EHR Hatred and the Search for Nirvana
EHR Hatred and the Search for Nirvana
Did you hear that? It sounded like whining coming from the examination lane. In the past 2 years, electronic health records (EHRs) have been ushered (dare I say, forced?) into our practices. Most of us have used practice management software, but consign that central processing unit (CPU) and screen to the haven of the examination lane and our primary focus changes. The blue glow, the low hum of the CPU, the clickety-clack of the keys -- all impinge on our interpersonal relationships with our patients. Historically, the healthcare professions are driven by change and take to new technology like a child to a new toy. Why is it that we hate this particular technology? The list of complaints is long and detailed.
Topping the list is the data entry. What used to be accomplished with a few checkmarks and abbreviated jottings has become an endless series of box-checking, pulling down menus, tabbing, keyboarding, and spell-checking. Could the perfect legibility, fast note-queries, immediate outcome analysis, obvious medication alerts, improved billing, and instantaneous audits possibly be worth all the effort?
Another common gripe is the number of staff needed to support the new electronic documentation. Efficiency demands that a scribe enter the examination findings, document the conversations, and complete any "paperwork" (still, oddly, the term that we use) required for the encounter. Mastering the system and putting the time into the necessary modifications couldn't possibly be accomplished by the practitioner, could it? The IT department is needed -- daily -- but is this any different from the IT support we required for our practice management systems over the years?
We have heard that the drive to convert all of healthcare to an interconnected and seamless electronic system is nothing more than a "jobs program." Even worse is the rumor that EHRs are actually being used by the government or the insurance companies to monitor our practices. Painless, immediate audits couldn't justify this effort and expense, right?
A fully integrated EHR also has a significant price tag, in terms of both time and money. A practice pays for the EHR platform, the associated software, patient portal, image management instruments, and other add-ons needed for the particular practice. Don't forget user licenses, software maintenance, and monthly fees for data security, along with the expenses of selecting and modifying the EHR platform, and for initial and ongoing staff training.
No doubt, EHR implementation is time-consuming. Unlike adding a new piece of equipment or a new staff member to your practice, the EHR touches every molecule of the practice and fundamentally changes how we do our jobs; we document differently, we review differently, we talk differently, and we think differently. This is the most disruptive change to occur in healthcare in the past 30 years. Perhaps this is why we are resisting this technology so much. But, despite our resistance to complete adoption of an EHR, the goal of improved patient care -- with enhanced knowledge, performance, and outcomes at our fingertips -- is medical nirvana.
Did you hear that? It sounded like whining coming from the examination lane. In the past 2 years, electronic health records (EHRs) have been ushered (dare I say, forced?) into our practices. Most of us have used practice management software, but consign that central processing unit (CPU) and screen to the haven of the examination lane and our primary focus changes. The blue glow, the low hum of the CPU, the clickety-clack of the keys -- all impinge on our interpersonal relationships with our patients. Historically, the healthcare professions are driven by change and take to new technology like a child to a new toy. Why is it that we hate this particular technology? The list of complaints is long and detailed.
Topping the list is the data entry. What used to be accomplished with a few checkmarks and abbreviated jottings has become an endless series of box-checking, pulling down menus, tabbing, keyboarding, and spell-checking. Could the perfect legibility, fast note-queries, immediate outcome analysis, obvious medication alerts, improved billing, and instantaneous audits possibly be worth all the effort?
Another common gripe is the number of staff needed to support the new electronic documentation. Efficiency demands that a scribe enter the examination findings, document the conversations, and complete any "paperwork" (still, oddly, the term that we use) required for the encounter. Mastering the system and putting the time into the necessary modifications couldn't possibly be accomplished by the practitioner, could it? The IT department is needed -- daily -- but is this any different from the IT support we required for our practice management systems over the years?
We have heard that the drive to convert all of healthcare to an interconnected and seamless electronic system is nothing more than a "jobs program." Even worse is the rumor that EHRs are actually being used by the government or the insurance companies to monitor our practices. Painless, immediate audits couldn't justify this effort and expense, right?
A fully integrated EHR also has a significant price tag, in terms of both time and money. A practice pays for the EHR platform, the associated software, patient portal, image management instruments, and other add-ons needed for the particular practice. Don't forget user licenses, software maintenance, and monthly fees for data security, along with the expenses of selecting and modifying the EHR platform, and for initial and ongoing staff training.
No doubt, EHR implementation is time-consuming. Unlike adding a new piece of equipment or a new staff member to your practice, the EHR touches every molecule of the practice and fundamentally changes how we do our jobs; we document differently, we review differently, we talk differently, and we think differently. This is the most disruptive change to occur in healthcare in the past 30 years. Perhaps this is why we are resisting this technology so much. But, despite our resistance to complete adoption of an EHR, the goal of improved patient care -- with enhanced knowledge, performance, and outcomes at our fingertips -- is medical nirvana.
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