Do Electronic Health Records Deserve to Get a Bad Rap?

Put a few otolaryngologists in a room together and each will likely have a story about how electronic medical record (EMR) systems have made life more difficult. Time away from the patient, they’ll say. Or hours spent on paperwork that could be used to build a practice, they’ll note. Money lost, they’ll grouse.

Everyone hates EMRs, right?

Well, not really, said Gregory Ator, MD, associate professor and director of the Division of Otology/Neurotology at University at Kansas Medical Center in Kansas City. Dr. Ator and colleagues recently surveyed approximately 500 providers in their medical system and, surprisingly, found that two-thirds have a positive view of EMR.

“One of the things I want to talk more about is, ‘What can a well-designed, well-implemented EMR do for the doctor?’” said Dr. Ator, who is also the chief medical informatics officer (CMIO) for the University of Kansas Health System. “I think that’s one of the things that we in this business have not thought about,” he added.

In fact, Dr. Ator thinks EMR has gotten a bad rap. To be sure, the fits and starts of nascent systems have caused myriad issues for otolaryngologists and other specialists. But as vendors have improved, systems have been upgraded. The promise of EMRs—more efficient workflow, improved patient care, even increased patient safety—is still worthwhile, Dr. Ator said.

“The core concept in informatics is that a computer plus a person is better than the person alone,” Dr. Ator said. “That’s really a fairly complex topic, because that includes concepts such as human-machine interface …[but] assuming that’s all done right, the computer can be, not an intrusive thing, but something that helps the doctor be better.”

Understanding the Past

Luis Saldaña, MD, chief medical information officer at Texas Health Resources of Arlington, Texas, acknowledged that the initial introduction of EMRs over the past decade has had issues.

Physicians wanted “this tool to help them be more compliant, but then it can easily become your master,” Dr. Saldaña said. “You go from it serving you to [you] serving it because, all of a sudden, the requirements and expectations just grow and grow.”

Those reporting requirements, especially to older physicians who spent decades writing “succinct, hand-written notes that effectively communicated what happened,” turned off many users, Dr. Saldaña added. “Now, even just the daily progress note, to fulfill the least-perceived regulatory requirements for being reimbursed … you have to create notes that are two full pages long,” he said. “We’ve created this kind of monster, and that whole journey kind of then led to this split.”

The split, as described by Drs. Saldaña and Ator, is that EMR users have lined up in proverbial camps. “For some people, they don’t see any way out,” Dr. Saldaña said. “And other people have a lot of hope; they’ve learned to master the tool to [fit into] their work flows, and they thrive. Then, there are a lot who struggle. It’s probably a bell curve of physicians. The great majority fall in the middle.”

The core concept in informatics is that a computer plus a person is better than the person alone … assuming that’s all done right, the computer can be, not an intrusive thing, but something that helps the doctor be better. —Gregory Ator, MD

Teaching the Future

Laura Fitzmaurice, MD, a pediatrician and CMIO at the University of Missouri-Kansas City School of Medicine, said that things are better now than when EMRs first appeared on the scene. Part of the reason they have a bad reputation is that studies and anecdotal evidence on their efficacy lag the technology, she said. “There have been a lot of advances, but I feel like sometimes in the literature, we’re behind,” added Dr. Fitzmaurice. “Stuff out there is from maybe a few years ago, [and] advances are happening so quickly.”

In large part, those advances arise from the fact that CMIOs across the country are working to ensure that rank-and-file physicians don’t give up on technology. “In the beginning, it was trying to get people up on EMR,” Dr. Fitzmaurice said. “Now, it’s about, ‘What do we need to improve your experience? How can we do more for your workflow?’ We’re using science from human factors, interactions. We’re using LEAN process improvement. Technology project management that’s with LEAN. Trying to just keep working through.”

Dr. Saldaña agreed that working with all stakeholders is important all the time, not just when choosing a vendor up front. “When we implemented the electronic health record, we didn’t just say we’re turning it on, and that’s it,” he said. “It was, we’re going to partner with you to try to continue to make it better. And that’s a commitment.”

Dr. Ator said he is working on future research to help better identify different types of EMR users. By being able to understand the types of users, EMRs can take the next step in being more useful to them, he added.

Take “digital natives,” for example. Those are people who have grown up on technology that older physicians came to later in life. Or, “low-touch users” and “super-users,” physicians who are on either end of the spectrum depending on often they integrate technology into their daily flow.

“If you have a low-touch doctor, you can imagine that they aren’t going to be so inclined to interact with a computer on a decision if they’re just kind of sour on the whole concept,” Dr. Ator said. “That’s why it’s very complex. Human factors, machine interactions. You have to deal with people differently …. We must deal with the adoption of technology differently, depending on where people come from.”

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Richard Quinn is a freelance writer in New Jersey.