Op-Ed: Making Electronic Health Records Right

The following is a guest blog post by Benjamin Shibata, MPH Student at GWU.
Ben Shibata
If you want to give hospital clinicians sever heart burn and arrhythmia, talk to them about implementing a new state-of-the-art electronic health record (EHR) system.  Although EHRs may seem like an intuitive improvement over paper health records, the transition to them has been a huge headache because the process is being forced rather than being organically chosen by the professionals using them.  Spurred along by the American Recovery and Reinvestment Act (ARRA), incentives to implement EHRs in a timely manner were laid out.  Although helpful in motivating hospitals to make the change, the ARRA has contributed to an overly expedited process that needs to be more thoroughly thought out.  In order to roll out EHR systems correctly, we need to understand how health records have historically improved medicine so that we can improve upon rather than complicate an already complicated system.

From a public health standpoint, EHRs should have been something implemented years ago.  HealthIT.gov explains how EHRs stand for improved efficiency and better patient care through greater care coordination.  And why shouldn’t they?  Electronic records are more portable and can be theoretically accessed anywhere in the world.  Doctors would have better access to their records, be able to practice more efficiently, and collaborate with other physicians to achieve the best possible patient outcome.  Unfortunately this is not what is being seen in many places for varying reasons: poor usability, time-consuming data entry, interference with face-to-face patient care, an inability to exchange health information, and degradation of clinical documentation are a few of the most common complaints based on surveys from RAND.

To better understand why these complaints are happening, we need remind ourselves of how health records came to exist in the first place.  Health records were first embraced in the 1920s when health care providers saw that keeping records in detail improved safety, treatment results, and quality of the patient experience.  Even though the process of keeping written records created an added burden, the transition from no records to records provided added benefits that the medical profession as a whole could not function without.  This contrasts very differently with what is happening with the rollout of EHRs – many systems are adding burdens with no perceived benefits.   This is ultimately leading to the friction we are seeing today.

Rather than improving their workflow and the patient experience, many of the EHR systems offered today are impeding it: 70% of respondents to a Medscape survey taken last July reported decreased face-to-face time with patients due to EHR implementation.  Although it can be argued that it is only a matter of time before physicians get used to and see the benefits of EHRs, large room for improvements clearly exist.  Healthcare providers do not reject technology because they are stubborn or unintelligent; they reject technology when it doesn’t work right just like the rest of us.  If EHR systems are to be embraced, they need to fundamentally change and improve the physician-patient relationship just like the original paper records did, and that change needs to be apparent.  The following is a list of things EHR developers should be mindful of:

  • Good EHRs are more than converting a paper record to a portable digital format. Improved portability is a game changer, but the burden associated with allowing portability needs to be balanced with that benefit.
  • The patient experience with EHRs is just as important as the physician experience. Although it is important to make sure physicians are satisfied, EHRs provide patients with the ability to access their health records like never before.  Improvements with the patient experience will motivate faster adoption of EHRs.
  • Efficiency is not everything.  An EHR that gives patients and physicians useful information that improves outcomes is much more useful than an efficient EHR that is efficient but does not provide as much information.

The shift from paper health records to EHRs is inevitable, and in that process we deserve to get EHRs right.  We should be confident that this will be achieved if we improve the experience, outcome, and relationship of both the patient and the healthcare provider just as it has been since health records were created.  At the end of the day, EHRs are about improving our healthcare system and not settling for anything less than the best.

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2 Comments

  • As a consumer, it would be great if the patient had a medical dictionary that would translate the medical record into common english. It would be wonderful if the the patients medical record cited the current standards in care that one could take to an appointment, and discuss with the provider their clinical experiences with standards and patients. Yes, it is tacky when the provider spends more time reading the electronic record, than talking the patient. Let the patient be one of the checks and balances to the accuracy of the medical record. When I found an error which said my colon was removed, it was a very cumbersome process to get the error corrected. Where is the patient input in the implemenation of electronic records? Just one consumer’s experience.

  • As a healthcare provider I have always maintained that EHR’s were more about control and not about patient care. It would seem the author is much more intuitive than the “experts” who ask us to reduce our patient time to click, fill in a blank, check this box, open, close record…what total nonsense. The only addition to your article Benjamin that I would suggest is not settling for the “best” but having an intuitive program that does not by its very existence change the doctor-patient relationship. I am waiting for the APP that measure’s the eye contact that the provider maintains in a given visit….now thats an idea….
    In response to a previous comment…..there is absolutely no known method…at least that I am aware of that will correct a documentation error…after all we have opened and closed the record…oops…too late…

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