To EHR Is Inhumane—Addressing the Shortcomings of the Interface, Medscape March 26th 2019
That is the title that Peter M. Antevy, MD and Tracey A. Loscar, BA, NRP chose for their excellent article reproduced below. I hope you enjoy it as much as I did. I have written about the factors leading to physician burnout before. Keeping electronic records is a big one. I Occasionally get requests to send my notes to insurance companies so that my patients may have a drug or test covered. I wish I could see the former’s faces when they see how minimalist my hand-written notes are. They are that way so that I can talk to my patients when I am with them, and so that I can go home early to enjoy my life.
ARTICLE
“Documentation is a vital part of medicine, both the science and the art. It’s a series of notes and observations, recording interactions and treatment that eventually coalesce into the sum of a patient’s medical history. It is by turns probably one of the most crucial, and tedious, tasks in patient care delivery.
The modern age has replaced the scratch of a quill with the muted click of the keys, and as the Information Age progresses, so does the amount of input it requires to keep the healthcare machine turning. Instead of working with a snapshot of time, practitioners have years’ worth of history available instantly at their fingertips. Electronic health records (EHRs) have the capacity to make the physician’s job more efficient and effective, increasing both scope and clarity.
What is the cost for this potentially infinite wealth of information? Is there such a thing as too many records? Or does it become more of a matter of devising a system that balances amount of input with the quality of output?
HIT-Related Stress and Exhaustion
“Today the utilization of health information technology (HIT) and the completion of the EHR has become a fundamental part of any form of practice. But technologies advance at different rates, and the EHR can have a steep learning curve. While transitioning from one smartphone to another may be seamless, the same cannot be said for the various EHR applications. You can switch from app to app with a swipe of the thumb, but requesting outpatient tests may require multiple log-ins and authorizations on a patchwork of proprietary programs that may or may not communicate with one another.
HIT-related stress is not only miserable, it’s also measurable, and it’s emerging as a major factor in clinician burnout. The amount of effort required to navigate today’s HIT systems is directly inverse to its original intent. It has morphed into an exhaustive, time-consuming requirement that is damaging the very systems of healthcare delivery it was designed to assist. HIT-related stress is not only miserable, it’s also measurable, and it’s emerging as a major factor in clinician burnout. Studies report that as many as 70% of physicians report HIT-related issues as a major factor in their stress level, with insufficient time for documentation being the strongest predictor of burnout overall.[1]
While no specialty is immune, the highest prevalence was among primary care–oriented specialties, with pediatrics and psychiatry almost doubling the rate of other respondents. Working in an era when billing is driven by documentation, the EHR is pulling more and more time away from direct patient care. Physicians estimate that they are spending over half of their time doing HIT-related tasks, with only a portion of that directly relating to patient care.
Treatment Errors Still Common Despite EHR Implementation
“The medical profession is renowned for its poor handwriting. Often a loosely organized series of scratches resembling bird tracks across the page, the inability of the average person to read what’s written has become easy fodder for litigators and patient safety advocates. It is not a far reach to wonder just how frequently poor handwriting or incomplete notes have resulted in errors in treatment and medication administration.
“Patient files become bloated, full of identical-looking forms and repetitive entries in order to satisfy requirements.”
