Adapting to Flexibility in the Age of the EHR

I love traveling for a variety of reasons. One of the biggest is the ability to meet a diverse group of people who start as strangers and become friends. On a recent trip to San Francisco, I had breakfast with an IT professional working in the banking industry. Our conversation turned to the proliferation of data in both of our worlds, and how it can complicate the analysis and productive use of that data.

I have worked as a PA for more than 34 years, and have witnessed a dramatic transition of how we collect and view patient health records, from paper records and manual charting to the modern EHR and computerized physician order entry (CPOE) systems.

In my travel buddy’s banking world, similar to the medical world, data management is an expensive proposition. The size and complexity of the data expands exponentially every year. Software is the interface between professionals in our fields, allowing us to interpret and record information into this burgeoning database.

It has dawned on me on more than one occasion that the weak link in this whole system is the end user, and this is true for every industry. I have observed over the years the age diversity of physicians, PAs and others providers directing patient care within the healthcare system in the U.S. Prior to computers and digital data, we all charted the same way. The only tool that we all had was pen and paper. This has changed dramatically over the past ten years.

A number of policy changes on the federal level, as well as the Affordable Care Act, have driven a rapid transition to the EHR at every level of the healthcare system. A combined carrot and stick economic stimulus has been the force behind this transition. It has, at times, been challenging from a provider standpoint. I imagine that it has been the same from the corporate level.

I can only address the view from the trenches. What used to be a uniform documentation system has moved into one in transition. We don't allow anything but CPOE in our hospital. However, we still allow handwritten progress notes. Administration has moved gently in this area in order to cater to some providers’ lack of computer skills. While everyone is different, having practiced healthcare for many years, technology adoption can fall into several transitive groups.

Today’s recent medical professionals are highly computer literate, and have never touched a paper record, and never will. They can research a patient problem, FaceTime with their friends, text, and handle e-mail all at the same time, from a variety of devices.

Then, there is a middle group who have grown up in the computer era and have decent computer skills. They remember the paper era, but see the promise of the digital age and are able to keep their heads above water in the burgeoning digital age.

The last cohort is my age group, those nearing retirement who have spent the majority of their careers in medicine in the paper age. Many in this age group find managing technology to be a frustrating endeavor. However, with challenges and transitions come opportunities and I have seen many baby boomers and hospitals adapt to leverage more holistic systems. It simply takes patience and a little bit of flexibility.

That said, we have to be gentle in our expectations of the transition towards a digital world. Big organizations, like the one running the hospital in which I work, have deployed many resources towards easing the transition towards the EHR that are available 24/7. Unfortunately, some providers in private practice might not be so lucky, and find themselves having to go it alone. Assisting all those at every level of EHR skill and ability is imperative toward full implementation of the EHR.

Patience is an important virtue in this transition. Nothing this difficult and complex can be done easily or quickly. However, by being reasonable and rational about the problem that we are trying to solve - being flexible and ensuring we are building tools that will ultimately allow us to better serve our patients - will help with the solutions towards dealing with the mountain of data that is burying every industry in the nation, service or otherwise.