In April, President Obama signed into law the merit-based incentive payment system (MIPS), which will base physician payments on quality of care, EHR meaningful use, the use of healthcare resources, and clinical practice improvements. Meaningful use requirements might continue to morph, added Dr. Scher.
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July 2015“I think it behooves all of us to look at this, gripe about it as appropriate, but gripe toward making meaningful changes that benefit us and our patients rather than just requiring us to push more buttons on a computer screen,” he said.
Professionalism
Sujana Chandrasekhar, MD, director of New York Otology and president-elect of the American Academy of Otolaryngology-Head and Neck Surgery, said that the use of EHRs can strain the professionalism of doctors, largely when it comes to the in-office visit. Physicians might face sideways toward a computer screen or even sit with their backs to patients, which can take the patient “completely out of the equation,” she said.
Dr. Chandrasekhar said she types during office visits but has the screen and keyboard situated so that she is still facing the patient, and she tries maintain face-to-face contact while doing so.
Research shows a divide between how patients would like to communicate with their physician’s offices—via cell phone, text, or web—and how physicians prefer to communicate, via face-to-face, letter, and telephone conversations.
“When I’m e-mailing a patient or texting to a patient, which sometimes happens, I don’t really know what they’re getting from what I’m saying, and I think that’s a real issue for a lot of us,” she said. “We need to learn how to adapt to the new reality…. We just need to become better suited to the new environment.”
There is also a difference of opinion about EHRs she said. Almost 80% of patients say they have no problem with EHRs and note-taking in the exam room, and most prefer them over paper charts (Software Advice. 25 April 2015). “However, about half of us [physicians] think that EHRs are making healthcare worse,” she said. “So there’s that divide between us.”
“I think the way we maintain professionalism while using EHRs is you keep the patient at the center of the interaction,” Dr. Chandrasekhar said. “You design your office space so that the computer is not interfering with your ability to actually be a good doctor. And, the leaders in your field need to enable the physician to do their best work and therefore maintain professionalism.”