- Last Friday, EHRIntelligence.com took a look at Dr. Dennis Gottfried’s recent Huffington Post article and raised the question of whether this was legitimate criticism or just rogue opinion. LinkedIn users answered swiftly over the weekend and some actually think that Gottfried was too light in his EHR condemnation. Here are a few of their comments:
Kevin H. (physician)
Gottfried is much too positive bout EHRs, granting them advantages they lack. He states that monetary, productivity and efficiency gains have been greatly exaggerated but fails to point out the high cost with decreases in productivity and efficiency. Massachusetts medical society says to cut your practice in half when you install an EHR and that you can hope to get back to baseline in 2 to 3 months. A lot of cost and lost revenue to not see a gain in productivity. Specialists really have a hard time even getting back to baseline, due to increased need to document in the specific EHR way without reimbursement.
EHRs are not just not interoperable, they are not intraoperable. They can’t talk to themselves. The next time a path report shows up in the EHR with a diagnosis of cancer, look at the problem list. It will not mention cancer until a human reads the report in that EHR opens up the problem list in that EHR and types it in. HIT is extremely important to health care improvement. Hopefully the next generation of EHR will also be useful. The cost of ripping out the current versions and putting in good EHRs will be astronomical.
Jonena R. (group moderator)
What suggestions do you have for vendors to improve their products besides being interoperable and intraoperable?
It is critical that the interface and the Clinical decision support system (CDS) match the specialty. The only way that is possible is with specialty specific modules that can be used with any EHR. Each specialty should develop its own module and the EHR should act as the database, displaying the data and accepting data to and from any module.
Here is a discussion of this concept:
Also, some examples of specialty specific modules we have developed.
No vendor will be able to make all interfaces for all specialties. This needs to be farmed out. Asking a megalithic EHR vendor to make a specialty specific interface is like asking a heavy duty construction company to make fine jewelry.
The EHR software we have today is built to document everything you do, but it doesn’t help you one bit to find out what you need to do in the future, and that is what we really need the software to assist us with.
I like the idea of having specialty extensions to EHRs; it can solve piles of problems with productivity and just plain usefulness. Of course, to make it practical on a large scale, EHR’s would have to have consistent database design from vendor to vendor, or at least a standard interface between the EHR and any add-ons that specialty groups would build. It’s too bad that this is not part of MU, at least as far as I understand it.
I had a conversation yesterday with an allergist. It is easy to see added value for such; better prescribing, better patient instructions, remote access to records, much more efficient scheduling and billing among others. But this allergist also works in a hospital setting with that hospital’s EHR, and tells me that when implemented they didn’t really care what doctors needed, they are not very enthusiastic about workflow customization, and don’t provide much of any other type of support. It takes so much time to enter in patient data during an exam that the allergist gave up and went back to paper, and at end of day spends hours typing everything into the EHR. The EHR has vastly added to the doctor’s work load. Of course, this very common method of shoving a new EHR down the throats of the doctors in a hospital really doesn’t work very well – and turns the doctors off to EHR.
Kevin is right on… EHRs slooooow down the doctors and reduce their productivity. Several improvements would help including, as Kevin pontificates, “specialty templates”. Another improvement that would be quickly adopted is a simple mobile interface that walks doctors through their charting in an intuitive way. Doctors that have to interface with their practice EHR and then multiple EHRs in hospitals are very frustrated. There is technology available today that can give doctors a single, intuitive mobile interface that works with any clinical system, synchronizing protected health information (PHI) via HL7.
As you can see above, EHR software still has a lot of holes in it that need to be filled before physicians everywhere are happy with the technology. The idea of specialty templates is one that many doctors bring up, as well as interoperability and intraoperability. Physicians are certainly making their opinions known, hopefully EHR vendors are listening.