The Future is Now – Physician Discontent and Adopting EHRs Today – Breakaway Thinking

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc

In the movie Back to the Future II, a young man named Marty McFly and his time-traveling companion Doc Brown travel thirty years into the future—October 21 2015—to unite his parents and correct the space-time continuum. Although this “future” date occurred several weeks ago, the technological advancements presented in the movie are not far off from reality.  In the “future” Marty cruises around his home town on a new hoverboard and the sky is filled with mechanical drones. There are a few hologram images and people are dressed in brightly colored, plastic outfits. Aside from the fashion statement, many of these technological advancements are well under way. The future is now!

Not all technology has advanced as rapidly as depicted in the movie, though. From a health information technology (HIT) perspective, it often feels like we are back in 1985 dreaming of better technology.  Electronic health records (EHRs) present one of the biggest opportunities for improvement in healthcare.

A recent study published by the RAND Corporation and sponsored by the American Medical Association (AMA) examined how satisfied physicians are with their EHRs. It found that they approve of the concept of EHRs and are largely satisfied by the ability to remotely access patient information at any time. Most physicians, practice leaders, and staff also agreed that advancements in EHR technology such as improved interoperability and improved interfaces have great potential to improve care as well as physician and patient satisfaction. On the other hand, the current state of EHRs worsened overall professional satisfaction among respondents. Data entry, usability, inefficient workflows, and lack of interoperability were a few of the main pain points mentioned in the study.

A recent parody of Jay Z’s Empire State of Mind articulates many of these same frustrations. “Just a glorified billing system with patient info tacked on,” is one of the poignant lyrics mentioned in the video.  Many physicians are fantasizing about going “back to the future” or using a more sophisticated system.

In order to move forward in advancing EHRs and HIT, clinicians, support staff, and administration need to take responsibility for their organization’s initial technology investment. If data entry, usability, and inefficient workflows are causing pain, it is time to re-revaluate those clinical workflows and escalate system issues and enhancements to their vendors.

Each time I am onsite with a client preparing for go-live I am reminded of all the energy spent on implementing these systems. But it is equally important that clinical leaders re-evaluate their initial workflows and develop a plan for sustained use after the initial excitement has faded. And during this time, leaders must provide feedback and escalate system issues to their vendor.

Engaged clinical leadership is required to not only adopt the current state of EHRs but to transform the future of health information technology. How can clinical leaders do both? First, realize an EHR is not something you can throw-away or easily replace without enormous costs.  In our consumer-based culture, old technologies like cell phones or televisions are often thrown out for the latest advancements. Although EHRs are in many ways less sophisticated than some consumer-based applications, most of those applications (if not all) do not have the ability to improve patient care or patient safety. If using today’s EHR technology saves more lives than using paper alone, it is our collective responsibility to adopt these systems.

Once this paradigm shift has occurred and clinical leaders have made a sustained commitment to using EHRs, progressive and impactful change can occur. Conversations can begin to shift to improving clinical workflows, enhancing interfaces, improving interoperability, and utilizing health information exchanges. But these later conversations will never occur if the focus is on the initial difficulties and stress associated with implementing and using these systems. In order to live up to our vision of the “future,” we must accept the realities of today.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

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  • I think the example of the frog being put in a pot of boiling water versus the frog in a pot of water that slowly starts to boil might be appropriate here. I think doctors are experiencing the later. In the frog situation, the frog dies in the later. Doesn’t look good for doctors if something doesn’t change dramatically.

  • Ms Paykoc should cease and desist from promoting what is a seriously flawed concept – ‘engage clinical leaders’ as a mechanism to force [or enforce] use of dysfunctional EMRs. What constitutes an ‘EHR’ is not the source of the widespread dissatisfaction among physicians/clinicians it is the EMR component, ie the ‘medical record’ as used by physicians in the practice of medicine. A large component of the ‘IT’ within an ‘EHR’ has already been adopted and is being used by the majority of physicians.

    Ongoing use of ‘EHR’ is NOT a problem of ‘initial difficulties/stress of implementation’ which remains a focus thus a source of’resistance to use’. The problem resides essentially with the EMR dysfunctionality which must be promptly remedied rather than recommending the approach of continuing ‘forced use’. Consider the below:

    “The 2011 Institute of Medicine report, Health IT and Patient Safety: Building Safer Systems for Better Care, concluded that the information needed to analyze and assess health IT (HIT) safety and use was not available and that our understanding of the benefits and risks of EHRs was anecdotal.”

    “plaintiff attorneys are suggesting that the defendant clinician is so preoccupied with typing in the EMR that he or she isn’t paying adequate attention to the real live patient in the exam room.”

    ……….. If you build it, we will come…

  • I repeat — I have heard some or all of the above every year since the early 1990’s when I wrote what is probably the first PM/EMR for Windows.

    Let’s stop talking about and get on with fixing it. Let’s team-up.


  • Dr. Birmingham,
    I’m not sure I agree with you. I think there are EHR implementations that have successfully benefited the doctor. In many cases the key is to have the right implementation and to continue to improve that implementation over time.

    Plus, I’d add that much of the overhead that doctors hate about an EHR isn’t really the EHR at all, but is a reflection of the reimbursement and regulatory requirements. Unless you’re a practice that has chosen to shun both of those, then the EHR has to facilitate those workflows if you want to get paid and you don’t want to get the EHR penalties.

    I do agree that EHR vendors could and should make improvements in what they offer, but especially at the hospital level there is usually a lot more that can be done to the current EHR to make a doctor’s life much better. Most just haven’t invested the time and money to make that happen.

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