Why Do Doctors Dislike Electronic Health Records?

Great topic. I don't buy their estimate of report writing to patient contact time. I've seen my doctor's notes on my visits and they seem rather simple and don't much reflect anything different from our conversation during the visit. If there is more being added to or reviewed in the records, then the appropriate course of study would be observing the doctors as they do their work, not a survey of the doctors impressions of how they do their work. Efficiency in user interface is a complaint in many systems. It's surprising to me that all businesses haven't become "cleaner" in the User Interface department. Maybe programmers just don't listen to the UI folks. ;-{)

Dragon Software for the MD, OD and others to speak into and have the words appear on the necessary forms (as I suggested to the VA some time ago).

Many times the only word to describe how I feel is a Yiddish expression. Since most all the doctors I used to see spoke, or at least understood the expressions there was no problem what so ever. Doctor "Chippy" Felson who grew up in the same ghetto of Cincinnati as my father spoke Yiddish. There never was a problem. Chippy's hand was in your hand not on a keyboard and he was looking directly into you eye, not a glowing blue screen making typos. Two generations later and computers do not understand Yiddish or probably any other language. [Note: I've been around computers since the IBM 360, tape drives and when the first hard drives were around a foot and a half in diameter and very heavy.] Thanks for allowing my rant. LOL

The missing piece in this is the fact that doctors have to see so many patients a day. Even without the data input, having to see a patient every 15 minutes doesn't allow for any in-depth evaluation and/or treatment. If they did not have to see so many patients, or they had someone else available to enter the information while the doctor takes care of the patients, would solve much of the problem. But that would mean cutting into the profit margins of the corporations involved. It's no wonder that concierge medicine is expanding across the country.

When the electronic record system was installed at the offices of one doctor I saw, it ruined my visits with her. When she took her own notes on paper, she glanced at those and began talking with me with full knowledge of my situation, all brought back to her mind by her notes. The electronic system was not to her liking but she had to use it. She no longer had the memory of medicines or routines we had tried, and she was clearly frustrated. So was I.

A doctor I see now is better at putting things in online files than he is of taking care of me.

When can this situation get turned into something useful?

I'm a Canadian so the system is different here. My doctor uses an EHR and I've never heard any complaints about it. The big advantage, of course, is that any doctor I go to has my health history immediately available. However, your article doesn't really say why doctors dislike them. Is it because they are badly laid out? Something else?

There is (or at least CAN BE) a huge win for the electronic system. Here in Wisconsin all hospital records at the major facilities at least are on Epic Software and are available across the competing hospitals.

In February my wife was taken out by a drunk driver and had a compound fracture of her ankle and a lot of blood loss as a result. The ambulance crew was fantastic and took her to the closest Level 2 Trauma Center and passed right by her hospital of choice.

The Trauma Center put in her name, SS#, etc and had INSTANT access to all her medical records from the competing hospital less than two miles away. All the medications, treatment records, the name and phone number of Primary Care Doctor etc.

When her blood pressure dropped to 40 over whatever they were able to stabilize after seeing a medication that interfered with the sedation and pain med they gave her. Six months later she is finally able to walk with a cane (slow but at least able to) but without that access to those records she would probably have died.

Every state should mandate that these records are available for such emergencies.

Another Canadian here -one of my Dr.'s creates an EHR while I am in his office. Sometimes he scrolls up to view previous notes or medical records from a medical specialist. The medical specialist records cannot be accessed by Dr's at a Toronto Hospital. When I had a 2 night stay in our local hospital last year they could not access the medical history created by my PCP (including my current medications prescribed by both my PCP & medical specialist). Obviously our EHR system is still a work in progress.

I have known the rate of Dr. & dentist suicides has been above average in Canada over many years. Overall recognition of burn out is a problem that should be addressed.

The professionals I see have a "scribe" in the exam room who directly enters the medical data during the visit.

My general practitioner makes house calls which are NOT limited to 15 minutes and immediately records medical data during the extended visit.

The value of consistent, readily available medical history and data does not require extra work if efficiently made part of the visit to begin with.

To Jim H:

Doctors are required to correct or add an amendment to your records.

Quote (directly from HHS government website)

Corrections

If you think the information in your medical or billing record is incorrect, you can request a change, or amendment, to your record. The health care provider or health plan must respond to your request. If it created the information, it must amend inaccurate or incomplete information.

If the provider or plan does not agree to your request, you have the right to submit a statement of disagreement that the provider or plan must add to your record.

End quote

Having spent the majority of my life as an RN, one of the biggest reasons that doctors and the medical field in general don't like electronic records is HIPPA. There are too many ways that records can be hacked and then the health care professional becomes the responsible party.

The line that jumped at me was “designed by computer programmers who do not have to work with patients.” This is too true of too many websites. I imagine the issue is with the software used more than the age of the doctors, though.

From what I understand the ACA mandated electronic storage of health records. It did not however mandate they be in a universal format. Therefore each medical group has proprietary software so we end up with faxes,cd's and printed pages as the means of communicating between health care providers. Extremely wasteful or time and resources for both the provider and the patient. Due to Covid restrictions I recently waited 2 hours in my vehicle an appointment for my wife because the lab had not faxed the lab results to the doctor, and the lab was closed for an hour for lunch. The appointment usually takes 30 minutes.

Whenever I have needed medical attention in the past, I have always thanked my lucky stars that I didn't live in the US. This article just confirms my opinion.

Boy, did this topic bring out the responses. I would note that the "Say ahh..." bit is usually carried out by a Medical Assistant, thus not cutting into the 15 minute visit time of the physician. The data entry time, on the other hand, does. Hopefully, this problem becomes less so as technology advances. An AI that recorded the visit/interaction might allow for a less time-intensive experience on the part of a valuable resource, the physician.

The reason that the Amazon website is so good: they hired Seattle Librarians to design it, and the computer programmers had to make it that way.
The EHR program that my doctor uses requires filling out every box on the page before it will go to the next page. They need doctors and nurses to redesign the programs they use.

Thank you Bob Rankin, for all you do to keep us informed.
In my neck of the woods, the actual Doctor walks into the room w/a 'stenographer' (of sorts) in tow. Maybe my health provider provides TMI but I notice that a normal routine yearly doctor's visit is billed as 30 minutes but I am venturing to guess that my face time with the doctor (+tow) is about 5 minutes and another 10 minutes with other healthcare aids asking questions and/or probing. I don't seem to feel any pity for GP computer burnout. It's like me complaining that breathing is stressing me out just because I need oxygen uptake!
@StefWohl - What is the Yiddish expression you speak of? Is it 'hand-in-hand' or do you mean "Oy Vey"?

How does EHR compare to how much time a Dr spent doing records?
Totally agree with systems designed by programmers simply are useless for any frontline workers in terms of utility. I have experienced systems in the medical field, social services field and finance field. They all have created more work for users. And no utility. And created issues and dangers. And of course never implemented with proper or any training at all. Most recent example MS 365. MS office 2010 works better!

My best friend for 50+ years is a pediatrician. The notes done in the office are only a portion of what he does on their records. The rest of it comes at home, at nights, and on weekends. And this is with him having an electronic system. Electronic systems deal with what is usual or typical or frequent. Pediatricians and other doctors deal with unique individuals that do not necessarily follow the book exactly; their symptoms don't quite match, etc. The true doctoring comes in seeing what does not (often should not) go together. Electronic systems are not open to "AHA" moments where something just clicks in a good doctor's mind.

Watching nurses forced to use drop down lists and scrolling to enter a temperature or blood pressure, some of the most obvious issues are exposed. Basic data entry should NEVER use a mouse! Entering 97.6 is 4 keystrokes, press [ENTER] is a 5th. If you want to skip fields, then a mouse might work better then the [TAB] or [ENTER] key. But the data entry screens programmers are creating these days SUCK! The doctors often aren't treated any better. If your condition is not in some list, they can't enter it! This is the worst of software design and I see it not just at my doctor's office, but on my banking website and shopping cart systems constantly! I've been programming full time since 1978 and the advent of the mouse might be one of the worst things to ever happen! Understand what you need to do BEFORE you create a user interface!!