Electronic Health Records: Why Teach New Tricks When The Old Tricks Work Better?

Guest post by David Cooper, CEO and co-founder, Medical Mime.

As most of us involved in the healthcare industry already know, the Affordable Care Act calls for providers to adopt secure, confidential, electronic health information systems. Why? Because most experts agree that by using these electronic health records, we can collectively reduce paperwork and administrative burdens, cut costs, reduce medical errors and, most importantly, improve healthcare outcomes. But reality has had a funny way of challenging those expectations.

Yes, financial incentives have motivated doctors to get on the bandwagon, and many – if not most – office-based physicians have adopted some form of electronic health records. A study published in the journal Health Affairs reported that 78 percent of doctors working in office-based environments had implemented an electronic health record.

However, only about 48 percent of doctors had an EHR system with advanced functionality, according to the same source. Only 39 percent reported they had used their system to share medical data with other providers, and a stark 14 percent reported sharing data with providers outside their own practice. In short, the adoption of EHRs has not resulted in the promised integration of patient data that we hoped for. In fact, the use of electronic medical records – so far – may actually be having a negative impact on the quality of care doctors deliver.

According to a Northwestern University study published in the spring of 2014 in the International Journal of Medical Information, doctors who use electronic health records in their exam rooms spend one-third of their time looking at their computer screens. By comparison, physicians who rely on paper charting spend about 9 percent of their time looking at a patient’s records during an encounter. The study also asserts that because physicians spend so much time looking at their EHRs, they miss out on nonverbal communication cues from patients, thus affecting the quality of the care they’re delivering.

Despite the criticisms identified above, the concept of widespread implementation of electronic health records remains a worthwhile goal. EHRs have the potential to do all the things we hoped for them: reducing waste, avoiding medical errors and even improving the physicians’ knowledge base in real time. The problem is most of the systems available just aren’t good. More accurately, they’re not practical in the context of how many physicians train and practice.

So what’s wrong with EHRs? To understand the inherent flaws we have to take a look at recent history.

Prior to the availability of financial incentives for the implementation of electronic health records, physicians were unlikely to invest in expensive systems that only added to their capital costs. At the time, the developers of EHRs had to find a method of offsetting the required investment, and they looked to dictation costs. The idea was simple: If you purchase an EHR that records data from each patient encounter, you no longer have to dictate notes and then pay a transcription service to convert those notes into written records. As a result, the EHR systems that were created used templates or forms to gather data.

These templates are oftentimes set up to auto-populate based on the patient’s chief complaint. For example, when a physician sees a patient whom she diagnoses with COPD, the clinical notes will likely include a set of descriptors and treatments that appear for all of her patients with COPD. When those notes are reviewed by another clinician – alongside other medical records from the same doctor – the notes all start to look the same. The lack of specificity and uniqueness of the data minimizes its value. In addition, the absence of patient-specific detail exposes the provider to increased legal risk should the records become the source of scrutiny.

Even more troublesome, these template-based EHRs require the provider to either click her mouse, select from a drop-down menu, or in the case of touchscreen systems, tap on a screen. Each piece of information requires a physical action, and that takes time. As a result, the very tool that was supposed to improve efficiency ends up slowing down the process. What used to take 90 seconds to dictate in to a voice recorder can take eight or ten minutes to enter into a template-based EHR. In cases where a patient presents with complex problems, narrative notes can ultimately contain much more information than templated notes, including subtleties many physicians may leave off of a template note in order to save time.

The solution is simple. Give doctors what they already know how to use: dictation-based systems that allow the clinician to verbally describe the patients’ presentation using highly-descriptive language. Whether a doctor trained decades ago, or she just finished her residency, the chances are that dictation is part of her practice style already. Even physician extenders whose training may not have included dictating clinical notes find that dictation is a more natural, faster, and more thorough approach to recording clinical data.

Today, a handful of EHRs include dictation modules, but most still require templates and forms to collect the data. With these systems the dictation usually augments the forms. It doesn’t supplant them.

Our system is wholly dictation-based and takes advantage of the most advanced speech recognition tools and natural language software to process the transcribed physician’s notes. However, it doesn’t rely solely on computer aided transcription processes. All of our dictations are reviewed by medical documentation specialists to ensure accuracy. What’s more, the system parses the information into congruent, manageable data sets to allow for sharing and quantitative analysis.

Is ours perfect? Probably not for everyone, but it certainly relieves physicians of the time-consuming and challenging task of data entry. In addition, Medical Mime is based on a physician’s unique narrative templates, which means our system lends itself to multiple specialty practices as well as primary care.

Fortunately, the competitive nature of the electronic health records sector will continue to drive more innovation, better systems and lower prices. And one day, we will all see the many benefits of EHRs. Until then, let’s hope we don’t drive physicians mad with systems that could make anyone pull out their hair.

David Cooper is co-founder of Medical Mime, a dictation-based electronic health records (EHR) company and part of the Medytox Solutions Inc. family of brands.

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