EHR upgrades and patient care

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Each time my EHR is upgraded, I am informed on the new functionality and the wonderful tools it will encompass to make charting more efficient and patient care better. Improvement features with interoffice staff communication, improved coding features, and data sharing all seem to be a necessity with upgrades but why don’t I see improved efficiency and less screen time as a result?

Unfortunately, to the contrary, often with upgrades functionality changes, colors and format differ, and I find myself having to relearn EHR processes all over again. I usually don’t find the upgrade to be that much different than the version from the year prior, and personally I haven’t been mesmerized by the improved aspects of patient care as a result. What changes, however, is the logistical flow. As clinicians, we are taught on structure. Medicine uses tradition such as how we obtain a history starting with the chief complaint. There is a flow to medical notes, from taking a history to presenting a case. We are trained this way and medical school basic doctoring courses still teach the cadence of performing an exam with this style of flow. We organize our thoughts and communicate our presentations both orally and written in this manner. However, the EHR organizational structure is seemingly constructed with countless variations. The construct seems to ignore the legacy of how we are trained. We try to be flexible with the EHR flows and constant inflow of changes to colors, icons, functionality placement, etc.Why does it always have to change with every upgrade? Most recently, an upgrade to the EHR included emojis. Really?

Why EHR companies change color formats, icons, and sometimes location of functions is beyond me. The changes do make the upgrade readily apparent, but do the changes aid in patient care and safety? Is my job more efficient as a result? Functionality may indeed improve, but my overall arching question is why must all the icons, the colors, the locations of such tabs change as well? The Greek philosopher Heraclitus is credited with the idea that the only constant in life is change but with the frequency of “needed” upgrades, it is nearly mandatory we are forced to change every few months. Acclimatizing to our EHRs seems to be in competition with keeping up with newest medical advances in disease management -- a statement which I never thought I would have to make.

Respectfully, I do understand that EHRs may help to improve accuracy, help with clinical decision-making, have tools for medication interaction review, and search features to retrieve needed information in a sea of medical records hidden in specific tabs within the EHR, and in some instances help with medical legal defense. Conversely, I find efficiency of the patient examination, and the satisfaction of delivering care less so because of the complexity and task-oriented functions of the EHR. In many instances, I find myself feeling like a data entry clerk rather than a clinician.

Clinicians, now more than ever, have many data entry duties. The clinical encounter’s efficiency is dictated by the ease of the EHR. I would suspect that most clinicians do not feel that their efficiency and clinical duties ease because of such upgrades. The National Academy of Medicine stated that nurses and doctors spend 50% of their workday looking at a computer screen, not the patient, and the increased EHR demands contribute to provider burnout.

The “upgrades” seem like a barrage of changes like a video game that my kids play. The marketing of new features, colors, and graphics make computer games fun. I wish I had the same positive outlook as my kids do when I hear an upgrade is coming to my EHR. The EHR often seems like a video game in and of itself. It has many nuances and features that often seem hidden and depending on the training and skill of the user, can then be unlocked for clinical use. Developing such skill and adaptability takes work, time, effort, and practice -- but then may quickly fade once the newest upgrade is placed into motion.

If I had a wish, I would ask computer informaticists who assist with such upgrades to ask me if I even need an upgrade and at a bare minimum, keep the same icons, colors, and fundamental basics without significant change. The hours spent on meetings, emails, and videos about the impending new and improved upgrade could potentially be better spent on patient care. Until then, I will have to continue to get used to EHR upgrades and learning the new format and inefficiencies of such.

I wonder when Madden 2025 comes out…

Jesse D. Bracamonte, DO, FAAFP, is the Associate Chair of Education, Mayo Clinic Family Medicine.

Michael Underhill, DO, is a family medicine physician and site lead in the department of family medicine, Mayo Clinic Arizona.