Paper or pixels? Clunky EHRs have providers looking to the past

While nobody wants to go back to the pre-electronic health record days, pre-meaningful use is a whole other question.
By Bernie Monegain
10:21 AM
Clunky EHRs have providers looking to the past

Now that the EHR boom has moved healthcare into the software age, clinicians complain that electronic health records take the joy out of medicine, distracting them from treating patients and eating up time with unpaid tasks.

But while providers aren’t exactly pining for the days of paper records, there is some debate about electronic health record platforms being the most effective way of practicing medicine.

What happened to user-friendly?

Many people blame the HITECH Act and its meaningful use EHR program for incentivizing software vendors to craft products that meet the federal government’s specific criteria at the expense of innovative features and functionality.

But when it comes to record-keeping, physicians have documented or dictated patient notes for some time. The routine practice was often conducted after normal workday hours -- either through dictation, written notes, or a combination of both.

[Also: Doctors demand extreme EHR makeover ... right now]

But paper inherently limited how doctors could use patient records, notes, and any data tied to them, nevermind the seamless and real-time health information exchange the industry is striving toward now.

“Searching the paper chart was impossible. The writing was often illegible and while today’s copy and paste is appropriately maligned, being able to import pieces of yesterday's note and modifying it from there saves a lot of time,” said Robert Wachter, MD. “While I'm unhappy with the EHR, I wouldn't go back to paper. Nor would my colleagues.”

Count Charles Webster, MD, among those. The president of EHR Workflow said that incentive-driven mandates, notably meaningful use and MACRA, have essentially pinned down the current crop of EHR technology from significant advancements.

“Most physicians today would not go back to pre-EHR days,” Webster said. “But many who had EHRs before meaningful use would definitely go back to pre-MU days.”

Stuck in the middle

There was a time when hospitals developed their own EHRs and employees loved them.

“In the ambulatory medical practice world, some physicians wrote personal checks for their EHRs,” Webster said.

[Also: EHRs eating up half of doctors’ workday, and they are not getting paid for it]

They wouldn’t have done so if they thought the software was useless.

“In many cases, EHRs that were designed pre-MU, and originally had high user satisfaction, were redesigned to obtain MU subsidies and, subsequently, user satisfaction dropped,” Webster said.

Even health systems eschewing meaningful use, such as Intermountain Healthcare, cannot go back to the days before MU. The program has been running for nearly 8 years, the government spent approximately $35 billion on it, and almost the entire industry is using some sort of EHR now. 

That leaves hospitals and IT shops essentially waiting for meaningful use to end and, ideally at least, pave the way for software vendors to ratchet up the competition based on features and functionality rather than merely meeting government criteria in the next generation of EHRs.

Health execs aren’t powerless

Webster said the industry’s ability to improve the current installed base of EHRs is limited. He suggested instead implementing a new layer of workflow technology on top of “the existing layer of workflow-oblivious databases with lousy user interfaces.”

Wachter added that healthcare executives should ensure they have adequate clinician-informatics on staff to bridge the chasm between any vendor-built system and front-line clinicians.

[Also: Allscripts, Cerner, Epic signal more open EHRs ahead]

He also suggested instituting a program that involved IT people spending several weeks entrenched with actual EHR users -- as UCSF did a few years after implementing Epic -- to understand the challenges, tweak the software accordingly, and re-train users to take full advantage of the EHR.

Webster also advised that healthcare's “boil-the-ocean” approach to data and physician micromanagement needs to stop. “Stop directly incenting outcome measures,” Webster said, citing Goodhart's Law.

“When a measure becomes a target, it ceases to be a good measure."

Twitter: @Bernie_HITN
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