Don’t Pave the Cow Path

The July 7th issue of the Journal of the American Medical Association (JAMA) included an interesting article by Dr. Richard Baron. In his Commentary, Dr. Baron suggests that some physicians look to the EHR to be simply a better version of the paper chart, in effect, substituting electrons for the paper and pen that clinicians have traditionally used to document patient encounters. Let’s be straightforward, many clinicians still consider and use EHRs as a fancy word processor.  Progress notes are often generated using copy/paste features or by updating earlier visit notes to save time.  Many EHRs provide coding “guidance” which, for some physicians, provides added confidence in selecting the highest E&M code appropriate to the visit. But while using EHRs for these tasks might create the illusion of innovation, one might liken it to paving a cow path.

Cows create meandering, beaten down pathways as they go from one location to another eating grass and doing other “cow-things.”  Even if a farmer invests in asphalt to pave the route, the cows will only move marginally faster (of course, only if they agree to use the new, smooth route), and probably will not produce any more milk.

Now, by no means am I suggesting that clinicians are bovine-like in their approach to providing health care. However, if clinicians simply adopt health information technology to do the same things they are already doing in the same manner using the same people and processes, then they will get the same results as the farmer – maybe the office will do some things faster but overall, the practice will wind up in the same place.

Practices should try to realize the full potential of health information technology and re-think/redesign/re-evaluate how patient care is delivered.  Use the opportunity to examine how your clinical team currently works (being certain to include patients/families on that team) and how it might function better with the right technology, the right implementation, and smart optimization over time.

Dr. Baron closes his commentary with the following advice, that physicians are, “…well advised to think about the ways in which EHRs can help them care for patients and solve the practical problems confronted every day…”  I believe that this is good counsel.

Some questions for you…

For those of you currently using EHRs, how have you avoided paving the cow path? How has your EHR helped solve some work flow or office challenges? What has been the most challenging issue you’ve had to deal with in your implementation/optimization?

For those of you currently contemplating whether to make the leap, what do you hope/expect an EHR to do for your practice? What problems are you looking for an EHR to solve?

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(This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.)

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