#HIMSS16 A passing unpleasantness?Physicians and EHRs

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Finding out what US physicians think about electronic records at HIMSS16 took no longer than hearing the first speaker in the first pre-conference satellite session on Sunday titled: “The Electronic Health Record: What went wrong? Can it be fixed?”.

“The number one complaint for the quality of life and for practice is the EHR in its present form,” said Dr. Ed Livingston, Deputy Editor, Clinical Review and Education, for JAMA.

He was quickly followed by session moderator John Nosta who noted “the EHR seems to be ill. Should we put it in the ER, the ICU or the mortuary?”

This less than cheery outlook was then reinforced by Dr. Christine Sinsky, VP of Professional Satisfaction for the American Medical Association (AMA)who repeated results from a 2013 survey suggesting the number one reason for burnout among physicians was the EHR.

Sinsky then became the first of several speakers at HIMSS – including Andy Slavitt, acting administrator for the Centers for Medicare & Medicaid Services (CMS) – to quote individual US physicians and their angst in dealing with EHRs.

For a Canadian observer of the physician community, all of this initially seemed a little overwrought.

Sure, many Canadian MDs complain about their electronic records systems as well, especially during the implementation phase. But being driven to burnout or actually leaving medicine because of the EHR?

What seems to be at the core of the problem for most US physicians are the data recording requirements – the sheer number of clicks required to perform and document clinical interactions.

Thirty-two clicks are required to order and record a flu shot, Sinsky notes. Eight clicks to order an Aspirin, quoted Slavitt, 16 if its full strength.

Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston, noted physicians at Beth Isreal must make 450 clicks and enter 141 structured data elements during a 12-minute patient encounter “and make eye contact with the patient.”

Slavitt said the message from the physician community is clear: “Stop measuring clicks, focus instead on allowing technology to become a tool and focus on the results technology can create. Give us more flexibility to suit our practice needs and ultimately more control.”

The good news from HIMSS is that there appears to be a willingness to make this happen. With legislative changes in the US and a move towards outcome-based care and population health, the rigid process-based requirements – what AMA President Dr. Steven Stack terms the false sense of precision where accuracy really doesn’t exist – may fade into the background.

Furthermore, the EHR itself may become a relic as multiple platforms for providing virtual care and the growing movement of patient engagement and empowerment move the locus of patient data from the physician to the patient.

Halamka proclaimed the growth of mobile means “the desktop is dead” and he talked of Facebook-like social networking applications being better for capturing the physician-patient interaction.

All of this is being accompanied by a more realistic assessment of EHRs by knowledgeable physicians.

“Those who come into practice in 10 years won’t understand why people had been so unhappy,” Stack said.

(Photo: Dr. John Halamka speaking at HIMSS16)

 

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