Do Electronic Health Records REDUCE Patient Care?

Category: Health

Do you ever get the feeling your doctor is too busy typing notes into a laptop to hear what you are trying to say about the symptoms you are experiencing? No, it’s not just you who thinks so; according to a recent survey of over 500 physicians who use electronic health records (EHR) systems every day, all of that mandatory note-taking is interfering with patient care. Read on to learn what doctors say is wrong with the computerization of healthcare, and how they want it to be fixed...

Why Do Doctors Dislike Electronic Health Records?

Stanford Medicine, the umbrella name for the prestigious California medical school and its associated hospitals, conducted a poll of 521 primary care physicians (PCPs) with the aid of The Harris Poll. The survey of doctors' perceptions of EHR systems focused on problems that PCPs encounter with EHRs, and there are some pretty big ones.

PCPs are not exactly enthralled with EHR systems. Only 63% opined that EHRs have improved patient care, and only 66% are even “somewhat satisfied” with the EHR systems they use. Put another way, 40% of PCPs say electronic health records are more trouble than they are worth. It’s not to see why when we look at how much of a PCP’s time is chewed up by EHRs.

An astounding 62% of “patient time” is spent in the EHR system, the docs reported. Assuming an office visit is scheduled to last 15 minutes, that means your doctor has only 5 minutes, 42 seconds to spend talking with you, and those seconds are reduced by the obligatory “Take deep breaths… now breathe normally… say ‘Ahhh...’” routine. So the next time your doctor is running late, remember that he may be trying to actually practice medicine as well as type.

Why Doctors dislike Electronic Healthcare Records

Many PCPs have little discretion about how much time they can spend examining and talking with patients instead of feeding data to “the system.” Large healthcare corporations own many primary care practices, and those corporations require data for a variety of reasons. The data is required by insurers to be used in setting reimbursement rates. The government incentivizes data collection through Medicare and Medicaid programs that tie physician pay, in part, to proper documentation of a patient’s diagnosis, treatment, and health outcome.

Seventy-one percent of PCPs surveyed agree that EHRs “greatly contribute to burnout.” Fifty-nine percent agree that EHR systems they use “need a complete overhaul.” This is no surprise because EHR systems tend to be designed by computer programmers who do not have to work with patients.

Benefits of Electronic Healthcare Records?

The primary benefit that 44% of PCPs see in EHR systems is “data storage,” not better patient health outcomes. Your doctor, too, feels like just a cog in a machine.

Seventy-two percent of PCPs feel that improving the user interface is the most important thing that EHR system designers should be pursuing right now. Sixty-seven percent believe that interoperability deficiencies are the most important thing to address during the coming decade. If that means I won’t have to repeatedly write the same info on “new patient intake” paper forms over and over, then I am all for interoperability! But we have a long way to go before we get there.

Recently, I got some X-rays taken at an imaging center whose office was nothing short of palatial. The specialist who ordered the scans has an equally well-appointed office. During intake, I was asked if I would like to be part of a program that allows any of my physicians to access any of my images electronically. “Where do I sign?” I asked immediately!

On my way out, I had to wait five minutes while my images were copied to a CD, which I was told to give to my specialist the next time I see him. It’s occasions like that one for which the “facepalm” was invented.

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Most recent comments on "Do Electronic Health Records REDUCE Patient Care?"

(See all 29 comments for this article.)

Posted by:

BobD
29 Jun 2018

Re: "...EHR systems tend to be designed by computer programmers who do not have to work with patients."

This is a generic problem. Cars are designed by people who don't repair them. Laws are made by people who ignore them. Wars are started by people who don't fight them.


Posted by:

BobD
29 Jun 2018

On my recent visit to my urologist, I met Pete, the doc's "scribe". Pete sat behind a curtain and typed on a laptop while I and the doc yabbered about medical stuff. I asked Pete a couple of times, "Pete, did you get that?" Much better than waiting silently while the doc typed into some programmer's application.


Posted by:

BobD
29 Jun 2018

We will solve this problem in the obvious way: with good old AI. The doc's laptop will listen, record, transcribe everything that's said, deploy info into a database, and upload to the national database. Voila! Now any urologist in the world can discover the size of my prostate without having to do a rectal exam. I can hardly wait.


Posted by:

Daniel Knorowski
29 Jun 2018

Embracing EHR may correlate to the PCP's age group. My PCP focuses on my health concerns no matter if he is "behind schedule" AND he updates the EHR very quickly and accurately.

Thankfully, this PCP's group IS INDEPENDENT and is NOT submerged into a huge corporate structure.


Posted by:

Steven A Horn
29 Jun 2018

Why not standardize the way data provided by new patients is input so that doctors can integrate this information with their observations? Making the process interactive would reduce the time doctors would have to spend on data gathering and management. There are issues involving integrity of the data (like who maintains the master record) which would have to be addressed but these are not in themselves insuperable.


Posted by:

tiranda
29 Jun 2018

" The doc's laptop will listen, record, transcribe everything that's said, deploy info into a database, and upload to the national database. Voila!"

Not for a while yet, though. Go to Youtube, pick a video, turn on closed captions and turn up the sound. Now compare the spoken word with the printed word. So often captioned words are just wrong, even make no sense in context, yet you can tell the AI picked a very close sound to the spoken words. Happens on videos with trained speakers too...this goal needs some more time...


Posted by:

Bob
29 Jun 2018

As a practicing physician for 30 years, I've been through paper only to complex EHR systems. Yes, I take a laptop in the room, yet make dedicated time to talk, eye contact, allowing questions etc. Using scribes may be a solution for some yet in primary care that's another salary and benefits to pay and we are not reimbursed enough to make that doable, unless you see 50 plus patients per day. I see 15 maximum per day. Not using EHR is appealing yet the penalties from insurance are getting bigger and bigger each year if you don't use one. Main thing to me is the user interface could be much more user friendly. As mentioned above, software is not made by those who actually have to use it.


Posted by:

Jkcook
29 Jun 2018

It’s much easier for doctors scribble or voice notes and have someone else transcribe what they’ve put down. Doctors were not trained to be fast typists and so when they have to spend time keyboarding instead of seeing patients, that takes time away from the patients. Until insurance companies are willing to pay for the transcription of the doctors notes, the patients lose. It’s all about money


Posted by:

Charley
29 Jun 2018

I use a large health provider (Sutter Health)that has multiple facilities. When I go to a specialist at a different facility, they have access to all my records. Also, I have online access to 15 years of my records (lab work, visit summaries, xrays, etc.). For me it is a great.

When I was seeing a specialist at Stanford, he would dictate into his cell phone and it would get automatically transcribed into the the EHR.

So it really depends on the particular EHR system. It also depends on how well the EHR is supported by the IT staff at the facility (small doctor offices have a harder time than large facilities). Also it makes a difference how well trained the doctors are on using it efficiently.


Posted by:

top squirrel
29 Jun 2018

The more efficient electronic records are, the less privacy we all have. You may be delighted any urologist anywhere can learn things about your prostate that only an exam can discover, but the down side is that any clerical employee of any medical office can too, and that is the death of your privacy. Private investigators slip somebody a c-note or two and get a complete copy of your medical records. Errors, vindictive statements and all.
HIPAA gives patients a right to get a complete copy of your records (not just the portion they put for you on line) and the right to propose amendments to correct the glaring errors that virtually all records include. Doctors never admit a mistake so they routinely deny amendments but HIPAA gives the patient the right to add a statement of disagreement to his chart. [Just Google US Code 45CFR164.526(a). ]When I do, the statement is the text of the rejected amendments. And if they try to bury it, tell them you will complain to the US civil rights commission, which oversees such things, and demand that your statement of disagreement enjoy equal prominence to the doctor's flawed Notes.
I insisted Notes for my chart be on paper. I get a copy of the Notes for each visit and I wait until they're ready. I want the doctor to know I'll be reading his stuff. And I file amendments (so be careful, and no inappropriate comments).
Doctors I know usually retire early, complaining medicine has been taken over by the business types who interfere with the proper practice of medicine. You can't really blame the doctors for this. I'd say the universality of insurance and the interference of government (Medicare and Medicaid, and much, much worse if single payer ever gets started) are responsible.


Posted by:

Phil
29 Jun 2018

Way before electronic health records came about and right to the present many doctors would use a recorder that would be transcribed into your record if, in fact, they didn't do it themselves.

I like the EHR's because the records are more complete for transfer to another physician. A doctor that won't use the system is doing his/her patients a disservice IMO.

Some doctors have an aid entering the notes right in the examination room.

Because of EHR we now have access to our records via patient portal although I will admit that in many cases the record isn't posted due to that being yet another task for the staff.

EHR's are here to stay and I like it.


Posted by:

Jack
29 Jun 2018

Well, this is something that has bothered me for a long time! I have brought it to the attention of my primary doc--"Yes, doctor, I know you have to worship the beast first!"--but there nothing changes. To his credit, he does spend more than the average 5+ minutes you cite in your article and is an excellent physician. But both of us are bothered by the demands of "corporate" for his attention to his computer. Worse, he often has trouble finding the information he wants in the system. The exception (sometimes) seems to be lab results which are uploaded by his staff. I was an IT guy for more than 45 years. I say: Woe unto you IT geeks who do not understand patient needs comes first, not system IT performance!


Posted by:

Mike
30 Jun 2018

I like the fact that my VA Doctor and my Local Doctor can both see what is going on. I am down to only going every 5 months to the Va and once a year to local Dc. My VHA Doctor is great but since I live over 45 miles from the Clinic She wants me to keep a local Doctor for emergency's. At work we have health clinics and they also e-mail both Doctors blood work and physical condition.I have a password for my records so if I want I can see what is posted. If my life is on the line I want whom ever is trying to save me to know what has been going on.


Posted by:

j
30 Jun 2018

Where do I start?? I have an orthopedist who used to be great. Then his group was purchased by a larger group and the service is gone. He walked into the room the other day and thought I was a different patient. That was uncomfortable for both of us. Also, the electronic records had me down as a multiple drink/day drinker. I haven't had a drop in several years and never had several a day or even a month!! How many places is that information at now? My PCP organization charges me $250 "facility fee". When I asked what that was for, I was told it was for inputting my records in the electronic data base. I offered to do it for much less. I wasn't taken up on the offer. Do I think EHR is good? No. For many reasons of which just a very few are stated above.


Posted by:

MARK FOTHERINGHAM
30 Jun 2018

This article is clearly written with experience relating to the(north)American market - understandably considering the author's location (and experience)
In the U.K. where most patients are treated under the National Health Service (NHS) my experience of the introduction of EHR (from the patients perception) is mostly positive.
A medical consultation must surely result in some form of note taking be it long hand or voice recorded notes for later transcription and both are subject to errors causing problems for others requiring access to the information. Whilst EHRs may take a little longer to complete surely the advantages out weight the minor inconvenience.
With EHRs the practitioner's notes are available to the hospital specialist. MRI,x-ray or any other diagnostic information is quickly able to added to the patient's record and is accessible to any physicians at any establishment. Also as a patient I have the right to access my records and can see and review the record of consultations and be able to ask questions of those providing medical service.
Equally important is the systems ability to alert physicians to contra prescribing of drugs that may pose a health risk to patients.
Yes, there are risks, including the risk of unauthorized access to the information but that applies to virtually all other avenues of life these days.


Posted by:

MmeMoxie
30 Jun 2018

@Mark Fotheringham - Your experience isn't just in the UK, it is here in the USA, as well. I know exactly what you are talking about, because I have experienced most of the same things, you have.


EHR is a positive enhancement for doctors, as well as patients. I see many comments that complain about EHR but not one person has commented on the positive benefits from EHR.


I went to a Clinic for over 10 years and saw this clinic go from transcription to EHR. Your privacy is well protected, even if you don't want to believe that. At the Clinic, my records, as well as my husband's records were seen by every doctor that we went to within the Clinic. The BEST positive is that ALL medications were noted and each doctor seen knew what they were and what to add and NOT add. Meaning, contraindicated and do NOT mix such and such with so and so!!!


Now, that is a real positive in my book, especially when you take over 16 different prescriptions daily! This makes for better care by your doctors in the end. Is this spying??? Hell no, it is called good medicine and proper care of the patient.


There was another benefit with the Clinic we went to. . .When either of us was put in the hospital, all of the doctors on staff, could see our records and know what meds we were taking and prescribed. They also could get information about any conditions we had. This to me is vital when you are put in the hospitals.


Most hospitals today have Hospitalists who take care of you , as a patient. Now, please understand that the Hospitalists can see your records, but can NOT change any of them from your doctor's offices. However, Hospitalists can add to your records, so that your doctors, especially your PCP can read the progress notes daily.


After being a patient in a hospital where my EHR records could be seen by a Hospitalist, I know that my care was wonderful and awesome. Sorry, but all that has happened to me and my Hubby while hospital bound, has only enhanced our stay with proper care!


Both of us are seeing new doctors, since we have moved. NO, they are not a Clinic, but the doctors we are seeing are connected by the group of Hospitals that we can go to. The system is called the WellStar system. It does have a EHR program from ©Epic EHR System. For me, it is wonderful.

I can see my complete list of medications, my diagnosis of medical issues that I have and I try to go to doctors that are part of the ©Epic EHR System, so that the new doctors know what is necessary about me or my Hubby. Both of us have definite medical issues that must be addressed at the first visit. Then after that first visit, it is a simple matter of quickly updating what has happened to you, your tests and results.


My and my Hubby's data is NOT going for "data sharing" that we have read so much about. The sharing is only within the perimeters of those who need to know, period and nothing more.


I have worked in Acute Hospitals and a Doctor's Office, plus I have been a hospital patient multiple times. I will stand by EHR and all of the benefits it provides, when you, as a patient, know how to use the system. First of all, you need to have a computer, so you can benefit from all of it's positivity and workability.


Bottom line, I see no difference in the time spent by my PCP or Specialists with me or how much they listen to me. I have had the issue of a doctor NOT listening to me and trust me, I quickly fire them! I don't mind the short time that has been granted by the Office Manager to visit with my PCP. We get a lot done and if more time is needed the doctor takes it. That is they way it should be
.

I suggest that everyone needs to get personal with their PCP, especially, since that is who you will see the most. Trust your PCP to recommend the best Specialists for you, when needed. If, you know of an excellent Specialist, especially one that uses the same EHR system, suggest them yourself. This is called having good medical care. You do have a right to make suggestions on your own, when it applies.

It is also easier to get your prescriptions to the pharmacy that you use with EHR. Most of the EHR programs have some sort of electronic prescription system that can easily be sent to your pharmacy, so that when you go to get your prescription, it should be ready or almost ready.


Bottom line, EHR is more of a benefit, than a problem, in my book and I have been dealing with EHRs for over 10 years now and embrace the whole idea and system.


Posted by:

Don
01 Jul 2018

My doctors are superb. In the past 15 years, only one doctor has entered data during my interview/examination, and she had the computer out to examine my current x-rays. Several doctors have a nurse-practitioner/assistant to take down observations and comments, or to upload photos of my skin into the record. The doctors focus on me.

But user interfaces are often horrendous. My mother's PT can't enter a repeating appointment (Monday and Thursday at 2 PM for a month); they have to enter every one individually, even though my smart phone can do it in a trice. Choosing from lists of conditions may produce easily searchable categories, but they are slow to use, and typically miss subtleties so that they end up being at least somewhat inappropriate.

Yet interoperability is the big hassle. I haven't looked into it yet, but there's where the biggest benefits lie. One list of medications, not 3 or 4 or 5, some of which have not been updated recently, and some with typos or misspelling of drugs. We keep signing releases to allow our data to be shred, but it seems like it never is, because even different departments in the same organization can't access others' data. I can only speculate that vendors of the software don't want data shared outside their systems, because it will lose sales - or else they are too busy adding new features to advertise to put in features which are needed.

What's required is for the federal government to establish an XML standard for sharing information between health systems, like the WWW consortium - and require every manufacturer to comply with it, providing means to import, export, and validate data on demand.


Posted by:

top squirrel
02 Jul 2018

Mme Moxie's post gives good examples of the good things electronic records can bring about. Unfortunately, it shows ignorance of the other side.
(1) HIPAA allows disclosure of your records "for treatment" to anyone with credentials (or even just working in a medical office), WITHOUT leaving an audit trail if it's alleged to be "for treatment." They don't check to see if the requester really is treating you. Your consent is never requested nor are you ever notified nor is there any indication in the chart that such a disclosure has been made. In other words, if your privacy has been violated six ways from Sunday you'd never be able to find out. And you can't tell if it's happened already.

(2) Misdiagnoses and vindictive comments will thus be easily spread and will follow you forever.
And they will refuse to correct them even when you show that the misdiagnoses were not evidence-based. They diagnosed me with hypertension and diabetes despite the fact there is no BP reading out of the normal range (and plenty within it) and there has never been an A1c anything but normal(never higher than 6.4, last one 5.3). But present providers pick up on and carry forward misdiagnoses, calling a normal one "in remission" and ordering tests forevermore to "make sure of that," meanwhile, who do you think pays the cost, and the uprated premiums for medical insurance once there has been a diagnosis (and it doesn't matter if it is wrong or not -- they just ask "have you ever...").
Of course if you refuse the tests and challenge the false diagnoses, by this point the relationship between you and the provider is ruined. I tried to put a "do not share nohow" on my records and they just laughed at me. Were we into paper records diagnoses and incompetent practitioners could safely be put behind you and you wouldn't have to drag around obsolete or incorrect stuff the rest of your life. Thank you, electronic records.

I therefore don't want my records shared unless I share them. That electronic records takes the decision out of your hands is one mark against it.

Knowing the above, my only recourse is to avoid medical care entirely, and had I started doing so long ago I would be no less healthy today. And a lot more moneyed. Of course, this means that if something really bad happens, I'll wind up getting care after a lot of damage is done. And it will cost a lot more. Time for the insurance provider to thank electronic records.

Everything good about EHR could be preserved if the patient just had a copy of his records and could show them to anyone treating him. By cutting the patient out of the decision process much bad stuff is perpetrated.

They made a big deal about your records being accessible to the patient via the "patient portal," but what you can access there is just a portion of your chart. Most of the real important stuff is excluded, including things like the doctor's thoughts, plans, what he really thinks of you and where this seems to be going. You have to go to medical records and sign all sorts of stuff and wait a few weeks to get the full records
while any doctor can get them in 2 seconds at a computer terminal. I tell them if he can get such access there is no reason I can't have similar access instead of just a portion. No answer.

I'd have no problem with EHR if they were restricted just to people who had a real need to know, and if the patient had the same access your doctor has to them, and has the power to opt out.

I suspect Mme Moxie has never run into a problem caused by electronic records. If and when she does, she may learn what it feels like to get stuck in a vat of jello and stop being such a believer.


Posted by:

Ken Mitchell
05 Jul 2018

I've known medical professionals (several nurses and at least one doctor) who have "retired" abruptly after electronic health record systems have been deployed.

One of the biggest problems is, as Bob notes, that the EHR systems are designed by programmers rather than doctors. And nurses are entirely cut out of the design loop. Too many irrelevant fields are mandatory; SOMETHING needs to be filled in there. And too many of the fields are highly structured; the doctor must pick an option from a drop-down list rather than being able to enter data directly.

For lazy doctors (as with lazy police officers) the temptation to copy/paste notes from the last visit rather than typing new, slightly different notes is irresistible. This is especially true with surgeons who routinely perform the same procedures over and over.


Posted by:

Kenneth Heikkila
08 Jul 2018

My doctor also uses a scribe via the internet. Seems pretty efficient and simple. There is another person looking at me via something like Skype during my visit, but I'm not particularly shy.


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