Docs say how they really feel about EHRs

'We spend more time with EHRs than we ever did with the patient with a simple paper chart'
By Frank Irving
10:04 AM
stressed doctor

We've seen the numbers: About 8 in 10 office-based physicians have adopted some type of electronic health record, and about half have an EHR with advanced functionality. But if we dig deeper, how do doctors really feel about these systems?

We posed that question to a handful of physicians from very different backgrounds. As shown in their comments below, docs see a lot of room for improvement in the ways in which they interact with EHRs in the patient care setting.

[See also: Practices buried under MU 'avalanche']

"EHRs are a necessary evil. We can't run from technology, but the reality is there is essentially no effective interoperability platform for practices to share this information. Even more distressing, the value of our time as practicing physicians is clearly minimized in the eyes of vendors and in terms of return on investment. We spend more time with EHRs than we ever did with the patient with a simple paper chart. The EHR does not improve care but over the long run will improve data and accountability. The government's requisites for meaningful use are not relevant to practicing physicians and only serve to create more burdens in the seemingly ever decreasing pool of time left in a day to really practice and speak to patients."

Steven Hacker, MD
Palm Beach, Fla.

[See also: Docs 'stressed and unhappy' about EHRs]

"While not yet perfect in terms of physician workflow, EHR vendors are making strides to design systems that are more intuitive and clinically driven. EHR technology supports the patient-centered medical home, a foundation of primary care. EHRs also enable robust population and chronic disease management, optimal care coordination, continuity and patient-centeredness. This enables physicians to deliver safe, high-quality care for the optimal health of patients, families and communities."

Michael Munger, MD
Overland Park, Kan.

"The most critical interoperability function is the interface of the patient, doctor and EHR. How well does the EHR project visually to the patient at the visit? How easy is it to access graphs of vitals and labs over time and how easy is it to understand for the patient? Does the medication reconciliation, e-prescribing, health maintenance and educational application project well and integrate well in real time at the visit? For the future the EHR has to move from documentation as the primary function and turn into a fantastic teaching tool so one can be proactive and maximize the educational aspects of the EHR. Mine does this exceptionally well; those that don't won't survive in my opinion.”

James Legan, MD
Great Falls, Mont.

"I am a fan of the EHR edict, but I believe the EHR is mainly a repository for clinical, regulatory and financial data. One doctor in JAMA commented that the EHR is destroying his ability to listen to the patient's story and to do an examination in the way he wants to do it. I don't mean to slam EHRs; we do need them. But there are ways we can work smarter with them to take some burden off doctors and nurses so that their time is spent in patient encounters instead of typing into computers."

Bridget Duffy, MD
Chief Medical Officer, Vocera Communications
San Jose, Calif.

"The doctors I've talked to who are on EHRs — especially EHRs bought for them by hospitals — are telling me their productivity has gone down 20 to 25 percent. Well, guess what their payment is based on? Productivity. Doctors who are running their own practice are saying, 'I can't afford this.' The system needs to be smart enough to know what I've got pending on this patient, what I've got planned, what I need to be doing for preventive healthcare — all that needs to be right in my face before I walk in the door to see the patient. I want to look smart to my patient. I don't want to be the doc who didn't even remember the patient's last labwork. So software providers are going to have to take a different tack. They're going to have to look at task-oriented and mission-oriented types of design to software and workflow because most of the EHRs that are out there now are written by database people, looking at database solutions. That's not the optimal use of EHRs. Doctors are not going to be enthusiastic about this until somebody comes up with a system that increases productivity."

James Palen, MD
Cape Girardeau, Mo.

This article first appeared on Medical Practice Insider.

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