The Problems With Paperless

In our April issue, we looked at the U.S. health-care system’s transformation from a paper-based system to electronic health records (EHRs), and clinicians’ love-hate relationship with the latter (“Are EHRs and Physicians Out of Sync?”). Experts in health information technology spoke about how the ongoing implementation of EHRs has affected hematologists’ practice and care delivery. Below, a reader expands on a few implementation challenges mentioned in the article, sharing the perspective of a clinician who uses the EHR system.

To the editor:

I read with interest the feature article on EHR issues in the April issue. While the article touches on some important points concerning the issues confronting EHR use, there were several missing pieces that I think should be pointed out.

First, the experts that were interviewed for the story – and those who served on panels discussing this issue in general – probably do not spend much time “in the trenches” with an EHR system. Heads of departments rarely have heavy clinic schedules and might not understand the burdens of time and clinical responsibility experienced by most of their more junior peers and practicing physicians. Furthermore, the patients seen by these experts are a highly select group of individuals, often seen in consultation and then not again. It is not surprising, therefore, that the senior physicians don’t feel the pain that those of us in active practice do. This is not to say their opinions don’t matter, but their perspective is somewhat limited.

Second, there are limited data to support the claim that EHRs make for better patient care, fewer errors, and more efficient practice. There are few randomized trials comparing patient outcomes before and after the implementation of EHRs. While a couple of unique small studies were mentioned in the article, the larger question of risk reduction and better outcomes was not addressed. Most of the “improved outcomes” of EHR institution relate to gathering “big data,” instituting clinical pathways and guidelines, and – above all – patient billing. It is no coincidence that Epic software is based on a hospital billing system and remains a very efficient way to collect money.

Third, all this data collection and pathway compliance comes at a cost – time. Practicing physicians often state that they could occupy an entire patient visit by just clicking on boxes to demonstrate compliance in the EHR. Hence, the frustration and high dissatisfaction amongst primary-care and active tertiary-care providers.

As a practicing hematologist, I applaud the Centers for Medicare & Medicaid Services’ EHR-related initiatives.

This kind of scrutiny was never undertaken during the prior administration, and there was no attempt to regulate the proliferation of for-profit organizations that have done so well with the money the government has spent on the Health Information Technology for Economic and Clinical Health (HITECH) Act. I am glad to see the American Society of Hematology and other organizations starting to pay attention to this issue, which stands to be a critical component of our practices in the future.

Robert F. Taylor, MD
Aurora BayCare Medical Center
Milwaukee, WI

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