EHRs: The Way it Should Be

Don Burt ¥Ê Patient Keeper ¥ 05/21/07By Donald M. Burt, MD, Chief Medical Officer, PatientKeeper, Inc.
Twitter: @PatientKeeper

Some things in life are perfect as they are; you could not ask for more. Maybe it’s that idyllic vacation spot you return to time and again. Or a restaurant that never disappoints. Or (if you’re really lucky!) a spouse, parent or sibling who is always there for you, in just the way you need.

Most things in life, however, could stand at least a little improvement.

And so it is with electronic health records systems (EHRs), especially from a physician’s perspective. Talk to a doctor and you’ll find that typical hospital EHRs leave a lot to be desired. This is not because physicians are Luddites; quite the contrary. They love their smartphones, and almost every operating room in the country is full of physician-demanded automation. It’s not technology in general that physicians resist, it’s EHRs in particular – and for legitimate reasons. Here are five of them:

  1. Hospital EHRs impose an unfamiliar workflow on physicians dictated not by what the physician knows about treating patients and has been doing for years, but rather by the processes that exist deep inside the hospital. The paper world completely (and appropriately) insulated physicians from these hospital operational processes, since exposing them does nothing to help improve patient care. However, as a side effect of trying to support physicians’ workflow using a computer system designed to run a hospital, physicians now see far more than is necessary.
  2. Because the typical EHR implementation involves not just educating a physician to execute their workflows using a computer but also forcing them to adopt new workflows, hospital EHRs require extensive classroom training that often takes physicians away from their patients for days. That’s a lose-lose proposition.
  3. Physicians find that getting all the information they need about a particular patient is cumbersome in most hospital EHRs. That’s because the data may live in multiple systems/modules, and the systems are structured in a process-centric way rather than a patient-centric way. As a result, physicians waste a lot of time clicking around to find what they need.
  4. Much has been written about alert fatigue, which occurs when there are so many alerts that physicians no longer pay attention to them. Alerts issued by computerized physician order entry (CPOE) systems are a case in point. Many alerts are unnecessary and/or irrelevant. They typically fail to take into account the physician’s specialty, knowledge, and patient situation. When physician users of CPOE become jaded and routinely tune out alerts, they may miss the occasional important one, which defeats the purpose of having alerts – and to a large degree CPOE – in the first place.
  5. In the paper world, physicians are careful editors and include only the most relevant results in their notes. In many computer systems, physicians are almost encouraged to dump large amounts of clinical information into their notes, providing little value for the next clinician reading the note. As a result, physicians are spending more time sifting through lengthy clinical notes trying to discern the vital nuggets of information necessary to inform the care they’ll deliver to their patients during that shift that day.

These and other impediments to using hospital EHRs demand attention because physicians are by far the most expensive and limited resource in the healthcare system. Fortunately, solutions exist to all five of the common EHR problems described above. Unfortunately, at many hospitals, those solutions have not been implemented. The result has been mounting physician frustration, which is understandable – because, as with so many things in life, it’s unsatisfying to accept something the way it is when, with greater attention and effort, it could be the way it should be.

About the Author: Donald M. Burt, MD, is Chief Medical Officer at PatientKeeper, Inc. Before he joined PatientKeeper in 2007, Dr. Burt served as President of Berkshire Faculty Services, the multispecialty physician practice group affiliated with Berkshire Health Systems; Vice President, McKesson Corporation; and Vice President and Medical Director of Health New England, a provider-owner HMO.