AMA docs fed up with EHR woes

'It's slowed our productivity dramatically'
By Erin McCann
11:05 AM
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When it comes to EHRs, many docs are more frustrated than ever. And they let that be known Monday at an American Medical Association Town Hall, bringing their EHR challenges and experiences to the fore.

"We know there are many frustrations with electronic health records," began AMA President Steven J. Stack, MD, in a July 20 AMA Town Hall in Atlanta. "They have so much potential to improve healthcare, improve quality, improve our efficiency, improve patient engagement, and yet that's not the current state of reality," he added. "Our experience as physicians is often falling far short of the promise that I think we all hope we eventually reach."

[See also: AMA: Freeze ICD-10 in carbonite!.]

Stack called on participating AMA Town Hall members to bring their stories – the good, the bad and the ugly – of their EHR experiences, so they could send a "clear message" to policymakers on Capitol Hill regarding what's working and what needs serious re-working.

The physician voices in the room were overwhelmingly negative, with many docs citing decreased efficiency, less time with the patient and considerable ongoing expenses as a big part of the problem.

One physician, Melissa Rose, a pulmonary critical care and sleep practitioner, was among those sharing their experiences. Rose, who works in a three-physician practice, was an early adopter of EHRs in 2006. And since then, the challenges have been overwhelming. It's "very costly," she said. "I am still paying a huge amount.

"It's slowed our productivity dramatically," she explained. "Every time they have more regulations, more things I have to answer takes time away from the patient."

Rose then detailed an account of what it's like when the Internet goes out at the practice, which is not altogether uncommon. When the Internet goes down, "you're stuck," she said. Even switching to Comcast didn't help Rose and her team. "You have a slight blip in the Internet connection, and you have to sign back in" to the system, she said. And because they're a small medical practice, they've outsourced their IT department, making it difficult to deal immediately with server issues.

Despite the crux of her woes being attributed to EHRs, they're not all bad news, she acknowledged. "The e-prescribing is awesome," she said, easily the "best part" of electronic health records.

Vinaya K. Puppala, MD, an Atlanta-based anesthesiologist, also spoke at the Town Hall Monday. Puppala, who works at Alliance Spine and Pain Centers, a 17-doc practice, says his biggest problem with EHRs is that they were not designed for the patient. "Most systems being designed today are not designed (for clinical care)," he said. "It's set to comply with the federal regulations as opposed to actual physician patient care."

Puppala's concern is that with meaningful use and EHRs, there's been a shift in medicine away from physicians acting as clinical decision makers toward being "data miners." And with that, is the accompanying decrease in efficiency which ultimately detracts from patient care. 

For a Savannah-based anesthesiologist who spoke at the town hall, the biggest problem around EHRs was the complete lack of interoperability.

Describing anesthesiologists as essentially the "last of the generalists," the ones who have to look at the whole patient, she explained how often she'll get a patient in the early morning, with the history of the patient. And "all of a sudden, there's a question about heart disease and congestive heart failure," for that patient, she said.  And it's an important question, as some 50 percent of her patients have this history.

"I want the echo that was done three years ago in California," she said. But she can't get it. "This is the main thing you're hearing is interoperability," she added. And it's a big problem.