Driven largely by an expanded legislative mandate and the implementation of new health policy, the scale has seemingly tipped in the direction of large-scale Electronic Health Record (EHR) adoption. By some estimates, nearly 80 percent of all family practice physicians will be using EHRs in their practices by the end of this year. And while we’ve heard about the clinical and administrative efficiencies of EHRs, we haven’t talked a great deal about the burden that potentially accompanies them – in particular, the physical and emotional stress associated with managing technology that is continuing to evolve as well as meaningful use requirements and e-prescribing penalties. By Linda M. Girgis, MD, FAAFP
By Linda M. Girgis, MD, FAAFP
Driven largely by an expanded legislative mandate and the implementation of new health policy, the scale has seemingly tipped in the direction of large-scale Electronic Health Record (EHR) adoption. By some estimates, nearly 80 percent of all family practice physicians will be using EHRs in their practices by the end of this year. And while we’ve heard about the clinical and administrative efficiencies of EHRs, we haven’t talked a great deal about the burden that potentially accompanies them – in particular, the physical and emotional stress associated with managing technology that is continuing to evolve as well as meaningful use requirements and e-prescribing penalties.
Everyone wants data to be made readily available, as if this were the secret of improving the quality of medical care in this country. EHR technology has great potential to streamline our practices while also improving communication with patients (e.g. summary visit notes and patient instructions that are both better organized and more legible). However, many of the products that are currently on the market have just not delivered on this promise. Instead, they have increased time spent charting and simultaneously decreased face-to-face time with patients. In fact, I’ve personally decided to no longer take a laptop into the exam room when I see patients. I want the person in front of me to have my complete attention and, as a result, I often take work home with me.
A poll of physicians by Sermo found only 10 percent felt that EHRs made them more efficient. In the meantime, 37 percent felt it doubled their charting time, 18 percent never implemented EHRs, and the remainder felt it slowed them down to varying degrees. So, the technology designed to improve workflow and free up time for patient care has, in many cases, had the opposite effect for a substantial number of doctors. For doctors who are already pressed for time, this has added to the burden, causing many to feel crushed for time and contributing to burnout.
Along with the adoption of EHRs – which is time consuming and costly in and of itself – come regulations. Meaningful Use (MU) has greatly exacerbated the problem, especially for doctors in small practices. We need to learn and implement these regulations, as well as train our staff on them. Software vendors often release updates that seemingly fail to enable their systems to maintain congruence with the MU requirements. Finally, the documentation is often complicated – including detailing what is needed to qualify for MU – and not necessarily aiding in providing care to the patient. We often have to go through reams of documentation to see what we truly need.
Another requirement associated with EHR implementation is e-prescribing (e-Rx) incentives, and now penalties. In order to send an e-Rx, physicians, in some cases, have to go online through an interface to access a separate E-Rx site. This means going through several screens to successfully send a prescription and oftentimes interaction alerts pop up that are irrelevant to the patient who is being treated (i.e. medication alerts for therapies that are no longer being taken). Those who have not yet started e-prescribing face the added stress of penalties in their Medicare payments.
Yet another stress posed by healthcare technology relates to the influx of medical apps. Physicians are trying to catch up and learn more about them, while patients are already actively using them. Patients ask for advice, but the rapid infusion of them into the market makes it difficult to keep pace. And now it has been revealed that the FDA intends to regulate these apps. Again, the burden falls to physicians who will need to learn the new regulations and become familiar with what the FDA has already approved, or not.
Technology in medicine is advancing at exponential rates. It has the potential to truly advance the medical field and quality of medical care. However, as we are riding out the development of these technologies, we risk burning out in the learning and implementation process. In fact, about 95 percent of physicians who responded to a survey posted on Sermo felt technology contributed to burnout. Now more than ever, we need software vendors and med tech developers who anticipate what physicians really need to make us more efficient. Rather than developing a product around an unexpressed need and then trying to gain adoption, vendors should be focusing on solving validated problems and automating clinical workflows.
