. It wasn’t always pretty or perfect but this was 20 years ago. For as long as I have been practicing the hospital systems have had EHRs. My access to information (I recognize people have to input the data) is much better than if it was paper-chart based.
Are the physicians the past several years that have had to experience this really having this hard a time?
More than 10 years ago I was recording procedure notes from FNAs into the EHR. The consent , my notes, preliminary assessment and discharge instructions were all recorded. It seemed to take me longer on paper and potential for loss or error seemed to be greater.
As a consumer (patient), I understand that my physician may spend more time with the monitor than with me. But I can also see my medical record (at least some of it) and it is somewhat portable beyond a chart room somewhere and if I want to, can print copies for my own paper records.
I think the major problem with electronic records is how much can be documented that concerns most people and reminders or check boxes that perhaps are not relevant but could be missed in a simple paper recording. On the other hand, it seems to me writing out “Subjective, Objective, Assessment, Plan, Labs, Radiology, Social History, Family History, Physical Exam, etc…” over and over, even brief is simplified once recorded in the EHR.
