The Joy and Pains of Using an EHR

A few years ago, I heard a speaker talk about the EHR as both a major cause of burnout and opportunity to regain work-life balance (if used more effectively). Previous to this, I considered all kinds of factors intrinsic to my own sense of work-life balance, including the length of my commute, whether I had the time and energy to exercise after a day in clinic, the relationships I had with colleagues, whether I was able to eat lunch, and if I could attend important family events despite my work schedule. The EHR was a necessary tool -not evil but also not good - a neutral part of my day. However, after being introduced to the concept of EHR as indicator of what is wrong with medicine, my eyes have been opened, and I recognize how the EHR reflects so much of what frustrates and burns out physicians and helps to explain why physicians have lost their joy. However, as I’ve studied this topic more, I also recognize that the EHR has the capacity to address challenges in medicine -to help prevent the types of errors that make hospitals dangerous for patients, to fill the gaps in knowledge for physicians who cannot possibly remember or know everything in an era where thousands of medical articles and updates are published each week, and allow physicians to spend more time doing what they love.

I say this, admittedly, after having an extraordinarily frustrating week documenting office visit notes. One night, I was up until after midnight completing charts and another day found me at work for an additional two hours after my last patient left. I struggled with the usual suspects -charts laden with useless information, having to search needle-in-the-haystack style for the data I actually needed, and lengthy documentation requirements that were reminiscent of the tax code. As I start this new week, I am determined to try again and bend the EHR to my work, my needs, and my practice so that it can become the tool it was meant to be, allowing me to quickly access the needed information and make sure my diagnostic and treatment plans are soundly based on the most accurate and evidence-based information.

What will make this week different (I hope!) than last? It will start with an honest assessment of what the EHR can provide and what it can’t. I will remember that the EHR cannot fill all gaps and that it is a tool, not a solution. Finally, I will not use it to fill gaps it cannot possibly fill,  such as making up for me running late, spitting out information that was never put into it, or substituting for the all-important conversation with a patient.

In order to prepare for this week, I started on Friday afternoon, reviewing the patients scheduled and spending a few minutes looking at my last note and what other intervening things had happened. I then used the sticky note function of the EHR to jot notes to myself so that I would be prompted to remember these nuggets of information. I also spent some time constructing smartphrases - pre-built templates - that I knew I would need to be more effective at documenting the questions I actually ask and care about. Before the end of the day on Friday, I finally committed to learning the most effective way to document while toggling back-and-forth for historical information in the patient’s chart.

Wish me luck.