Electronic health records (EHRs) have become such a back-and-forth subject. Some doctors hate them, but others love them. Some say the technology has ruined their practice, but others say they have saved their organization millions. You can talk to five different medical professionals and probably get five different answers. It’s already been more than a year since our Senior Editor Gabe Perna asked if the EHR debate has reached its boiling point.
So that’s why it didn’t really surprise me to see a letter that was published this week in the online edition of JAMA Internal Medicine saying that doctors surveyed in a recent study complain that EHRs waste their time. The study was conducted through a 19-question survey mailed to members of the American College of Physicians and nonmember internists in December 2012. Of that, they received usable responses from 411 people, with 61 different EHR systems being used.
Among all respondents, nearly 90 percent reported that at least one data management function was slower post EHR-adoption, with 64 percent reporting that note writing took longer. And about a third of respondents said it took longer to find and review medical record data.
What’s more, doctors complain that they waste an average of 48 minutes a day, or four hours a week, when they record their patients’ health information into digital records. Comparatively, the mean loss for trainees was lower than the average, at 18 minutes a day.
On Monday, a healthcare reporter at U.S. News wrote a story on the study, headlined “Doctors Say Electronic Records Waste Time.” I don’t really have an issue with the author writing the story, as the draft of the letter was released to group of healthcare reporters at the National Library of Medicine, according to the U.S. News reporter. It was the study that accumulated the doctor’s responses; the author merely reported the results.
However, towards the end, the author writes this about EHRs: There are still are numerous disconnects for implementation, however. Different digital record systems do not work with each other, for example, and doctors can miss visual cues when they are looking at a computer instead of at a patient. Some patients do not understand the systems and think doctors are checking their email during an appointment.
Meanwhile, the author uses just one line in her story about the potential benefits of EHRs: Proponents of electronic health records say they have the potential to reduce medical errors, better coordinate care, and save time. But, she quickly goes on to quote the study’s lead author on how that has yet to happen. “It simply takes longer [to enter patient information into a computer]," says McDonald, who is a proponent of EHRs and was among a group which created the first system in the country. "There is already so much to do and you have to look at patient safety.” Deep consequences can come out of one typo, he adds, and adding another data point carries additional time cost.
Now, allow me to take some time and defend EHRs as talked about in this study and in the story. First of all, saving time is not something that will come automatically. In life in general, it’s rare that something will work to its intended benefits right away. Time and commitment to the technology is necessary; in fact, the federal government’s website for health IT addresses this very question and gives its recommendations for how to save time in the EHR. That’s not to say that all these tips are perfect and guaranteed to help, but more so that if your organization is committed, you will be more likely to see positive results. In this case, the letter does say that respondents were “experienced EHR users,” but that can mean a variety of things.
Secondly, it was mentioned above that in the study, trainees only lost 18 minutes a day—compared to the 48 minutes a day that doctors lost—but we don’t find out why. “We can only speculate as to whether better computer skills, shorter (half-day) clinic assignments with proportionately less exposure to EMR time costs, or other factors account for the trainees’ smaller per-day time loss,” the study read.
Well, if trainees lose less time per day, one reason could be age. It is no secret that doctors—particularly older ones— don’t like change. While older physicians are embracing EHRs more than before, they still aren’t as keen on the technology as their younger counterparts, recent data suggests. Most would agree that older doctors are stuck in their ways (and many will even admit that), so they will see data entry as time consuming. In their defense, their expertise is practicing medicine, not technology, so it’s not hard to see where there frustration is coming from. But this could be a factor that skewed this particular study.
What’s more, the study’s author writes that “Deep consequences can come out of one typo, and adding another data point carries additional time cost.” Personally, it’s hard to fathom that with today’s technology, entering a note or looking up a record on a computer takes more time than thumbing through paper charts or writing a note that needs to be transcribed. We all know what doctors’ handwriting looks like, and this could be a process that takes a few days.
As far as a doctor missing visual clues or a patient thinking that his or her doctor is checking an email during an appointment? I mean, talk about a stretch. Doctors can miss visual clues by writing into the paper chart just as easily as they can by typing. And if I ever think my doctor is checking email during my appointment, forgive me, but I’m finding another one. In fact, one doctor recently told me that by dictating a note into the EHR, his patients can become more engaged.
Now, are there improvements to be made? Absolutely, there are—especially when it comes to things such as interoperability and even user interface. But it’s going to be hard to convince me that IF patience is preached and IF organizations are committed, EHRs won’t save time in the long run. Unfortunately, that won’t be something we will find out until (if) this debate ends.