The vast majority of office-based U.S. physicians are currently using modern electronic health records (EHRs), but the system is bringing costs as well as benefits.

Although EHRs are designed to improve access to medical data such as medical history, medication, allergies, and diagnostic test results, and to avoid duplication of effort and lost paper files, dissatisfaction with EHRs continues to mount across the United States. Many clinicians report that EHRs are failing to improve efficiency and productivity.

One major issue with EHRs is the burden they add to clinicians' workloads, which can limit the time spent providing care. The proportion of time available for physicians to interact with their patients is shrinking each year.

Using EHRs adds to the requirement for physicians to communicate with other members of the expanding healthcare team in order to enter notes and place orders. This in turn adds to the workload of the other team members. As such, healthcare information technology is rapidly becoming a source of daily frustration. Although most agree that information technology is central to the future of healthcare provision, the systems currently in use are largely slow, hard to navigate, and can be incorrectly reconciled with frontline clinical workflow.

The creation of a computerized physician order entry system was anticipated to revolutionize the way doctors put in orders for their patients. Experienced physicians and nurses, however, are often brought to despair by the struggle to navigate inefficient and cumbersome systems.

Doctor and patient sharing information on EHR

Some believe that medical scribes may be the answer to this problem, overseeing all of a physician's documentation requirements and allowing them to return to focussing on direct patient care. Suneel Dhand, MD, a hospital medicine physician at Beth Israel Deaconess Medical Center, in Boston, MA, outlines on kevinmd.com why medical scribes could be a win-win solution.

He states that physicians would have more time to engage in direct patient care, could see more patients, and be more productive. There would be, "Increased physician job satisfaction, retention and lower burnout rates as they spend more of their day doing what they were trained to do and less time staring at a screen," he adds.

The scribes themselves are often college-aged students who want to enter a healthcare profession, explains Dhand. "They are paid an hourly rate and are very happy to be there learning about medicine," he writes. "Hospitals benefit from happier staff, patients and higher productivity."

Dhand believes that many physicians would gladly pay $10 to $15 an hour out of their own pockets for more overall productivity, efficiency, and a happier time at work. "But it shouldn't come to that, because if used correctly, they are an asset to any hospital or clinic."

The American Medical Informatics Association agrees than many improvements are needed to EHRs. In a recent report, the group calls for speedier data entry and clarified and simplified certification procedures and regulations.

In addition to the many frustrations felt by doctors, patients themselves are feeling the strain of these new systems. One common complaint is the lack of eye contact from doctors who appear glued to their screen during consultations.

"The proliferation of health care IT over the last decade has come about mainly due to the federal government's meaningful use program, and the fact that hospitals and clinics are incentivized financially to become fully computerized," reports Dhand.

"And while I don't doubt that the program had some noble intentions, the way that systems have been rolled out across the country has been rushed and haphazard, with little thought put into the effects on the front lines of medicine."

He warns that nurses, too, are feeling the pressure of "the enormous data entry requirements now heaped upon them". This also limits the time they have available to take care of their patients. "Make no mistake, we have witnessed something of a disaster happen regarding what health care information technology has done to the doctor (and nurse)-patient relationship," he warns.

He calls on healthcare IT, administrators, and entrepreneurs to do a better job in understanding the realities of everyday medicine - the humanity, compassion, and strong personal relationships that they would want for themselves or their loved ones.

 

References:

Dhand S. Why medical scribes are the ultimate answer to our health IT woes.
Published November 14, 2015. http://www.kevinmd.com/blog/2015/11/why-medical-scribes-are-the-ultimate-answer-to-our-health-it-woes.html. Accessed November 30, 2015.

Tripathi M. Policy and Legislation Forces Changing the EHR.
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049747.hcsp?dDocName=bok1_049747. Accessed November 30, 2015.

Dhand. S. Health IT: Damaging patient satisfaction one click at a time.
Published November 11, 2015. http://www.kevinmd.com/blog/2015/11/health-it-damaging-patient-satisfaction-one-click-at-a-time.html. Accessed November 30, 2015.

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