Report Notes Downside to EHR
EHRs have been on the HIM talk circuit for years, but until recently they haven't had much buzz amid the ordinary folk. I admit I didn't know much about EHR when I came on board at ADVANCE last summer, save for a mention by Sen. Hillary Clinton at a pre-primary rally in New Hampshire earlier that year. (I guess I missed Bush's now well-known vow to implement EHR by 2014). I remember thinking the concept was oh-so-innovative; who could squash such a revolutionary idea?
Well, time progressed and I learned-as millions of Americans are bound to discover-that EHRs don't come so easily. High costs, interoperability issues and lack of standards pose hefty hurdles, and there are countless other obstacles beyond those. Take the employment effects: Sure, EHRs will usher in new jobs, but ask MTs and they'll likely scoff at the "promising" job prospects. Positions may open in IT, but will there be enough talented professionals to fill the spots?
Now a report from the National Academies of Science (NAS) has raised another concern about EHR: Does it actually improve patient care? According to an article from Ars Technica, the NAS report pinpointed a number of issues in adopting EHR and found the odds of it revolutionizing health care to be, well, less than favorable.
Perhaps most interesting, however, is the possibility that doctors may become too dependent on a cumbersome system, relying on collections of discrete data instead of old-fashioned medical know-how to diagnose and treat patients. Many EHR systems require doctors to point-and-click their way through charts and, as the report suggests, may even require more information to be input than necessary. Who cares? The more information, the better, you may think. But according to the article, NAS researchers worry that those additional details may end up having no impact on treatment except keeping the doctor stuck in an office and away from seeing patients for a longer time.
In the most recent Transcription Zone, Rebecca McSwain, PhD, CMT, pondered the demise of medical narratives, the little stories behind the tests, procedures and prescriptions. Echoing NAS sentiments, McSwain noted that sometimes sharing experiences and encounters can be just as helpful to physicians as point-and-click reporting, but with the medical record medium in flux, providers may lose that personal touch.
Ars Technica points out a key suggestion made in the NAS report that EHR should provide "cognitive support" to providers. Rather than serve as a dumping ground for details, EHRs should help providers combine hard evidence with intuitive medical knowledge to select the best approaches to treatments.
It all brings me back to 8th grade math class, when we finally got to use calculators during exams. Before that, all formulas were held and equations processed by the trusty thinking cap. Now, we simply punched in the numbers and got our answers. "But remember," my teacher cautioned, "it's just a tool."
We still needed critical thinking skills and had to prove we understood each process (who could forget the dreaded "show your work" caveat at the top of every test?). Woe to the student who threw all math memory to the wind for the plastic contraption.
As physicians eventually adopt EHR, perhaps it's best they bear the same advice in mind; EHR can be a great automated assist, but don't neglect the personal process of patient care.