Electronic Health Records

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Epic Implementation in Boston to Blame for Frustrated Docs?

Not too long after a recent Epic implementation across Partners HealthCare, a trio of Boston doctors has criticized EHR adoption for minimizing a personal touch.

EHR Documentation

Source: Thinkstock

By Kate Monica

- In an op-ed to Boston’s WBUR, three doctors — two of whom are currently or once-affiliated with Massachusetts General Hospital — voiced concern about the effects of EHR adoption on doctor-patient relationships.

The two cardiologists and one neurologist spoke on behalf of providers in Boston exasperated with the healthcare industry’s digitization. The area’s leading health system, Partners HealthCare, began its system-wide Epic implementation a little under a year ago in a process that has caused headaches for some.

While EHR technology such as Epic EHR can offer a more efficient way to store and share information, many doctors are fed up with spending so much time focused on EHR documentation rather than interactions with patients.

“Electronic medical records, or EMRs, were supposed to improve the quality, safety and efficiency of health care, and provide instant access to vital patient information,” wrote the authors. “Instead, EMRs have become the bane of doctors and nurses everywhere. They are the medical equivalent of texting while driving, sucking the soul out of the practice of medicine while failing to improve care.”

The Boston doctors urged EHR vendors to improve the quality and time-effectiveness of their technologies to shift the onus from EHR management to patient care.

Providers also seek reduced administrative burden through less stringent government policies — a call entire organizations have echoed since before MACRA implementation began.

John Levinson, MD, PhD, and his co-authors emphasized the importance of the personal touch in healthcare. He and his colleagues stated that patients offer insight into their condition during one-on-one conversations doctors can’t get anywhere else.

While technology has a unique place in healthcare, so does honest conversation.

“Making sense of a patient’s blood panel means knowing the patient’s work and eating habits, and where he or she may have traveled,” reasoned authors. “We need to know if the patient is experiencing a traumatic life event, like the death of a parent or domestic abuse, in order to interpret an elevated blood pressure.”

Administrative burden is not the only area of EHR use stealing time from the provider workday. Simple tasks also require extra attention and time to complete within the automated systems.

“Want to order a simple test?” authors wrote, “That requires getting through multiple prompts. Need to write a prescription — an exercise that used to take less than 15 seconds? Another set of clicks.”

Evidence suggests these extra clicks add up. A recent study showed EHR documentation accounts for over half of a physician’s 8-hour workday.  

Despite the strain and frustration, the added burden EHR systems place on providers may be worth it. Additional studies show EHRs can be used to improve preventive medicine and formerly dismal weekend health outcomes.

Still, physician burnout poses its own threat. Doctors initially pulled into medicine to heal and create meaningful connections with patients are disillusioned by what can often be perceived as ‘busy work’.

“We are frustrated by EMRs because they pull us away from our patients,” wrote the trio. “We are driven mad by the fact that EMRs in different locations do not talk to each other. And we think it’s just wrong that much of the EMR’s busywork is about optimizing billing for the hospital.”

While interoperability is improving in health systems across the country, nationwide interoperability is still a distant dream.

Federal agencies, healthcare organizations, and coalitions of vendors have attempted to hold conferences and ban together to brainstorm ways to strive for more efficient EHR use in the past.

Authors suggest Boston doctors and patients follow suit on a community-based scale.

“The public and private institutions of this city have long and illustrious histories of leadership in health care,” concluded authors. “Now is the time to embrace that tradition and do something about EMRs. We plan to hold town hall meetings to give providers, patients and community members a chance to discuss how to address the problems of EMRs. We invite executives and administrators from all our hospital systems to participate.”

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