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Paper or Electronic – Does Physician Age Matter?

Posted on February 13, 2015 I Written By

The following is a guest blog post by Jennifer Della’Zanna, medical writer and online instructor for Education2Go.
Jen - HIM Trainer
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.

Going Beyond EHR Data Collection to EHR Data Use with Dr. Dan Riskin

Posted on April 28, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We had a chance to sit down and do a Google Plus hangout with Dan Riskin, MD, CEO and co-founder of Health Fidelity to discuss the challenges of EHR today and how we can reach the real benefits of EHR adoption. We had a great discussion about how the industry is so caught up just getting the data in the EHR software that we’re missing out on the opportunity to get the benefits of actually using the EHR data.

For some reason the Google hangout audio and video didn’t sink right (welcome to the cutting edge of technology), but the audio is good. Just start up the video below and enjoy listening to it like a podcast or radio show. I expect that’s what most of you do anyway with our videos.

I hope you’ll enjoy my interview with Dr. Riskin.

EMR Perpetuates Misinformation

Posted on March 15, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I have a number of doctor friends that I know from church, scouts (yes, I’m an assistant scoutmaster), or other local group. I must admit that generally our focus is whatever activity is at hand, but every once in a while they or I will bring up the topic of EMR.

These types of discussions are especially fascinating because they give a nice insight into a doctor’s perspective from someone who’s not inside the healthcare IT bubble. You know, that bubble where we all know the difference between meaningful use stage 1 and 2, ONC-ATCB and CCHIT, and a whole set of other acronyms. Certainly these doctors know some of these terms or have at least heard of some of these terms, but they definitely don’t know all the details. In fact, that’s what makes it so interesting to see what they know and what they don’t know.

I bring all of this up because I had a short discussion with one of the really smart doctor friends of mine. When I say smart I mean it from a clinical standpoint (he’s seen me a few times), but he’s also a very smart businessman as well. So, with this respect I’m always interested to hear his take on things.

This doctor has been a user of an EMR for quite a few years. He’s quite satisfied with his EMR and in our discussion he is planning to get the Medicaid EHR incentive money. After a short discussion he stopped and told me, “John, you know the thing I dislike most about an EMR?”

Then, he proceeded to tell me, “The thing I dislike most about an EMR is that it perpetuates misinformation.”

I’d certainly considered the topic before, but I thought it was an excellent description of this EMR challenge.

Part of this reminds me of a guest post done by Dr. West about Copy and Paste in EMR (He now blogs at Happy EMR Doctor). Copy and paste has the challenge of perpetuating misinformation too. Although, I think his comment is much deeper than just copy and paste.

There’s a challenge in most EMR software to take whatever was entered as complete fact. It’s not usually as easy as putting a line through it to correct something that was entered incorrectly. There’s no reimbursement for correcting or updating records even if it’s really essential to great patient care. As a commenter on the above copy and paste post said, “It is not the machine or process, it comes down to ethics, professionalism, and accountability.”

Electronic Health Records Video Explanation

Posted on May 28, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve posted previously the best video I’ve seen promoting EHR use. Today I came across another video that talks about some of the benefits and challenges associated with electronic health records. It’s a little bit dry compared to that other video, but for someone just wanting to learn more about electronic health record or those considering the benefits and challenges of an EHR, it’s worth a watch. Those experts in the field of EMR can carry on.

Benefits of Converting from Paper Chart to EMR

Posted on November 6, 2008 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today, I decided to start a new web page that I believe will really grow over time. It’s basically a list of the possible benefits a doctor or clinic can receive from using an EMR or EHR rather than paper charts.

I haven’t take much time to make the list at all, but I think it’s better to start it and then as ideas come to my head I can add to it as time permits. I already have a number of other ideas (like quality of medical care), but I need some more free time to put all the details down. Now that I’m thinking about it a little bit more, maybe each benefit of an EMR should have it’s very own blog post describing the benefit that’s received by using EMR. We’ll see how that works. Seems like a worthwhile series of posts to me.

Also, in all fairness I’m certain that I’ll also soon be creating a list of problems associated with EMR. I think it’s important to keep the discussion well rounded and that people are well aware of both the benefits and challenges associated with using an EMR.

Finally, I certainly welcome comments from people on benefits or challenges associated with use of an EMR. I look forward to hearing ideas from other people’s experience to help me round out the list of benefits and challenges that many have already experienced first hand. Might as well try to pass on that knowledge to those who are still implementing or looking to implement.