- With the adoption rate of EHR systems running at about 55% according to the U.S. Centers for Disease Control, more and more hospitals and practices nationwide are leaving paper behind. But considering Meaningful Use incentives, and the purported practicality of electronic health records, it’s surprising that their use is not almost universal.
Or is it so surprising?
Many providers are extremely frustrated with their EHR systems. They are finding that electronic records are more time-consuming than paper. Some dissatisfaction is to be expected with any major change in systems, but most of their complaints are legitimate.
If time is money, we’re in trouble
Most EHR systems force providers to enter data using “way too many clicks,” says Carolyn Hartley, president and CEO of Physicians’ EHR. An intake specialist in the Partners HealthCare network apologized to this reporter when entering routine data for a lab sample: “With this new system… it’s supposed to save time, and it takes longer! You have to fill in something in every field, at least a period,” even when the field is not applicable.
Dr. Douglas Blayney, an oncologist, wrote about his observations of EHR use at Palo Alto Medical Foundation in California for the 2010 ASCO (American Society of Clinical Oncology) website. Blayney told of talking to a computer-generation colleague at Palo Alto Medical Foundation in California who complained that “the EHR slowed him down in the office: whereas in the paper world, his medical assistant would line up the X-rays on the view box, now he had to wait for his PACS to load the images after he signed on to the computer terminal; formerly he would have documented his findings on one page of paper, whereas now he had to point and click, dictate, and type his way through a note.”
An administrator at a mid-size Boston-area health network, generally pleased with EHR, said that the lack of well-designed templates particularly stymied specialists. “The downside [of EHR] is that it takes more time on the provider’s side of things,” she said. “Lots of specialists like paper better” because they find that, while specialized templates help, they don’t fill the bill. Better-designed customization (ideally involving the appropriate specialists) could fix the problem, the administrator said.
Wanted: well-designed, adaptable templates
In one study, flexible templates that providers can tailor to their needs definitely emerged as one of the most promising solutions to the time problem. “One-size-fits-all is not a valid approach to EHR implementation,” wrote California family physician Robert Rowley on his website.
“If it takes you five minutes to create a chart note, you’re using the wrong template,” Rowley said in an interview with EHRintelligence.com. “That’s the time deadline I give a template. If it’s too clunky, it gets in the way.” Rowley, who helped design numerous specialist templates for EHR vendor Practice Fusion, finds well-designed templates faster to use than speech recognition software.
Can’t get there from here
Often there’s no connectivity between EHR systems of different networks, a problem when providers need patient data from outside their own network.
When electronic record systems are incompatible, said Kimberly Winter, a medical litigation attorney who still has a nursing license, “you have to depend on the clinic staff to deliver the correct record to you, and to make sure it’s the complete record,” or at least every part of it you need. But harried staff often miss some portions of the needed records. “Usually the first time I get the medical record, it’s not the whole thing… the [parts of the patient record] are not even stored in one place, as physical [paper] files used to be. They’re printing from several different data banks… for example, I might see that there was a consultation, but [I receive] no report of the consultation, or no list of current medications.”
Even within an organization’s own network, connectivity is sometimes a problem. “The only advantage to paper is that it’s always available, while electronic records frequently have server or connectivity issues. Then you’re dead in the water,” said a physician in the Partners HealthCare system who wishes to remain anonymous. On their EHR system, connectivity “never gets better.”
What else should EHR systems include?
The lack of a universal standard for consistency and portability irked some providers; not all EHR systems are HL7-compliant.
“I’d like to be able to have two windows open at the same time, side by side, such as lab data and the patient record,” said the Partners physician of their in-house system. “If you’re a geek you can do it, but it’s not routine and it’s not easy.”
“An EHR system should also have e-prescribing, drug interaction lookup, lab results, and the ability to scan in faxes,” said Dr. Rowley in an interview with EHRintelligence.com.
“[Our EHR system] doesn’t have a place where you can note how a medication made a patient feel different than he did two hours before, nor a place to log new symptoms,” said John, a nurse at a Washington, D.C. hospital for the homeless, Christ House.
At a small independent practice in Massachusetts, a nurse complains that their EHR system doesn’t have a way to remind the staff about important screenings for diabetic patients.
Vendors, step up to the plate!
As the human population swells, especially graying baby-boomers with ever-increasing healthcare needs—and cost-cutting requirements become more and more stringent—pressure mounts on doctors to perform quickly and accurately. Even if some provider complaints about EHR could be ascribed to human error or avoidable factors such as inadequate training, it’s imperative that EHR systems become as streamlined as possible. They must also be accuracy-focused and offer clear, easily understood interfaces, and customizable templates. Vendors need to support these systems well, not just selling and running. Excellent IT teams and robust host systems are a must, but the product has to be ready to serve out of the box.
As a provider wrote in an EHR/EMR forum: “We (doctors) will not embrace EMR systems until they are usable and they add value! ”