When I started my career, there was no such thing as an electronic medical record. My hospital progress notes and office notes were handwritten. A few documents such as hospital discharge notes were dictated, transcribed by a human and then typed on a typewriter, not a computer!
Now more than 90% of physicians use an electronic health record.
Part of the reason was the 2009 Health Information Technology for Economic and Clinical Health act. This act provided $36 billion in financial incentives to encourage hospitals and clinics to switch from paper charts to EHRs. Then-president Obama said this would “cut waste, eliminate red tape and reduce the need to repeat expensive medical tests.”
Another purported benefit was that EHRs would “save lives by reducing the deadly but preventable errors that pervade our health care system.”
The current state of EHRs is —in my opinion — a mess. There are certainly advantages in terms of legibility. But many bugs have yet to be ironed out.
A big drawback is that there are many different systems and for the most part they can’t speak to each other. It’s similar to when two people who don’t speak the same language try to converse without an interpreter. A complex conversation can’t happen. That’s why when you go to a hospital facility, it doesn’t matter that your health record is “already in the computer.” Meaning your primary care provider’s computer. If your doctor’s office uses a different system, the hospital facility EHR can’t read it.
Another huge problem is the user interface. The American Medical Association recently teamed up with a healthcare organization called MedStar Health to examine the usability of two of the most widely used EHRs (Epic and Cerner.) Emergency physicians at four Washington D.C. area hospitals were asked to perform standardized tasks (ordering medications and tests) on a fictitious patient.
Here’s an example of the challenge of ordering acetaminophen (Tylenol) for an adult male patient. That seems like it ought to be quick and straightforward. First the doctor must locate the medication in the EHR. At one hospital the search for Tylenol brought up 80 — yes EIGHTY — options. This included doses for menstrual cramps and for infants, clearly not relevant to this scenario. But when the doctor tried to type in “Tylenol 500 mg.,” the most common strength, the EHR returned zero hits. The doctor had to return to the previous list and scroll down, where the correct dose was the 68th choice in the list. This simple task took a ridiculous amount of time and brain power. This is just one of many frustrations that EHR users face every day.
The researchers found that the time and number of mouse clicks to complete the same task varied widely from site to site. The confusing interface contributed to medical prescribing errors.
For example, when doctors attempted to order a tapering dose of medication, the system complexity meant that at one site the error rate was as high as 50%.
Another problem is the sheer volume of data entry physicians must complete. For example, researchers found that a 31-minute patient encounter consisted of 12 minutes of face-to-face patient interaction, and 19 minutes spent with the EHR. Some physicians use scribes to help enter data, a stop-gap solution that’s really a Band-Aid for the bigger problem inefficient user interface design.
Is there hope in sight? Perhaps.
Some companies are beginning to tap the power of AI to improve EHRs. For example, Epic developed a sepsis-prediction model and one hospital in Louisiana using this system reduced deaths from sepsis by 18%. But this and other “modules” offered by various EHR companies are add-on purchases that drive up the cost of EHRs and are often out of reach of many hospitals, health care systems, and private practices.
I don’t want to go back to the paper chart days. But I hope that some day, the sooner the better, we will see EHRs that interface with one another and that are user-friendly.
In the meantime, if your healthcare provider asks you a question that you think is in your electronic record, it’s because they really can’t find it in there. It may be in an incompatible system. It may be buried in a clunky EHR bloated with useless data obscuring with the important stuff.
So it’s in your best interest to keep track of your own medical history and to be patient when we inquire about it.
Eva Briggs is a retired medical doctor who practiced in Central New York for several decades. She lives in Marcellus.