It is clear at this point that physicians are not friends of electronic health records (EHRs). The predominant sentiment is that EHRs are costly (1/3 of providers are buying their second EHR system) and are poorly functional. Much has been said about the failures of EHRs. The shortcomings discussed have ranged from lack of cost benefits to interoperability with medical devices and security of interoperability with medical devices. Decreasing provider productivity and direct patient interaction time are also of concern. These opinions were raised in a ‘Medical Economics’ survey as well as a study by Rand Corporation. Interestingly, physicians do not desire to return to paper records. I will discuss what I call “The Five Important ‘I’s” of EHRs.
1. EHRs are not INTUITIVE. Navigating an EHR is akin to guessing what is behind Door Number 2 of “Let’s Make a Deal.” Documentation does not follow a provider’s thought process or the interaction workflow. It is built to meet regulatory and billing requirements. Many physicians are required to learn and be facile with different EHRs if they go to different hospitals. The AMA has called for a design overhaul of EHRs.
2. EHRs are IMPOSING. Providers are spending an inordinate amount of time with the EHR and less with patients. Most providers do not receive adequate training time, which is inversely related to privacy and security breaches. EHRs are inflexible and progressive practices with ambitious patient quality initiatives cannot implement them because of IT issues.
3. EHRs have limited INTEROPERABILITY. At a recent session of the Office of the National Coordinator at the annual conference of the American Health Information Management Association, Chief Science Officer Doug Fridsma laid out an ambitious vision of what he calls the “Learning Healthcare System” which comprises the building blocks of health IT systems. This will result in improved interoperability by way of the system adapting to change with encounters.
4. EHRs need INSIGHTFUL analytics. Data without good analytics is almost useless. Clinical decision support tools make EHRs pertinent insomuch as they can incorporate accepted practice guidelines as well as customized “best practice” decision support. These follow provider workflows and make the tool more intuitive. Add to this proscribing analytics that actually recommend (not prescribe) tests or treatment plans, and one ends up with a physician’s friend.
5. EHRs must INCLUDE robust portals. Robust patient portals will be critical in creating a true patient-centric health care system. Most portals used today are proprietary to the customer’s EHR vendor because of its low cost. There are some excellent third-party portals that have the ability to corral data from different providers who might have different EHR vendors. In addition, they are places to communicate multimedia content including video consultations.
While this list is not inclusive of all issues regarding EHRs, it serves as a focal point for discussion by clinicians about them. A 6th ‘I’ might be ‘IMMOBILE.’ A physician running back and forth to computer stations from patient beds creates self-evident inefficiencies. Presently available (not offered by most all vendors) mobile versions of EHRs have their own drawbacks. The small screen on a smartphone is a severe limitation, though many physicians do use tablets. That being said, in a 2013 cited survey by Black Book, only 8% of physician responders used the mobile EHR for purposes of ePrescribing, accessing records, ordering tests, or viewing results. As a champion of digital health technologies, I can only be frustrated about the vision I and many others have for their use. However, as with most technologies (and few have been as disruptive as EHRs) adoption in health care is slow. I look forward to leaders like Doug Fridsma and organizations like HIMSS, which has excellent representation by clinicians to help bring about necessary changes.