Medicine through the looking glass

A doctor’s prescription for ailing EHRs
By Teresa Knight, MD
03:47 PM

I still remember my first encounter with an EHR. I was visiting my primary care doctor, and the green glow from her computer screen reflected off her glasses like an extraterrestrial aura. Where there should have been eyes, I saw boxes and pop-ups, scroll-downs and charts.

My doctor wasn't alone in this scenario. Eight out of 10 office-based physicians use an EHR, but few of us are fans. Yes, EHRs reduce errors, guard safety, remind us about the arcane rules of medical billing and provide a clean chart with legible handwriting. Yet the EHR has largely transformed into a compliance tool, focused on accountability, regulation, and meeting industry mandates. It distracts doctors and alienates patients who receive less and less attention during the encounter.

One need only observe a physician for a short time to witness the daily tragedy of health IT. We spend hours reconciling charts, searching for patient information, filling prescriptions, minimizing pop-ups, checking boxes. The result is less time with patients and, at times, what feels like an entirely inhumane encounter. As an OB/GYN, women strip down naked in front of me and share their most intimate details. Yet a computer demanding data entry leaves very little room for intimacy in the exam room.

How did we let technology so distract us from the healing power of touch and communication? Surely we physicians did not endure years of medical training only to treat our computer screens.

EHRs are commonly understood as a barrier to meaningful connections with patients. But what if it were something that could bring patients into focus? Like a looking glass, something that could actually help me see them more clearly?

Designed differently, EHRs would keep the patient story at the forefront and inspire a democratic record of health that reconciles both the physician's and the patient's view. And they would follow the four following principles:

·      Intuitive design that encourages physicians to enter essential information in a format intelligible to others. This experience must be simple and delightful and resemble the rest of the consumer world. 

·      Enhanced delegation that redirects work from the physician and delegates it elsewhere, to mid-level providers, medical assistants, and coders. Patients can aid the process, too, by reviewing and updating their health information pre-visit. 

·      Productivity features like enhanced search features and documentation accelerators that make it easier and quicker to surface common diagnoses and associated orders.

·      Simplified clinical summary that captures the heart of the patient narrative. It's time to look beyond the template and to the clear, plain honesty of free text. Doctors are, in fact, comfortable with summaries. It's what we all learned in Grand Rounds.

These are some of the recommendations I'll be sharing with, a recently launched industry conversation to engage physicians on the future of the EHR. It's time to speak out – to share our complaints, our hopes and fears.  EHRs have the promise to do so much: to provide a single view into a patient's health and keep us in close digital touch with the continuum of care our patients travel every day. They have the power not only to provide more accurate and precise information, but also a more complete portrait of a patient's health – and yes, of his or her life.

So let's complain and air our grievances. But let's also give advice. Together, we can design a more human-centered EHR that, like a looking glass, brings every patient into focus.  

Visit to contribute your vision for the future of EHRs and to watch ZDoggMD's rap parody music video, "EHR State of Mind."  Join the conversation on Twitter with hashtag #LetDoctorsBeDoctors.

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