Guest Editorial by Benjamin Shibata
If you want to give hospital clinicians severe heart burn or an arrhythmia, talk to them about implementing a new state-of-the-art electronic health record (EHR) system. Although EHRs may seem like an intuitive improvement over paper health records, the transition has been a huge headache because the process is being forced rather than being organically chosen by the professionals using them. Spurred along by the American Recovery and Reinvestment Act (ARRA), incentives to implement EHRs in a timely manner were laid out. Although helpful in motivating hospitals to make the change, the ARRA has contributed to an overly expedited process that needs to be more thoroughly thought out. In order to roll out EHR systems correctly, we need to understand how health records have historically improved medicine so that we can improve upon rather than complicate an already complicated system.
From a public health standpoint, EHRs should have been implemented years ago. HealthIT.gov explains how EHRs stand for improved efficiency and better patient care through greater care coordination. And why shouldn’t they? Electronic records are more portable and can be theoretically accessed anywhere in the world. Doctors would have better access to their records, be able to practice more efficiently, and collaborate with other physicians to achieve the best possible patient outcome. Unfortunately this is not what is being seen in many places for varying reasons: poor usability, time-consuming data entry, interference with face-to-face patient care, an inability to exchange health information, and degradation of clinical documentation are a few of the most common complaints based on surveys from RAND.
To better understand why these complaints are happening, we need remind ourselves how health records came to exist in the first place. Health records were first embraced in the 1920s when health care providers saw that keeping records in detail improved safety, treatment results, and quality of the patient experience. Even though the process of keeping written records created an added burden, the transition from no records to records provided added benefits that the medical profession as a whole could not function without. This contrasts singificantly with what is happening with the rollout of EHRs – many systems are adding burdens with no perceived benefits. This is ultimately leading to the friction we are seeing today.
Rather than improving their workflow and the patient experience, many of the EHR systems offered today are impeding it: 70% of respondents to a Medscape survey taken last July reported decreased face-to-face time with patients due to EHR implementation. Although it can be argued that it is only a matter of time before physicians get used to and see the benefits of EHRs, large room from improvements clearly exist. Healthcare providers do not reject technology because they are stubborn or unintelligent; they reject technology when it doesn’t work right just like the rest of us. If EHR systems are to be embraced, they need to fundamentally change and improve the physician-patient relationship just like the original paper records did, and that change needs to be apparent. The following is a list of items EHR developers should be mindful of:
- Good EHRs are more than converting a paper record to a portable digital format. Improved portability is a game changer, but the burden associated with allowing portability needs to be balanced with that benefit.
- The patient experience with EHRs is just as important as the physician experience. Although it is important to make sure physicians are satisfied, EHRs provide patients with the ability to access their health records like never before. Improvements with the patient experience will motivate faster adoption of EHRs.
- Efficiency is not everything. An EHR that provides patients and physicians with useful information that improves outcomes is much more useful than an efficient EHR that does not provide as much information.
The shift from paper health records to EHRs is inevitable, and in that process we deserve to get EHRs right. We should be confident that this will be achieved if we improve the experience, outcome, and relationship of both the patient and the healthcare provider just as it has been since health records were created. At the end of the day, EHRs are about improving our healthcare system and not settling for anything less than the best.
Benjamin Shibata graduated from UCLA with a degree in bioengineering. He is currently a Master of Public Health student at George Washington University studying health policy.