It is hard to argue against the long-term goals of Electronic Medical Records (EMRs)/ Electronic Health Records (EHRs). Even a recent AMA report that is, on the whole, critical of the current state of EMRs and meaningful use makes the point that: “Effective use of EHRs is a key element in achieving the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost of health care. “
And yet the current experience of EMRs for both patients and providers does not always live up to that goal. A recent RAND study funded by the AMA stated that:
“Aspects of current EHRs that were particularly common sources of dissatisfaction included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation.”
The AMA report further highlights a problem they call “Increased Cognitive Workload” that gets to the heart of the clinical concerns surrounding EHRs:
“Current EHRs focus primarily on data collection rather than synthesis of data at the patient level. Current data synthesis methods are typically neither context nor patient specific. The lack of context awareness can lead to frequent clinical and administrative reminders that may force physicians to make hard stops, even for non-urgent matters, to address these issues. As a result, the physicians’ workflow is interrupted and patient encounters are disrupted.”
Of course the obvious question here is why the front line doctors and providers are not leading the transformation. Don’t they have the best sense of what is needed?
The Agency for Healthcare Research and Quality (AHRQ) makes the strongest case that provider buy-in is a key requisite for HER successes. They write
“To succeed at implementation, clinicians, including physicians and nurses, must accept and use the EHR. Otherwise, the project will fail. Acceptance can be gained – and sustained – by identifying at least one clinician champion who will speak positively about the system to fellow clinicians and help recruit other enthusiastic EHR supporters.”
In short EHRs should not be viewed as a managerial problem from above, but rather as a clinical issue on the front line of patient care.
Have electronic medical records (EMRs) improved patient care and the doctor-patient relationship or are they another impediment and bureaucratic layer? Do EMRs improve efficiency or do they reduce the amount of a time a doctor can spend interacting directly with a patient (in a perhaps all too time-limited visit that the patient experienced after a long waiting time)?
What do doctors think?
What do our patients think?