The Pros and Cons of EHR Systems

I tend to be cynical about the global benefits of EHR systems. I can vouch for myself that it has made my life easier, and allowed me to care for my patients in a safer, more time-efficient, manner. But I am not the norm. I have always been an "early adopter," and a power user of any  of the EHRs that our practice and community hospital put in place.

I spend time studying and exploring the system as it evolves and becomes more "user friendly," but again, this is unique. ' One thing that has helped me is the fact that I'm extremely tech savvy and work hard to be fluent in MacOS and Windows-based systems, and the software that is applicable to my day-to-day work. The other is my ability to accurately touch type 50 to 60 words per minute, which is not so important in this day and age with enterprise grade medical dictation being rapidly introduced within the EHRs now available.

I have always said that the pace of adoption and increased utility of the EHR is dependent on the skills and abilities of the end user. It doesn't matter how much administrative or  healthcare system pressures providers are under there is a core of group of them who will never be comfortable in a completely digital world. Progress on adoption of EHRs is dependent on this group getting smaller through attrition and retirement.

Providers coming out of medical school right now know nothing of the paper world, and strong computer skills are a vital survival mechanism for them. They come out of training ready to embrace the digital world, as they know no other.

I started practice in 1982, and have handwritten hundreds of thousands of patient records. I was grateful to get past that, and nearly 100 percent of my charting and orders are digital now. While my specialty surgical practice is an entirely different animal than a practice like family medicine and internal medicine, I spend less time charting now than I did back in the paper era. I'm an outlier, but at least you can read my records now!

The promise of the EHR was more accuracy, fewer errors, better reimbursement, more time for face-to-face patient care, as well as increased data transparency and sharing, among other things. We have not achieved these goals, and we may never achieve them.

The first problem is that providers are spending more time  every day with charting and orders, not less. Another issue is a lack of computer skills in a subset of providers. And there is the inherent challenge of  the complexity of the EHR, many systems can be intimidating and difficult to maneuver. As a student of these issues, I can say, at least with the EHR at our community hospital, there has been a dramatic, positive shift towards supporting the end user experience. It has been slow in coming, and frustrating to the medical staff.

The bad part of the EHR is the ability to rapidly and effortlessly leverage the capabilities of digital data and document stuff that you really didn't do. "Cloning" is a buzz word that describes copying forward records and cut and pasting of data, to bolster a record and allow a provider to "upcode" a record, when in fact they really didn't do the work required of a certain level of coding. This is a big problem and has the attention of CMS and other large insurers. Digital expertise can be used forensically by CMS to uncover cloning, so it is just not worth it. I do like that labs, radiology, social information, procedures, and other diagnostics can be populated to a chart note with ease in this day in age, which helps in the efficiency of things like consults.

The other major hurdle is the interoperability and transparency of health data across systems. We have not even come close to making the transfer of vital health information seamless and easy. Multiple systems, multiple databases, and no common standards are a recipe for confusion and creates a lack of transparency.

Regardless of my cynicism given the current state of EHR evolution, I believe in the promise of the technology. It is just going to take more time and effort at multiple levels. On the positive side, finding the problems in the EHR is a good thing. We can't prescribe a treatment for a problem without making an accurate diagnosis.