Improved legibility Penmanship is not a virtue of most physicians. The EHR presents the patient’s record in a clear, readable format and reduces errors in care.
Portability The EHR can be viewed in the hospital, emergency room, or at home when the physician is on call.
Accessibility Multiple departments treating a patient may see one another’s work-up, records, and ancillary studies.
Easier and less expensive storage With the EHR, physical storage of records is minimal. There is also a reduction in staff to care for those records.
Security and liability The EHR provides more secure records and limits access. Once it is signed, the medical record in the EHR cannot be altered.
Improved coding High-quality, more legible medical records improve the accuracy of coding and the submission of more accurate claims.
Confidentiality The EHR is more confidential than paper records by virtue of its limited and controlled access.
Improved patient care is the most important part of medicine today. By virtue of its ease of use, great security, accessibility and portability, the EHR contributes to better care.
Dr. Avery is Professor and Chair of Obstetrics and Gynecology at the University of Alabama School of Medicine in Tuscaloosa, Ala.
“The EHR interferes with my assessment of the patient”
Carolyn V. Brown, MD, MPH
One of the most important changes in my practice has been implementation of the electronic health record (EHR). Supposedly, that is a good thing, but I have found that utility of the EHR depends on who designs it. Before the EHR, I relied largely on the patient’s history to reveal clues to her condition. Now, when I go into an examination room, I have to spend precious minutes blowing through a screen of questions that a high school graduate has plugged into the computer. I no longer can spend my time observing the patient’s body language or listening to her stories to detect the “second agenda” that patients inevitably bring with them on their visits. Remember: I only have 7 minutes to spend with each patient!
What in the name of evidence-based medicine are we doing? (I think I am trainable, but this waste of time is beyond the pale!)
Dr. Brown practices ObGyn in Douglas, Alaska.
“Too much paperwork!”
Anthony T. Bozza, MD
This year I have seen an increase in paperwork—precertifications, email, e-billing, and faxes. The electronic era was supposed to herald a decrease in this traffic and make it easier for us to focus on direct patient care, but I have seen an increase in both paperwork and the demands of patients! That means longer hours for less reimbursement. Although my patients always come first, they seem to want more and more of my time—not only face-to-face time but also telephone and e-mail responses. I try to do the best I can by being there for them, but I hope the paperwork demands begin to ease!
Dr. Bozza practices ObGyn in Lake Success, NY.
3. A few preoperative measures can avert complications, ease discomfort
E. William McGrath Jr, MD
When I perform a suction D&C or D&E, I administer 20 U of intravenous oxytocin preoperatively and intraoperatively to reduce the risk of uterine perforation. The firmer uterine wall lowers this risk in even the most difficult cases.
And when I schedule a hysteroscopic tubal occlusion (i.e., sterilization), I pretreat the patient with a progestin-only minipill 1 month in advance. The birth control pill renders the endometrium completely atrophic, making the tubal ostia easy to identify.
Dr. McGrath is Chief of ObGyn at Baptist Medical Center Nassau in Fernandina Beach, Fla.
Robert del Rosario, MD
I have been performing endometrial ablations in my office for about 2 years. Over that interval, I have “tweaked” my preoperative local injection and medication regimen, based on feedback from patients, conversations with other physicians and our instrument representative, and clinical experience. Although patients tolerated the procedure, I still found myself trying to talk an occasional patient through her discomfort.
Two events led to remarkable improvement in patient comfort during ablations:
- One patient refused our then-standard preop diazepam because it made her feel “too weird.” After a brief discussion, we opted to use lorazepam instead, with the understanding that I had not given the drug before as part of my protocol.
- My instrument rep mentioned that he had seen some physicians inject normal saline paracervically in cases involving intraoperative breakthrough pain. I decided to try injecting it in addition to paracervical mepivicaine preoperatively.
These two refinements to my traditional protocol, I feel, have dramatically reduced, and, in many cases, eliminated, intraoperative discomfort for my patients.