Although one goal of automation is to use data to design improvements in the healthcare system, some studies have shown reduced physician productivity and increased workload related to electronic health record use. Some physicians believe the costs of using EHRs outweigh the benefits and they are resisting implementation.
At the recent American Medical Informatics Association Symposium in Washington, D.C., Dean Sittig, Ph.D., made an interesting proposal: If physicians had a bill of rights (as well as some related responsibilities) around EHRs, they might feel better about the whole process.
Sittig, a professor in the School of Biomedical Informatics at the University of Texas, Health Sciences Center at Houston and a member of the UT-Memorial Hermann Center for Healthcare Quality and Safety, says upfront that his idea has drawn criticism from people he has discussed it with. One of the first questions they have is: who is responsible for enforcing these rights? He said he doesn’t have all the answers, but he thinks medical societies and physicians should debate the topic. “I propose that physician users who have rights are more likely to deliver higher quality healthcare and achieve better long-term outcomes for their patients,” he said. Here are brief summaries of what he proposes:
1. Right to uninterrupted EHR access. Physicians get access to a certified EHR via a secure network-attached device 24 hours per day, 7 days per week, 365 days per year. Vendors and hospitals must use fail-safe equipment and downtime processes to protect data. Physicians have a responsibility to review all EHR data pertinent to their patient’s medical history, although that does not replace observing, listening to, and examining patients.
2. Right to see all data required in order to provide safe and effective care. Patient privacy advocates argue patients should be able to hide data or opt out of having data available. Sittig suggested this practice introduces unnecessary ambiguity and liability issues. (This one is definitely controversial!) Physicians have responsibility to protect integrity of sensitive data.
3. Right to succinct patient summary. With the growth of health information exchanges, the amount of data will grow exponentially. EHRs must summarize data in ways that are helpful to clinicians — for instance, problem-oriented summaries. Physicians have a responsibility to maintain a problem list. (That is part of meaningful use).
4. Right to override any computer-generated alerts (except those prohibiting never events.) Physicians have better judgment than computers. But along with this right comes a responsibility to justify overrides and have actions reviewed.
5. Right to explanation of computer-generated clinical interventions. Clinical decision support should point to a clear evidence-based rationale, so the physician can see what data it was based on. They have a responsibility to consider clinical decision support and use judgment to assess appropriateness in the clinical context.
6. Right to review discrepancies in performance measurement. Many physician bonuses are based on performance measures, but data collection is not fail-safe. Physicians need access to queries, data extracts and statistical methods to review data. They have a responsibility to review and act on the feedback to improve performance.
7. Right to review all reported errors. There are increasing reports of health information technology errors that can lead to substantial harm due to large numbers of patients affected. Physicians have a right to have errors investigated and resolved in a timely manner. They have a responsibility to report errors and help others learn from them.
8. Right to training and assistance. Physicians should have access to online instruction, and immediate assistance via telephone and remote support while caring for patients. Responsibility: Physicians need to learn to type! They also must complete EHR training and demonstrate competence.
9. Right to EHRs that fit clinical work flows. EHRs are causing physicians to change the way they work, yet current systems are not good always a good fit.
10. Right to EHRs that facilitate communication, coordination and teamwork. Current systems are poor in this area, yet they fundamentally change the way clinicians coordinate their work activities. They have a responsibility to use EHRs in a way that fosters teamwork, such as not delaying their charting.
What do readers think of Prof. Sittig's proposed Bill of Rights? Are they workable? Did he leave any out?