Electronic health records (EHR) are here to stay. There’s even a federal program administered by the Centers for Medicare and Medicaid Services (CMS) to encourage “meaningful use” of digital documentation. On the surface, the idea of implementing EHR is great: issues with illegible handwriting and sharing paper records should be eliminated, and information and data captured can be used to benchmark performance and improve patient care.
However, the reality of everyday EHR use is much less straightforward. According to a recent, comprehensive report on how physicians feel about their digital documentation reveals a number of problem areas. Here’s a look at 6 areas where EHR might be holding you back, and what you can do to address these issues and smooth the path to achieving meaningful use and securing full incentives.
1. Data entry is time-consuming. The majority of physicians who use their EHRs directly, without using a scribe or other assistant, reported that data entry was cumbersome and took up too much of their time that could otherwise be used for patient care.
2. User interfaces are not in step with clinical workflows. EHR prompts — or failures to prompt — through clinical workflow in a user-intuitive way are seen as hampering information collection and diagnosis during patient appointments.
3. Face-to-face care is hindered. When physicians are interacting with the EHR as they go, they say interaction with the patient suffers. Although physicians in the report blame themselves for not being able to pull off this delicate balancing act, the choice is plainly a difficult one: divide attention while the patient is in the room, or wait until later to perform the actual data entry. The latter situation lengthens work hours, not to mention risks inaccuracies because the information is not entered in real time. Scribes solve both issues, letting physicians maximize the quality of interaction with patients and minimize time spent on administrative tasks.
4. Meaningful-use criteria don’t match clinical practice. Both primary care and specialist physicians reported that meaningful-use criteria aren’t necessarily aligned with the most important elements of patient care (such as interaction and a quality experience), meaning that the EHR tail is sometimes wagging the clinical dog.
5. Physicians end up doing lower-skilled work. Physicians who did not use scribes or other assistants reported that their EHRs required them to perform tasks below their level of training, decreasing their efficiency. That is, they are trained for medical care, and should spend their time focusing on it. Scribes — who have the knowledge and skills to record patient information in real-time — ameliorate that issue, freeing physicians to do the work they’re meant to.
6. Template-based notes can degrade documentation quality. Although templates standardize the process of writing clinical notes, many physicians reported that they were over-complicated, impeded retrieval of useful clinical information and blocked the flow of data entry.
What’s more, physicians reported that these issues don’t go away with time, nor does upgrading to more complicated systems improve satisfaction with use. Although the report acknowledges that physicians are enjoying better access to patient data, improved tracking of guideline compliance and disease markers, and better communication with patients and between providers, it’s drawbacks such as the ones above that are holding back the full potential of EHR — and why the AMA is calling for reform. As noted by physicians in several points of the report, the use of scribes can free up physician time for patient care, improve interactions between physicians and patients, and result in better-quality clinical documentation.
