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Physicians Pinpoint Frustrations with EHRs in Published Commentary

August 18, 2016
by Rajiv Leventhal
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Electronic health records (EHRs) have been known to frustrate physicians, and a recent commentary from practitioners in the Journal of the American Medical Association (JAMA) further clarifies what about the technology aggravates doctors so much.

The piece, authored by doctors affiliated with the Stanford University School of Medicine and elsewhere, titled “Evolutionary Pressures on the Electronic Health Record,” said that EHRs “have the potential to prevent medication errors and decrease duplicative tests, contributing to the safety and value of care.” But, the authors noted, "the evolution of EHRs has not kept pace with technology widely used to track, synthesize, and visualize information in many other domains of modern life.”

Specifically, they said that the tools are not integrated in a way that supports tailored treatment decisions based on an individual’s unique characteristics. “Existing EHRs also have yet to seize one of the greatest opportunities of comprehensive record systems—learning from what happened to similar patients and summarizing that experience for the treating physician and the patient,” they wrote.

The authors wrote that the amazing effects of computers and science are simply not seen with EHRs, leading to extra burden on physicians. “The dominant EHRs are designed for billing and not primarily for ease of use by those who provide care. In fact, a measure of successful EHR evolution may be that physicians spend much less time with the EHR than they do now,” they said. They continued, “Deimplementing the EHR could actively enhance care in many clinical scenarios. Simply listening to the history and carefully examining the patient who presents with a focused concern is an important means of avoiding diagnostic error.”

They continued, “For patients with multiple active health issues, EHRs can generate an overwhelming number of reminders, resulting in dangerous alert fatigue. Outside of healthcare, other sectors have found suitable solutions for this type of challenge: the airline industry limits pilots’ audible alerts to critical and life-threatening events, and financial software enables users to set investment goals without inundating their inbox at every price fluctuation. Better triage of EHR alerts and fewer workflow interruptions are needed so the physician can maintain situational awareness without being distracted.”

What’s more, they wrote that the most important shortcoming of the EHR might just be the absence of social and behavioral factors fundamental to a patient’s treatment response and health outcomes. “In this world of patient portals and electronic tablets, it should be possible to collect from individuals’ key information about their environment and unique stressors—at home or in the workplace—in the medical record. What is the story of the individual?” they wrote. They did add that the National Academy of Medicine has called for systematic integration of social determinants of health into the EHR, which the authors said could help clinical teams.

They conclude by saying that resentment against EHRs is only growing and every additional click just adds to doctors’ frustration. “Current records miss opportunities to harness available data and predictive analytics to individualize treatment. Meanwhile, sophisticated advances in technology are going untapped. Better medical record systems are needed that are dissociated from billing, intuitive and helpful, and allow physicians to be fully present with their patients,” they said.

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