The following is a guest blog post by Jennifer Della’Zanna, medical writer and online instructor for Education2Go.
During the Annual Meeting of the Office of National Coordinator for Health Information Technology (#ONC2015), one of the presenters commented that the new generation of doctors have never seen a paper chart, and they have fundamentally different views about what an electronic health record can do compared to clinicians who worked with paper charts for most of their careers. I was inclined to agree and thought it would be fun to find out what those differences are. Luckily, I have access to doctors of all ages, so I decided to conduct a very non-scientific investigation.
My first victims—er—test subjects happened to be my daughter’s pediatrician and a resident on his rotation. Who could ask for a more perfect situation to test this theory? She was a young resident, and he has been a physician since before I was born. I was surprised, therefore, to hear the same complaints about what was wrong with the electronic health record from both and no real answers for what they expected from an EHR. Neither were afraid of technology in and of itself, so I considered that factor controlled. Their complaints? The cut/paste feature allows too many errors through (and they had many real-life examples), alert fatigue, and the narrative portions are too long to scroll through. They get hung up on the mistakes and then decide they can find out more, and more quickly, if they just ask the patient for the information again.
Alright, he actually said he hated it, and she didn’t say that, but that was about the only difference. Ideas for what they’d want instead or how the technology should work? Not so much—from either one.
A trauma surgeon friend at Geisinger Medical Center in Pennsylvania recalled her experiences when they first installed an EHR in her hospital. She hated it. You have never seen such hate as when she recalls her first interactions with the system. She is a vocal sort and, eventually, the hospital said to her that they had an opportunity to customize the system to their hospital and asked if she would serve on the consulting committee. She protested that she knew nothing about computers. They told her they didn’t want somebody who knew about computers. They wanted somebody who had definite opinions about how the system could improve clinical workflow.
My friend said yes. Today, she says she can’t imagine practicing medicine without the EHR. She says it makes her a better doctor. For the record, my friend started out in a paper environment, switched to the EHR, but is not really tech savvy at all.
I checked in again with her recently and asked if she saw any real difference between how older docs and her residents use the system. She said that the older docs use it to get information, and the younger docs do things with it. “That’s the reason for the resident minion,” she says. The older docs get their information from the system and tell the minion to do all the things that have to do with CPOE. She says, “I’d never be able to spell ophthalmology correctly in the system in order to get a consultation!”
She agrees that there is some alert fatigue among physicians, but she thinks it definitely keeps patients safer. She also says it’s often a love/hate relationship for most staff members, but that nobody would willingly practice without it again.
So, is adoption of and satisfaction with an EHR a function of age or technical ability or is it something else?
Perhaps it’s specialty. A pediatrician or a family practice doctor sees many different types of problems, usually has a long history with patients, and may have an electronic record much like the old paper records. I’m sure you’ve seen those thick files, bulging with years’ worth of reports and letters and hand-written charts. It seems that the electronic record, in those cases, may be no better than an electronic form of a paper chart. A trauma surgeon, on the other hand, sees a patient for a short period of time, has less information that requires review, probably makes full use of clinical decision tools but hears very few alerts to make decisions about. The patient is seen, operated on, and discharged to another practice (where they have to slog through the narrative details of the patient’s hospital stay).
More likely, EHR satisfaction is simply a matter of not realizing the advantages we have in front of us because of the difficulties we still focus on. Back when the only option was a paper chart, there were plenty of complaints about those, too. At least we no longer have to deal with doctors’ handwriting (and my friend made the case for me about why doctors have such bad handwriting—they can’t spell—but that’s another story).
Are there problems with EHRs that could still stand some fixing up? Of course there are. But, if you had an honest discussion with yourself about whether you’d prefer going back to paper charts, what would your answer be?
Maybe it’s time to crowdsource solutions instead of complaining about the products as they stand today. What do you expect from your EHR, and how can you be part of the solution? By the way, there is one critical element about people who’ve worked with paper charts and those who haven’t—their expectations and ideas about EHRs are equally important!
What’s been your experience with EHR use and the impact of a physician’s age?
About Jennifer Della’Zanna
Jennifer Della’Zanna, MFA, CHDS, CPC, CGSC, CEHRS has worked in the health care industry for 20 years as a medical transcriptionist, receptionist, medical assistant, practice administrator, biller and coding specialist. She has written and edited courses and study guides on medical coding and the use of technology in health care, and she is an associate editor for Plexus magazine. She teaches medical coding, transcription and electronic health record courses and regularly writes feature articles about health issues for online and print publications. Jennifer is active in preparing for the industry transition to ICD-10 as a trainer for the American Academy of Professional Coders (AAPC). You can find Jennifer on Facebook and Twitter.