Electronic Health Records Pros, Cons Debated by Otolaryngologists

by Thomas R. Collins •

But there’s a flip side.

“The EMR, unfortunately, introduces new kinds of risks into our healthcare environment, which is already very complex.” Wrong clicks and entries, over-reliance on automation, and design problems can all go awry, he said.

An overdose of an adolescent patient on Bactrim, relayed in the book The Digital Doctor, by Robert Wachter, MD (McGraw-Hill Education, 2015), came about when a resident entered the number of milligrams of the drug into a field required in the EHR. The resident thought the field required him to enter the total amount, but it was actually asking for milligrams per kilogram. The downstream systems did not prevent the error from affecting the patient, who almost died from this error, Dr. Nussenbaum said.

He also mentioned a 2014 survey of the American Society for Healthcare Risk Management and the American Health Lawyers Association in which more than half of respondents reported at least one serious EHR-related safety event over the previous five years, and 10% reported more than 20 such events (J Healthc Risk Manag. 2014;34:14-26).

Meaningful Use

Richard Scher, MD, a head and neck surgeon at Duke University in Durham, N.C., reviewed what meaningful use requirements mean for physicians.

The 2009 HITECH ACT legislated the availability of $30 billion for the improvement and use of EHR systems, and some of this money was directed toward physicians putting the electronic record to “meaningful use.”

“Meaningful use meant that you were using the EHR to improve quality, safety, and efficiency for patients and our populations while maintaining appropriate care and privacy and security,” he said.

He distinguished an electronic medical record, a system physicians use on a computer in their office, from an electronic health record, which allows information to be shared—the latter is what is required to meet meaningful use requirements.

Meaningful use requirements for physicians and hospitals are different, though interconnected.

Stage 1 of meaningful use, which began in 2011, was focused mainly on promoting the consistency of documentation, i.e., what kind of data is presented and how it’s presented. Stage 2 began in 2014 and focused on advanced clinical processes, such as secure transport of clinical information from one system to another and the ability of patients to access their information.

The steps physicians have to take to meet these goals involve what can be a confusing blend of “core requirements,” “menu requirements,” and “clinical quality measures.”

Stage 3, which may be rolled out as soon as 2016, focuses on improved outcomes.

EHRs are not made for the efficiency of physicians but for compliance and billing purposes. Face time with patients can also be hindered.

Whether you’re in a single-physician environment or a multi-specialty practice might affect what you can and can’t report on, and physicians need to “take a very critical look at that,” Dr. Scher said.