If you want to know how doctors feel about their EHR software, all you have to do is look at Twitter. There are doctors complaining all of the time about their EHR and the impact it’s having on their lives. I’m careful to not take their complaints too far. If Twitter was around 15 years ago, I’m 100% sure we’d have seen just as many doctors complaining about paper charts as we do about EHR software.
That said, it’s important to acknowledge the impact that EHR software and the policies and regulations it reflects has on doctors. Let me highlight some tweets that illustrate what I mean and add a little commentary and perspective.
It has been about 3 months since EPIC.
Prior to roll-out, I was madly working at improving my echo skills.
Since roll-out, I have not touched a probe. I simply don’t have the cognitive bandwidth. Exhausted, I just click buttons.
EMR 1, Professional Growth 0
— Matt Sztajnkrycer (@NoobieMatt) July 31, 2018
The concept of cognitive bandwidth is an important one. We’ve all felt that burnt out feeling where some part of your job leaves you so burnt out that you can’t spend time on something else. I do find it interesting that this same doctor has still been able to tweet 6,660 times despite the cognitive burnout that Epic has offered him. Granted, tweeting doesn’t require the same cognitive load as other professional development tasks he could do. Twitter is much more bite-sized which makes us think that it doesn’t suck the life out of us as well. Maybe there’s a lesson here for us on how to better educate people. Regardless, I know this doctor is not alone in his feelings of an EHR making other things more difficult to accomplish.
Many replies to the tweet suggested that it would get better over time, but there was plenty of commiseration as well. There was also this reply:
I just finished my third (!) day of Epic on-boarding training. If #Apple can design an interface my nieces (each less than 10y/o) can use without formal instruction, how come EMR's are still so non-intuitive?
— Gregory Blair (@Greg_Blair_MD) July 31, 2018
To be honest, I hate this example. It usually leads to people saying that Apple could build a much better EHR than those out there today. Every day I’m more convinced that’s just not the case. Ok, maybe Apple’s EHR would be nominally better than what’s out there, but I’m quite confident that doctors would still hate it.
Here’s the problem. If your niece had to document 100 data points in an app with 10,000 possible variations, she’d hate it too. One day doctors will be able to walk into an exam room and microphones and video cameras will capture everything that happens with a patient, NLP will identify the various clinical elements, AI will know what it all means, and the visit will be documented automatically. Until that happens, many EHRs can improve what they’re doing, but it will all still feel “non-intuitive” compared to a simple app that your niece uses.
Any EMR that requires a desktop console, keyboard, mouse, badge scanner, printer and bar code reader along with a new password every 90 days for basic functionality is NOT going to make patient care more patient-centred. https://t.co/CPn7EBhTUM
— Hemant Shah (@hepatoMD) August 1, 2018
Is it too much to expect that my EMR will understand that a patient can have more than one brother?
— Dr. G (@DrGRuralMD) July 26, 2018
If you read through the full thread, you get more details about what’s really happening. Many of the complaints like this one are around poor configuration and implementation. There’s no doubt that every EMR can do what she’s asking. Someone in a reply acknowledges that they can do it. However, that doesn’t help the doctor when they’re frustrated in that moment. It’s amazing the impact poor configuration and implementation can have on morale.
EMR has become such a massive part of medical practice today.
We must not be enslaved by it. We must ensure that patient care is not affected negatively by EMR.
— Dr Eric Levi FRACS (@DrEricLevi) July 28, 2018
A hopeful view, but a challenging one when you stack it up against even just the simple complaints above.
The reality is that EHRs aren’t going anywhere. So, Dr. Levi is right. Providers can’t be enslaved by the EHR. Easier blogged than done.